14 CRR-NY 671.99NY-CRR
14 CRR-NY 671.99
14 CRR-NY 671.99
(a) Act, Social Security.
[section 1915(c)] Home and community-based services waiver—authorization from the Secretary of the Federal Department of Health and Human Services whereby pursuant to 42 USC section 1396n:
“The secretary may by waiver provide that a State plan approved under this Title may include as “medical assistance” under such plan payment for part or all of the cost of a home or community-based services (other than room and board) approved by the secretary which are provided pursuant to a written plan of care to individuals with respect to whom there has been a determination that but for the provision of such services the individuals would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded the cost of which could be reimbursed under the State plan. For purposes of this subsection, the term “room and board” shall not include an amount established under a method determined by the State to reflect the portion of costs of rent and food attributable to an unrelated person caregiver who is residing in the same household with an individual who, but for the assistance of such caregiver, would require admission to a hospital, nursing facility, or intermediate care facility for the mentally retarded.”
The person has been formally accepted for residency and service(s) in a facility certified under Part 686 of this Title, for which requirements of this Part are applicable.
For the purposes of the home and community-based services (HCBS) waiver, a party chosen by the participant in the waiver who assists the person with the application process and in the development, implementation, review, and revision of the services, supports, and activities that the person chooses in order to attain his or her personal life goals. A capable adult, as defined in section 633.99 of this Title may choose not to have an advocate. The advocate must be 18 years or older and may include an involved parent or other member of the family, legal guardian, friend, or member of the community who is not providing direct services to the person pursuant to the individualized service plan or who is not employed by an entity providing direct services to the participant in the waiver. However, an ombudsperson at a developmental center, appointed pursuant to section 13.34 of the Mental Hygiene Law, may also be considered as a person's choice for his/her advocate. The fact that someone is functioning in the role of advocate for a person enrolled in the HCBS waiver does not endow that party with any legal authority over the person's affairs unless they also happen to the adult person's guardian, or the parent of a minor.
The “agent” or “operator” of a facility operated or certified by OPWDD. In the case of State-operated facilities, the B/DDSO (see glossary) is considered to be the agency.
(e) Allowable community residential habilitation services.
Are those appropriately supervised activities, interventions and therapies which are necessary for the maximum reduction of functional and/or adaptive behavior deficits associated with the person's developmental disability or other mental disability. They are designed and implemented with the goal of restoring the person to an enhanced developmental level, and to his/her best functional capacity or lessening the effects of regressive or degenerative conditions. All services shall be designed to develop skills, capacities or knowledge appropriate to enhance or improve a person's independence, lessen dependence or minimize loss of functioning or adaptive capacity. The expressed treatment goal of community residential habilitation services shall be to promote and encourage outcomes related to independence, integration, individualization, and productivity. Allowable community residential habilitation services include the following categories as further defined at section 671.5 of this Part:
(1) health skills training services;
(2) self-administration of medication training services;
(3) socialization skills training services;
(4) communication skills training services;
(5) functional skills training services;
(6) assertiveness/self-advocacy skills training services;
(7) behavior skills training services;
(8) community integration and resource utilization skills training services;
(9) motor skills training services; and
(10) skills development training services.
(f) Authorization, physician's.
The written statement by a New York State licensed physician (or appropriately supervised physician's assistant or nurse practitioner) that indicates that rehabilitative services are necessary to meet the person's medical, remedial and developmental needs. For the purposes of this Part, the physician's authorization shall be deemed equivalent to completion of an ICF/IID level of care eligibility determination until such LCED is completed subsequent to September 13, 1993 for persons in residence as of September 13, 1993.
(g) Certification, standards of.
Those criteria which specify the basis of documenting compliance for the purposes of issuing an operating certificate. The basis of documentation may include facility specific record(s); specified forms of reports; specified contents of records, reports or forms; and/or other means of assessing compliance such as interviews with persons receiving services, employees or volunteers, and/or onsite observation of activities and the environment.
(h) Compliance, principles of.
Those requirements with which an agency must comply, but against which the facility will not be routinely surveyed for recertification purposes. However, evidence of failure to comply with the principles may be the basis for decertification in accordance with article 16 of the Mental Hygiene Law.
The Commissioner of the New York State Office for People With Developmental Disabilities, or his or her designee.
(j) Disability, developmental.
A developmental disability as defined in section 1.03(22) of the Mental Hygiene Law.
(k) Individualized service planning model (ISPM).
The information derived from a person's DDP regarding his/her adaptive skills, health, and behavior needs that is utilized to estimate the amount of staff time needed to provide the specific level of staff support necessary to enable the person to live in a residential situation of his/her choice.
(l) Level of care eligibility determination (LCED).
