Current through Register Vol.. 38, No. 17, April 11, 2022
A. Service description. Community coaching is
a service designed for individuals who need one-to-one support in a variety of
community settings in order to build a specific skill or set of skills to
address particular barriers that prevent individuals from participating in
activities of community engagement. In addition to skill building, this service
includes routine and safety supports. Community coaching service shall be
covered in the FIS, CL, and BI waivers.
Criteria and allowable activities.
Community coaching service shall be provided to individuals who require
one-to-one support to address identified barriers in their plans for supports
that prevent them from participating in the community engagement service.
Community coaching activities shall be documented in the plan for supports and
be sensitive to the individual's age, abilities, and personal preferences.
Allowable activities shall include, as may be appropriate for the individual as
documented in his plan for supports:
One-on-one skill building and coaching to facilitate participation in community
activities and opportunities such as:
Activities and public events in the community;
b. Community education, activities, and
c. Use of public
transportation if available and accessible.
2. Skill building and support in positive
behavior, relationship building, and social skills.
3. Routine supports with the individual's
self-management, eating, and personal care needs in the community.
4. Assuring the individual's safety through
one-to-one supervision in a variety of community settings.
5. Monitoring the individual's health and
physical condition and providing supports with medication and other medical
6. Providing routine
supports and safety supports with transportation to and from community
locations and resources.
Service units and limitations.
1. The unit of service shall be one
2. The community coaching
service, alone or in combination with the community engagement service, group
day service, workplace assistance service, or supported employment service
shall not exceed 66 hours per week.
3. This service shall be provided at a ratio
of one staff to one individual. This service shall not be provided within a
group setting. The service may be provided in the community in conjunction with
other Medicaid services delivered in a group of individuals for the purpose of
addressing socialization needs when supported by the plan for supports. Group
participation will be permitted on a limited basis.
Provider qualifications and requirements.
2. Providers shall be licensed by DBHDS as
providers of the non-center-based day support service.
3. Providers shall have a current, signed
provider participation agreement with DMAS to provide this service. The
provider designated in the participation agreement shall directly provide the
service and bill DMAS for reimbursement.
Providers shall ensure that staff who
provide the community coaching service meet provider training and competency
requirements as specified in 12VAC30-122-180
5. The DSP providing community coaching
service shall not be an immediate family member of an individual receiving the
community coaching service. For an individual receiving the sponsored
residential service, the DSP providing the community coaching service shall not
be a member of the sponsored family residing in the sponsored residential
documentation and requirements.
shall include signed and dated documentation of the following in each
A copy of the
completed, standard, age-appropriate assessment form as detailed in
plan for supports per requirements detailed in 12VAC30-122-120
Documentation as detailed in
. Data shall be collected as described in the ISP, analyzed to
determine if the strategies are effective, summarized, and then clearly
documented in the progress notes or supports checklist.
d. Documentation to support units of service
delivered, and the documentation shall correspond with billing. Providers shall
maintain separate documentation for each type of service rendered for an
e. A written review
supported by documentation in the individuals' record, which is submitted to
the support coordinator at least quarterly with the plan for supports, if
modified. For the annual review and every time supporting documentation is
updated, the supporting documentation shall be reviewed with the individual or
family/caregiver, as appropriate, and such review shall be documented.
f. An attendance log or similar
document maintained by the provider that indicates the date, type of service
rendered, and the number of hours and units provided, including specific
g. All correspondence to
the individual and the individual's family/caregiver, as appropriate, the
support coordinator, DMAS, and DBHDS.
h. Written documentation of all contacts with
the individual's family/caregiver, physicians, providers, and all professionals
regarding the individual.
Supervision of DSPs shall be provided
consistent with the requirements in 12VAC30-122-120
by a supervisor meeting the
Providers shall make available for inspection documentation of supervision, and
this documentation shall be completed and signed by the staff person designated
to perform the supervision and oversight. This documentation shall include, at
a minimum, the following:
(i) date of contact
contacted or observed;
summary about the direct support professional's performance and service
(iv) any action
planned or taken to correct problems identified during supervision and
documentation shall support all claims submitted for DMAS reimbursement. Claims
for payment that are not supported by supporting documentation shall be subject
to recovery by DMAS or its designee as a result of utilization reviews or