SUPPORTS WAIVER
Chapter Forty-Three of the Medicaid Services Manual
Is
sued June 10, 2011
State of Louisiana
Bureau of Health Services Financing
Claims/authorizations for dates of service on or after October 1, 2015
must use the applicable ICD-10 diagnosis code that reflects the policy
intent. References in this manual to ICD-9 diagnosis codes only apply to
claims/authorizations with dates of service prior to October 1, 2015.
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SUPPORTS WAIVER
TABLE OF CONTENTS
SUBJECT SECTION
OVERVIEW 43.0
BENEFICIARY REQUIREMENTS 43.1
Request for Services Registry
Verifying Screening for Urgency of Need and Request Date Level of Care
Beneficiary Discharge Criteria
RIGHTS AND RESPONSIBILITIES 43.2
Freedom of Choice
Notification of Changes
Participation in Care
Freedom of Choice of Support Coordination and Service Providers
Voluntary Participation
Compliance with Civil Rights
Quality of Care
Grievances/Fair Hearings
Additional Rights
Rights and Responsibilities Form
SERVICE ACCESS AND AUTHORIZATION 43.3
Provider Selection
Initial Plan of Care
Annual Plan of Care
Prior Authorization
Post Authorization
Changing Direct Service Providers
Prior Authorization for New Service Providers
Changing Support Coordination Agencies
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COVERED SERVICES 43.4
Supported Employment
Job Assessment
Documentation Requirements
Job Discovery and Development
Documentation Requirements
Staffing Ratios for Job Assessment, Discovery and Development
Job Assessment
Job Discovery and Development
Service Limits for Job Assessment, Discovery and Development
Authorization of Services
Initial Job Support and Retention
Restrictions with Other Services
Service Limits
Staffing Ratios
Additional Provider Responsibilities
Place of Service
Transportation
Provider Qualifications
Day Habilitation
Place of Service
Restrictions with Other Services
Staffing Ratios
Transportation
Service Limits
Authorization of Services
Provider Qualifications
Community Life Engagement
Place of Service
Restrictions with Other Services
Staffing Ratios
Service Limits
Authorization of Services
Provider Qualifications
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Prevocational Services
Place of Service
Staffing Ratios
Transportation
Restrictions with Other Services
Service Limits
Provider Qualifications
Respite
Restrictions of Other Services
Service Limits
Provider Qualifications
Community Career Planning
Place of Service
Staffing Ratios
Transportation
Restrictions with other Services
Service Limits
Provider Qualifications
Habilitation
Place of Service
Staffing Ratios
Restrictions with Other Services
Authorization of Service
Service Limits
Provider Qualifications
Housing Stabilization Transition Services
Standards
Service Exclusions
Service Limitations
Reimbursement
Housing Stabilization Services
Standards
Service Exclusions
Service Limitations
Reimbursement
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Personal Emergency Response Systems
Service Limits
Agency Provider Type
Support Coordination
Service Limits
Provider Qualifications
Expanded Dental Services
PROGRAM MONITORING 43.5
INCIDENTS, ACCIDENTS AND COMPLAINTS 43.6
Internal Complaint Policy
Complaint Disclosure Statement
Definition of Related Terms Regarding Incidents and Complaints
Provider Requirements 43.7
Support Coordination 43.8
DEVELOPMENTAL DISABILITY LAW APPENDIX A
SERVICE PROCEDURE CODES/RATES APPENDIX B
CONTACT INFORMATION APPENDIX C
FORMS AND LINKS APPENDIX D
CLAIMS FILING APPENDIX E
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OVERVIEW
The Supports Waiver (SW) is a 1915(c) waiver designed to enhance the home and community-
based supports and services available to beneficiaries with developmental disabilities who require
the level of care of an intermediate care facility for individuals with intellectual disabilities
(ICF/IID). The SW is funded by the Centers for Medicare and Medicaid Services (CMS), a federal
agency, and matching state dollars. The waiver is operated by the Office for Citizens with
Developmental Disabilities (OCDD) under the authorization of the Bureau of Health Services
Financing (BHSF), both of which are under the Louisiana Department of Health (LDH).
The mission of this waiver is to create options and provide meaningful opportunities for those
individuals, 18 years of age and older who have a developmental disability, through vocational
and community inclusion. The waiver is available to provide:
1. The supports necessary in order for individuals to achieve their desired community
living and work experience;
2. The services needed to acquire, retain, and/or improve self-help, socialization and
adaptive skills; and
3. The beneficiary an opportunity to contribute to their community.
Objectives:
1. Promote independence for beneficiaries through the provision of services, which
meet the highest standard of quality and are based on national best practices, while
ensuring their health and welfare through a comprehensive system of safeguards;
2. Offer an alternative to institutionalization and costly comprehensive services
through the provision of an array of services and supports that promote community
inclusion and independence by enhancing (not replacing) existing informal
networks;
3. Support beneficiaries and their families to exercise their rights and share
responsibility for their programs, regardless of the service delivery method;
4. Offer access to services on a short-term basis that would protect the health and
welfare of beneficiaries if their families or caregivers are unable to continue to
provide care and supervision; and
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5. Increase high school to community transition resources by offering supports and
services to those 18 years and older.
