23 Miss. Code. R. 208-7.5 - Covered Services
A. A person can
receive:
1. 1915(i) services if not eligible
for services available:
a) For Prevocational
Services under a program funded under Section 110 of the Rehabilitation Act of
1973 or Sections 602(16) and (17) of the Individuals with Disabilities
Education Act,
20
U.S.C. 1401(16) and (17), or
b) For Supported Employment under
Section 110 of the Rehabilitation Act of 1973 or the Individuals with
Disabilities Education Act (20 U.S.C. 1401 et
seq.).
2. Only those
1915(i) services which are documented on the Plan of Services and Supports
(PSS) by the Case Manager and approved by the Department of Mental Health
(DMH), and
3. Multiple 1915(i)
services on the same day but not during the same time of the day.
B. Transportation between the
person's residence, other habilitation sites and the employment site is a
component part of Habilitation Services.
1.
The cost of transportation is included in the rate paid to the provider.
2. Providers cannot bill
separately for transportation services and cannot charge the persons for
transportation.
C. The
1915(i) State Plan services are:
1. Day
Habilitation Services defined by the Division of Medicaid as services designed
to assist the person with acquisition, retention, or improvement in self-help,
socialization, and adaptive skills. Activities and environments are designed to
foster the acquisition and maintenance of skills, building positive social
behavior and interpersonal competence, greater independence and personal
choice. Day Habilitation Services:
a) Must
take place in a non-residential setting separate from the home or facility in
which the person resides.
b)
Settings must be physically accessible to the person and must:
1) Be integrated in and supports full access
of persons receiving Medicaid Home and Community-Based Settings (HCBS) to the
greater community, including opportunities to seek employment and work in
competitive integrated settings, engage in community life, control personal
resources, and receive services in the community, to the same degree of access
as individuals not receiving Medicaid HCBS.
2) Be selected by the person from among
setting options including non-disability specific settings. The setting options
are identified and documented in the person-centered service plan and are based
on the person's needs, preferences.
3) Ensure a person's rights of privacy,
dignity and respect, and freedom from coercion and restraint.
4) Optimize, but not regiment, a person's
initiative, autonomy, and independence in making life choices, including but
not limited to, daily activities, physical environment, and with whom to
interact.
5) Facilitate individual
choice regarding services and supports, and who provides them.
c) Do not include the following:
1) A nursing facility,
2) An institution for mental diseases,
3) An intermediate care facility
for individuals with intellectual disabilities (ICF/IID),
4) A hospital, or
5) Any other locations that have qualities of
an institutional setting, as determined by the Division of Medicaid, including
but not limited to, any setting:
(a) Located
in a building that is also a publicly or privately operated facility that
provides inpatient institutional treatment,
(b) Located in a building on the grounds of
or immediately adjacent to a public institution, or
(c) Any other setting that has the effect of
isolating persons receiving Medicaid Home and Community-Based Services (HCBS).
d) Must be
furnished four (4) or more hours per day on a regularly scheduled basis, for
one (1) or more days per week, or as specified in the person's PSS.
e) Must be provided in DMH certified
sites/community settings.
2. Prevocational Services defined by the
Division of Medicaid as services to prepare a person for paid employment.
Services address underlying habilitative goals which are associated with
performing compensated work. Services include, but are not limited to, teaching
concepts such as compliance, attendance, task completion, problem solving and
safety. Services are not job task oriented but instead are aimed at a
generalized result. Prevocational Services:
a) Must be included in the person's PSS and
be directed towards habilitative objectives and not explicit employment
objectives.
b) Provide choices of
food and drinks to persons at any time during the day to meet their nutritional
needs which includes, at a minimum:
1) A
mid-morning snack,
2) A noon meal,
and
3) An afternoon snack.
c) May include personal
care/assistance as a component but it cannot comprise the entirety of the
service. Beneficiaries cannot be denied Prevocational Services because they
require assistance from staff with toileting and/or personal hygiene.