An initial, and annually redone, eligibility review executed for the purposes of documenting that a person with developmental disabilities has need of ICF/IID level of care. Its purpose is to ensure that services are actually needed; rendered at the appropriate level; and received only for the time period needed. The appropriate forms and format acceptable to the commissioner are to be completed by the person's designated QIDP or a person with at least one year's experience performing assessments and developing plans of care for persons with developmental disabilities and subsequently reviewed and approved by a licensed physician. In the case of the annual redo, the sign-off may be done by a physician's assistant/nurse practitioner.
The New York State Office for People With Developmental Disabilities.
The results to be achieved related to the person's needs and choices that are being addressed through the program planning and service delivery process ant the person's participation in designated activities, experiences, or therapies. Outcomes should be developed and selected, as appropriate, with a consideration in promoting the goals of individualization, independence, integration and productivity.
(o) Person, eligible.
Someone who has a diagnosis of developmental disability and who has been prescribed by a licensed physician as needing rehabilitative community residential habilitation services which for the purposes of this Part, for the period from March 1, 1993 to September 12, 1993, is also deemed equivalent to needing ICF/IID level of care.
As used in this Part, these terms are understood to refer to children and adults who are eligible to receive and are receiving community residential habilitation services from a State, private, or voluntary operated provider certified or authorized by OPWDD.
(q) Policy/procedures or policy and procedure.
As used in this Part, the term indicating the need for appropriate written guidance for staff, whether such guidance is in the form of a policy statement, a policy statement with accompanying procedures, or procedures only. Determination of the nature of the material is that of the agency/facility.
For the purposes of this Part, a program shall consist of those certified facilities of the same facility class, and type, that are operated by the same authorized provider.
(s) Provider, authorized.
An incorporated or State government entity, holding a facility- specific operating certificate from OPWDD pursuant to Part 686 of this Title, to deliver community residential habilitation services in accordance with the provisions of this Part.
(t) Qualified intellectual disabilities professional (QIDP).
A party who has at least one year's experience in providing services to persons with developmental disabilities and who is qualified under one of the following categories:
(1) Applied behavioral sciences specialist. A person holding a master's degree from an accredited program in a field of psychology and who has at least one year of experience in the assessment and development of behavioral programs for persons with developmental disabilities. Note: In voluntary agency-operated programs, such parties must be supervised in their performance of psychology-related services by a licensed psychologist at a minimum of one hour per week per residential site or per 10 persons served.
(2) Human services practitioner. Someone holding at least a bachelor's degree in a human services discipline or a bachelor's degree with training or course work in human services.
(3) Psychologist. A person who is licensed and currently registered by the New York State Education Department who has specialized training or at least one year experience in training or working with the people with developmental disabilities.
(4) Registered nurse/licensed practical nurse. A person licensed and currently registered as a registered nurse by the New York State Education Department; or a person currently licensed as a licensed practical nurse by the New York State Education Department.
(5) Social worker. A person with a master's degree in social work from an accredited program or who holds certification and registration from the New York State Education Department as a social worker.
(u) Services, plan of.
A written person-oriented record system, by whatever name known, maintained in accordance with this Part, which documents the process of developing, implementing, coordinating, reviewing and modifying that plan. It is maintained as the functional record indicating current assessments, all planning activities as well as all services (i.e., activities, therapies and interventions), and interventions provided to the person. It contains, at a minimum, person specific identification data, health information, assessment information, service plans, a general description of activities, program planning recommendations and reports, expected outcomes, and staff action records. It constitutes the main portion of the clinical record or “record” as such terms are used in sections 33.13 and 33.16 of the Mental Hygiene Law. The community residential habilitation services plan of service shall be incorporated into the annual case management plan which shall be considered functionally equivalent to the individualized service plan (ISP) as such term is used at section 635-10.4(b) of this Title.
Those parties who meet the requirements for service delivery, service coordination, supervision or administration as set forth in the existing regulations governing the delivery of allowed community residential habilitation services. Nothing herein shall be interpreted to preclude an authorized provider from using part-time personnel or qualified independent contractor parties. Further, nothing herein shall preclude the use of volunteers, as long as such parties are not functioning as substitutes for needed paid staff and serve primarily to enhance the existing overall quality of care to the person.
(w) Supervised, appropriately.
Authoritative procedural guidance by a qualified party for the accomplishment of a function or an activity within his/her sphere of competence with initial direction and periodic inspection of the actual act of accomplishing the function or activity.
Any means including, but not limited to, observation, interview, the written word, and/or a sampling of cases to be reviewed in depth, that provides OPWDD with a basis for being reasonable assured that a requirement has been met. Nothing herein shall preclude OPWDD from making its determination based on a random selection of cases as opposed to considering every circumstance where the requirement would be applicable.
14 CRR-NY 671.99
Current through June 30, 2021
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