12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver)

What this rule requires your agency to do

• 1Effective January 11, 2016, services facilitators shall hold the specified degree and direct-care experience, and (effective April 10, 2016) pass a competency assessment with at least 80%, re-passing every five years at provider-agreement renewal (12VAC30-120-935.G.4.c.(3)-(5)).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 2The services facilitator shall make an initial comprehensive home visit, a 30-day monitoring visit, routine visits at least every 90 days, and six-month face-to-face reassessments; shall verify CD attendant work shift entries against POC-approved hours and notify the fiscal/employer agent of discrepancies; failure to conduct reviews/maintain documentation results in DMAS payment recovery (12VAC30-120-935.G.4.d, .f, .g).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 3Services facilitators and volunteers with direct contact shall obtain, within 30 calendar days of employment, an original criminal record clearance (barrier crimes per § 19.2-392.02) and, for minors, a VDSS CPS Central Registry check; provide a sworn disclosure statement; and not be on the federal LEIE exclusion list (12VAC30-120-935.G.4.c.(2)).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 4Agency staff (RNs, LPNs, aides) or CD attendants shall only be reimbursed if physically present with and awake to perform the services in the POC; a single aide/attendant/RN/LPN shall be reimbursed at a maximum of 16 hours per day per individual (12VAC30-120-935.D, .E).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 5For agency-directed personal care, the RN supervisor shall make an initial home assessment on or before start of care, a visit within 30 days, and supervisory visits at least every 90 days (increased if DMAS finds health/safety in jeopardy), documented in the record (12VAC30-120-935.G.2.a-d).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 6DMAS shall not reimburse for waiver services when the spouse of the individual, or the parent/legal guardian of a minor child individual, provides the service; payment for personal care/respite by other family members living in the same home requires objective written documentation that no other provider is available (12VAC30-120-935.B, .B.1).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 7Family members reimbursed for personal care or respite shall meet the same qualifications as all other personal care aides or CD attendants (12VAC30-120-935.B.4).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))
• 8Personal care aide records (DMAS-90) shall document services delivered, actual daily arrival/departure times, weekly observations, and be signed with dates by the aide and the individual/caregiver no earlier than the last day of the service week and no more than seven calendar days after the last service (12VAC30-120-935.G.2.e).(12VAC30-120-935. Participation standards for specific covered services. (Commonwealth Coordinated Care Plus Waiver))