To: Bureau of Developmental Disabilities Services Providers
From: Cathy Robinson, Director, Bureau of Developmental Disabilities Services
Re: Residential Habilitation and Support – Daily Rate Service Definition
Date: September 11, 2015
Provider Documentation Standards for Residential Habilitation and Support – Daily Rate Service Definition
Individuals Eligible for RHS Daily
Individuals who choose Residential Habilitation and Support (RHS) and meet all of the following criteria are eligible for and will utilize RHS Daily Services:
- Individuals who have an ALGO score of 3, 4, or 5 on their Objective Based Allocation (OBA).
- Individuals who are living with housemates and are utilizing a shared staffing model.
- Individuals who are living outside of their family home.
- Assistance with acquiring, enhancing and building natural supports. For example, a measureable outcome would be increased hours of natural supports and a decrease in the number of hours needed for paid staff. Another measurable outcome would be the number of activities an individual participates in with non-paid (natural support) supports versus paid staff.
- Working with the participant to meet the goals they have set for themselves on their Individualized Support Plan (ISP).
- Training the participant to enhance their home-making skills; meal preparation; household chores; money management; shopping; communication skills; social skills and positive behavior.
- Provision of transportation to fully participate in social and recreational activities in the community. For example, transportation to church, the park, the library, the YMCA, classes.
- Provision of transportation to community employment and/or volunteer activities.
- For individuals who are not otherwise eligible and receiving Wellness as a service, coordination and facilitation of medical and wellness services to meet the healthcare and wellness needs, including physician consults, medications, implementation of risk plans, dining plans and wellness plans. This would include maintenance of each participant’s health record.
- The individual must be present and receive RHS Daily services for at least a portion of any day the provider bills as a day of RHS Daily service.
- Electronic Monitoring
A minimum of one daily note for each day the individual is present and receiving RHS Daily services, with appropriate elements, documenting one or more distinct actions or behaviors as outlined in ‘Reimbursable Activities’ per individual served is required to support the billing of RHS Daily Services. The RHS Daily Service provider must able to demonstrate through relevant time keeping records or other similar documentation which staff members were working during the RHS Daily Service provided upon audit, or upon request by the State of Indiana or its contracted agents.
RHS Daily Documentation must include:
Documentation of Services rendered as outlined in the Individualized Support Plan Data record of service delivered documenting the complete date and time entry (including a.m. or p.m.). If the person providing the service is required to be professionally licensed, the title of that individual must also be included. For example, if a nurse provides RHS Daily services, the nurse’s title should be included.
Any significant issues involving the participant requiring intervention by a Health Care Professional, Case Manager or BDDS staff member are also to be documented. Documentation must be in compliance with 460IAC 6. Quarterly summaries as specified by BDDS and monthly, quarterly and/or annual outcome data as specified by BDDS.
Reimbursable waiver funded services furnished to an adult waiver participant by any combination of relative(s)* and/or legal guardian(s) may not exceed a total of 40 hours per week. (See Activities Not Allowed for definition of relative) Additionally,
- Individuals receiving RHS Daily Services cannot receive more than 10 hours per month of Community Habilitation Individual (CHIO) services from their RHS Daily provider.
- Providers will not be reimbursed separately for Electronic Monitoring Services for individuals receiving RHS Daily Services. Electronic Monitoring is built into the daily rate of RHS Daily services. Providers must adhere to all Electronic Monitoring Service Standards as defined within the Electronic Monitoring Service Definition. (Service Standards are found in the DDRS Waiver Manual)
- Providers may not bill for RHS Daily reimbursement for time when staff/paid caregiver is asleep. Only awake, engaged staff can be counted in reimbursement.
- Providers may not bill for RHS Daily reimbursement during the time when a participant is admitted to a hospital. (The care and support of a participant who is admitted to a hospital is a non-billable RHS Daily activity.)
- RHS Daily Services can be billed the day of a hospital admission and the day of discharge from a hospital if services are provided on those days; however, RHS Daily cannot be billed for other days the individual is hospitalized, even if the RHS Daily provider provided services in the hospital setting such as “sitter” services.
Activities Not Allowed
Reimbursement is not available through RHS Daily in the following circumstances:
- Services furnished to a minor by the parent(s), step-parent(s), or legal guardian
- Services furnished to a participant by the participant's spouse
- Services to individuals in Structured Family Caregiving services
- Services that are available under the Medicaid State Plan
- Reimbursable waiver funded services furnished to an adult waiver participant by any combination of relative(s)*** and/or legal guardian(s) may not exceed a total of 40 hours per week.
Enrolled as an active Medicaid provider
Must be DDRS-approved
Must comply with Indiana Administrative Code, 460 IAC 6
Must comply with any applicable BDDS service standards, guidelines, policies and/or manuals, including DDRS Waiver Manual and DDRS BDDS Policy Manual.
In accordance with Indiana Code [IC 12-11-1.1-1], Supported Living providers must be accredited by at least one (1) of the following organizations:
- The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor.
- The Council on Quality and Leadership in Supports for People with Disabilities, or its successor.
- The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor.
- The National Committee for Quality Assurance, or its successor.
- The ISO-9001 human services QA system.
- The Council on Accreditation, or its successor.
- An independent national accreditation organization approved by the secretary.