Current through Register Vol.. 38, No. 17, April 11, 2022
Service description. Group day service means a service provided to help the
individual acquire, retain, or improve skills of self-help, socialization,
community integration, career planning, and adaptation via opportunities for
peer interactions, community integration, and enhancement of social networks.
This service typically shall be offered in a nonresidential setting.
Skill-building shall be a component of this service unless the individual has a
documented progressive condition, in which case group day service may focus on
maintaining skills and functioning and preventing or slowing regression rather
than acquiring new skills or improving existing skills. Group day service shall
be covered in the FIS, CL, and BI waivers.
Criteria and allowable activities. For
group day service, an individual shall demonstrate the need for skill-building
or supports offered primarily in settings other than the individual's own
residence that allows the individual an opportunity for being a productive and
contributing member of his community. In addition, group day service shall be
available for individuals who can benefit from the supported employment
service, but who need group day service as an appropriate alternative or in
addition to the supported employment service.
Allowable activities shall include, as may
be appropriate for the individual as documented in his plan for supports:
a. Developing problem-solving abilities;
sensory, gross, and fine motor control abilities; and communication and
personal care skills;
self, social, and environmental awareness skills;
c. Developing skills as needed in (i)
positive behavior, (ii) using community resources, (iii) community safety and
positive peer interactions, (iv) volunteering and participating in educational
programs in integrated settings, and (v) forming community connections or
d. Supporting older
adults in participating in meaningful retirement activities in their
communities (i.e., clubs and hobbies);
e. Skill-building and providing routine
supports related to ADLs and IADLs.
f. Monitoring the individual's health and
physical condition and providing supports with medication and other medical
g. Providing safety supports
in a variety of community settings;
h. Career planning and resume developing
based on career goals, personal interests, and community experiences;
i. Providing routine supports
and safety supports with transportation to and from community locations and
2. Group day
service shall be coordinated with the therapeutic consultation plan, as
units and limits.
1. This service unit shall
be one hour. Group day service, alone or in combination with the community
engagement service, community coaching service, workplace assistance service,
or supported employment service, shall not exceed 66 hours per week. Group day
service shall occur one or more hours per day on a regularly scheduled basis
for one or more days per week in settings that are separate from the
2. Group day
service shall be a tiered service for reimbursement purposes. Providers shall
only be reimbursed for the individual's assigned level and tier.
3. Group day service staffing ratios shall be
based on the activity and the individual's needs as set out in the individual's
plan for supports and shall be at least one staff to seven
4. Providers shall be
reimbursed only for the amount of group day service that are rendered as
established in the individual's approved plan for supports based on the
setting, intensity, and duration of the service to be delivered.
5. In instances where group day service staff
are required to ride with the individual to and from group day service, the
group day service staff time may be billed as group day service, provided that
the billing for this time does not exceed 25% of the total time the individual
spent in the group day service activity for that day. Documentation shall be
maintained to verify that billing for group day service staff coverage during
transportation does not exceed 25% of the total time spent in the group day
service for that day.
2. Providers of the group day service shall
hold either day support or community-based day support current licenses issued
Providers of the group
day service shall also be currently enrolled as providers with DMAS. Providers
designated on the DMAS provider agreement shall:
a. Render this service directly;
b. Ensure that appropriate documentation of
the delivery of service supports claims that are filed for reimbursement;
Comply with HCBS setting
requirements per 42 CFR 441.301
4. Claims that are not supported by
appropriate documentation may be subject to recovery by DMAS or its designee
due to utilization reviews or audits.
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
shall ensure that staff providing group day service meet provider training and
competency requirements as specified in 12VAC30-122-180
Service documentation and requirements.
Providers shall include signed and dated
documentation of the following in each individual's record:
a. A copy of the most current, completed,
standard, age-appropriate assessment form.
The provider's 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, 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 that 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 that is maintained and 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/case manager, DMAS, and DBHDS.
h. Written documentation of all contacts with
the individual's family/caregiver, physicians, providers, and all professionals
regarding the individual.
2. Provider documentation shall support all
claims submitted for DMAS reimbursement. Claims submitted for reimbursement
that are not supported by provider documentation made available to DMAS or its
designee shall be subject to recovery by DMAS or its designee as a result of
utilization reviews or audits.