Sec. 10.09.26.05. Covered Services for Residential Habilitation

A. The Department shall reimburse residential habilitation services providers for those services listed below, exclusive of room and board. These regulations do not limit payments, within the fiscal guidelines of the Department, for room, board, and normal living expenses for waiver participants.

B. Habilitation. The services shall be provided as required and recommended in the IHP. Residential habilitation services providers shall provide, as a minimum, the following:

(1) A program of habilitation which shall:

(a) Be specified in the IHP,

(b) Provide training in the development of self-help, daily living, self-advocacy, and survival skills, and

(c) Use the principles of the Developmental Model;

(2) Mobility training to maximize use of public transportation in traveling to and from work training or day programs, work sites, community services, and recreational sites;

(3) Training and assistance in developing appropriate social behaviors which are normative in the surrounding community such as conducting one's self appropriately in restaurants, on public transportation vehicles, in recreational facilities, and in stores and other public places;

(4) Training and assistance in developing patterns of living, activities, and routines which are appropriate to the waiver participant's age and the practices of the surrounding community and which are consistent with the waiver participant's interest and capabilities;

(5) Training and assistance in developing basic safety skills;

(6) Training and assistance in developing competency in housekeeping skills including, but not limited to, meal preparation, laundry, and shopping;

(7) Training and assistance in developing competency in personal care skills such as bathing, toileting, dressing, and grooming;

(8) Training and assistance in developing health care skills, including but not limited to, maintaining proper dental hygiene, carrying out the recommendations of the dentist or physician, appropriate use of medications, application of basic first aid, arranging medical and dental appointments, and summoning emergency assistance;

(9) Training and assistance to waiver participants in developing money management skills which include recognition of currency, making change, bill paying, check writing, record keeping, budgeting, and saving;

(10) Supervision of individuals as appropriate.

C. Medical. Medical services provided shall be under the direction of a physician and shall include the following:

(1) Evaluation, diagnosis, and treatment;

(2) Consultation with the waiver participant and his or her family, staff members, and personal physician, if any;

(3) Participation in the development of the initial IHP;

(4) Monitoring, reevaluation and follow-up of medical services as appropriate;

(5) Referral of waiver participants who require additional medical treatment and services which are not available at the residential services site.

D. Occupational Therapy. Occupational therapy services shall be provided that are required and recommended in the IHP and shall include:

(1) Specifications of the treatment to be rendered, the frequency and duration of that treatment, and the expected results;

(2) Evaluation and reevaluation of the waiver participant's level of functioning through the use of standardized or professionally accepted diagnostic methods;

(3) Development and delivery of appropriate treatment programs which are designed to significantly improve a waiver participant's level of functioning within a reasonable period of time;

(4) Selection and teaching of task-oriented therapeutic activities designed to restore physical functioning;

(5) Improvement of mobility skills.

E. Psychiatric. Psychiatric services shall be provided as recommended in the IHP, under the direction of a board certified psychiatrist, and shall include:

(1) Treatment and prevention of behavioral or emotional disorders which result from psychiatric or neurological conditions;

(2) Written assessment of the waiver participant's mental and emotional status;

(3) Consultation with the waiver participant's personal physician, and other individuals involved in the care of the waiver participant as appropriate;

(4) Periodic monitoring and follow-up of waiver participant's progress.

F. Psychological. Psychological services shall be provided as required and recommended in the IHP and shall include:

(1) A written evaluation that includes use of psychometric data, provided that there is a significant change in the waiver participant's level of functioning, or behavior, or both;

(2) Interviews and consultations with the waiver participant, family, and other pertinent individuals;

(3) Participation in the development of the initial IHP, monitoring, reevaluation, and follow-up of specific individual programs as appropriate;

(4) Assessment and treatment related to the emotional needs of the waiver participant;

(5) Consultation with staff;

(6) Development and implementation of behavior modification programs.

G. Physical Therapy.

(1) Physical therapy services shall be provided as required and recommended in the IHP which specify:

(a) Part or parts of the body to be treated;

(b) Type of modalities or treatments to be rendered;

(c) Expected results of physical therapy treatments;

(d) Frequency and duration of treatment.

(2) The needs assessment shall indicate services which are of a diagnostic, habilitative, therapeutic, or maintenance nature to prevent further deterioration.

(3) Services shall meet accepted standards of medical practice, with developed time frames for effective professional treatment.

H. Social. Social services shall be provided as required and recommended in the IHP and shall include:

(1) Identification of the waiver participant's social needs;

(2) Individual counseling to assist the waiver participant's adaption to the environment;

(3) Family and group counseling to assist and facilitate the waiver participant's adjustment.

I. Speech Pathology and Audiology. Speech pathology and audiology services shall be provided as required and recommended in the IHP and shall include:

(1) Maximization of communication skills;

(2) Screening, evaluation, counseling, treatment, habilitation, or rehabilitation of waiver participants with hearing, language, or speech handicaps;

(3) Coordination of interdisciplinary goals related to hearing and speech needs;

(4) Consultation with staff regarding the waiver participant's programs.

J. Nursing. Nursing services shall be provided which:

(1) Are preauthorized by DDA as being medically necessary and not otherwise covered by the Program;

(2) Are rendered under the direction of a physician;

(3) Are required and recommended in the waiver participant's ISP; and

(4) May include:

(a) Meeting with provider's staff to discuss how the medical services that are identified in the ISP will be implemented,

(b) Education, supervision, and training of waiver participants in health-related matters, and

(c) Short-term or intermittent skilled or unskilled nursing services.