d) Beneficiaries must be
compensated in accordance with applicable federal laws and regulations. If a
person is performing productive work as a trial work experience that benefits
the provider or that would have to be performed by someone else if not
performed by the person, the provider must pay the person commensurate with
members of the general work force doing similar work per federal wage and hour
regulations.
e) Must be reviewed
for necessity and appropriateness by the person, appropriate staff and the Case
manager if the person earns more than fifty percent (50%) of the minimum wage.
f) Providers must inform
beneficiaries about Supported Employment opportunities and other competitive
employment activities in the community on an annual basis.
g) May be furnished in a variety of locations
in the community and are not limited to fixed program locations. Community job
exploration activities must be offered to each person at least one (1) time per
month.
h) Include transportation.
Time spent in transportation to and from the program cannot be included in the
total number of service hours provided per day, unless it is for the purpose of
training.
i) Settings must be
physically accessible to the person and must:
1) Be integrated in and supports full access
of persons receiving Medicaid HCBS to the greater community, including
opportunities to seek employment and work in competitive integrated settings,
engage in community life, control personal resources, and receive services in
the community, to the same degree of access as individuals not receiving
Medicaid HCBS.
2) Be selected by
the person from among setting options including non-disability specific
settings and an option for a private unit in a residential setting. The setting
options are identified and documented in the person-centered service plan and
are based on the person's needs and preferences.
3) Ensure a person's rights of privacy,
dignity and respect, and freedom from coercion and restraint.
4) Optimize, but not regiment, a person's
initiative, autonomy, and independence in making life choices, including but
not limited to, daily activities, physical environment, and with whom to
interact.
5) Facilitate individual
choice regarding services and supports, and who provides them.
c) Settings do not include the
following:
1) A nursing facility,
2) An institution for mental diseases,
3) An intermediate care facility
for individuals with intellectual disabilities,
4) A hospital, or
5) Any other locations that have qualities of
an institutional setting, as determined by the Division of Medicaid, including
but not limited to, any setting:
(a) Located
in a building that is also a publicly or privately operated facility that
provides inpatient institutional treatment,
(b) Located in a building on the grounds of,
or immediately adjacent to a public institution, or
(c) Any other setting that has the effect of
isolating persons receiving Medicaid Home and Community-Based Services (HCBS).
3.
Supported Employment services defined by the Division of Medicaid as intensive,
ongoing support to persons who, because of their disabilities, require support
to obtain and maintain an individual job in competitive or customized
employment, or self-employment. Employment must be in an integrated setting in
the general workforce for whom a person is compensated at or above the minimum
wage but not less than the customary wage and level of benefits paid by the
employer for the same or similar work performed by persons without
disabilities. Supported Employment:
a) Is
based on an Activity Plan that must be developed for each person based on
his/her PSS.
b) Includes
assessment, job development and placement, job training, negotiation with
prospective employers, job analysis, systematic instruction, and ongoing job
support and monitoring.
c)
Includes services and supports to assist the person in achieving
self-employment through the operation of a home or community based business,
and may include the following:
1) Aiding the
person in identifying potential business opportunities.
2) Assisting in the development of a business
plan, including potential sources of financing and other assistance in
developing and launching a business.
3) Identifying supports necessary for the
person to successfully operate the business.
4) On-going assistance, counseling and
guidance once the business has launched.
d) Cannot use Medicaid funds to defray the
expenses associated with starting or operating a business.
e) Must be provided at work sites where
persons without disabilities are employed and where payment is made only for
the adaptations, supervision, and training required by beneficiaries receiving
1915(i) services and does not include payment for the supervisory activities
rendered as a normal part of the business setting.
f) Must include transportation between the
person's place of residence and the site of the person's job or between or
between habilitation sites (in cases where the person receives habilitation
services in more than one place) as a component of supported employment.
Transportation cannot comprise the entirety of the service.
g) May include personal care/assistance as a
component of Supported Employment but cannot comprise the entirety of the
service.
h) Do not include
sheltered work or other similar types of vocational services furnished in
specialized facilities or volunteer work.
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