Services provided through the waiver include the following:
1. Individual supported employment;
2. Group supported employment;
3. Onsite day habilitation;
4. Community life engagement;
5. Onsite prevocational;
6. Community career planning;
7. Habilitation;
8. Respite;
9. Housing stabilization transition;
10. Housing stabilization;
11. Personal emergency response system;
12. Support coordination; and
13. Adult dental services.
All services must comply with the CMS Home and Community-Based Services (HCBS) Settings
Final Rule 42 CFR441.530. Any residential or non-residential setting where individuals live and/or
receive HCBS must demonstrate the following:
1. Integrate in and support full access of individuals to the greater community:
a. Provide opportunities to seek employment, work in competitive integrated
settings, engage in community life, control personal resources; and
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b. Ensure that individuals receive services in the community, to the same
degree of access as individuals not receiving home and community-based
services (HCBS).
2. Selection by the individual from among setting options including non-disability
specific settings and options for a private unit in a residential setting:
a. Person-centered service plan documents options based on the individual’s
needs, preferences, and for residential settings, resources available for room
and board.
3. Ensure an individual’s rights of privacy, dignity and respect, and freedom from
coercion and restraint;
4. Optimize individual initiative, autonomy, and independence in making life choices,
including but not limited to, daily activities, physical environment, and with whom
to interact; and
5. Facilitate individual choice regarding services and supports and who provides
them.
Beneficiaries have a choice of available support coordination (SC) agencies and provider agencies
and are able to select enrolled qualified agencies through the Freedom of Choice (FOC) process.
The plan of care (POC) is developed using a person-centered planning process and identifies all
of a beneficiary’s needs, both non-funded and funded.
All natural supports, available community resources, and applicable Medicaid State Plan services
must be exhausted prior to utilization of waiver funding. Also, if the beneficiary meets the criteria
for the programs, the beneficiary must apply for, and exhaust any similar services available
through Louisiana Rehabilitation Services (LRS) or the Individuals with Disabilities Education
Act (IDEA).
Providers are required to follow the regulations and requirements as specified in this chapter, the
Supports Waiver Rule (LAC 50:XXI.Chapter 1), the Standards for Participation Rule for home
and community-based waiver providers (LAC 50:XXI.Chapters 53-61) and all applicable
licensure and/or certification requirements.
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BENEFICIARY REQUIREMENTS
To qualify for the Supports Waiver (SW), a person must be 18 years of age or older, be offered a
waiver opportunity slot and adhere to all of the following eligibility criteria:
1. Meet the Developmental Disability Law criteria as defined in Appendix A;
2. Have their name on the Developmental Disabilities Request for Services Registry
(DDRFSR);
3. Meet the financial and non-financial Medicaid eligibility criteria for Medicaid
services;
4. Meet the medical requirements;
5. Meet the requirements for an intermediate care facility for individuals with an
intellectual disability (ICF/IID) level of care which requires active treatment of a
developmental disability under the supervision of a qualified intellectual
disabilities professional;
6. Meet the determination that the SW is the Office for Citizens with Developmental
Disabilities (OCDD) waiver, based on person-centered planning and a needs based
assessment, that will meet the needs of the individual;
7. Meet the health and welfare assurance requirements for home and community-
based waiver services; and
8. Be a resident of Louisiana.
To remain eligible for waiver services, a beneficiary must receive one or more waiver services
every thirty days.
Developmental Disabilities Request for Services Registry
Enrollment in the waiver is dependent upon the number of approved and available funded waiver
slots. Individuals who request waiver services are placed on a statewide Developmental
Disabilities Request for Services Registry (DDRFSR) and are selected for an OCDD waiver
opportunity based on the urgency of need and earliest registry date.
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Requests for waiver services must be made from the applicant or their authorized representative
by contacting the applicant’s local governing entity (LGE).
When the LGE determines that the applicant’s condition meets the definition of a developmental
disability as defined by the Louisiana Developmental Disability Law (see Appendix A), the
applicant’s name will be placed on the DDRFSR and the applicant/authorized representative will
be sent a letter stating that the individual’s name has been secured on the DDRFSR and informing
them of the original request (protected) date. The individual will then undergo a screening for
urgency of need (SUN). Entry into an OCDD waiver will be offered to applicants from the
DDRFSR by urgency of need and the earliest request for services date. If, through the needs-based
assessment, person centered planning process, and using the Tiered Waiver process, it is
determined that the SW is the OCDD waiver that will meet the needs of the individual, the
individual will be given a SW slot.
Verifying Screening for Urgency of Need (SUN) and Request Date
Applicants, or their authorized representatives, may verify their screening for urgency of need
(SUN) score and request date by calling their local LGE (see Appendix C).
Level of Care
The SW program is an alternative to institutional care. All waiver applicants must meet the
definition of a person with an intellectual and/or developmental disability (IDD) as defined in
Appendix A.
The LGE will issue either a Statement of Approval (SOA) or a Statement of Denial (SOD).
The Bureau of Health Services Financing (BHSF) “Request for Medical Eligibility Determination”
90-L Form is the instrument used to determine if an applicant meets the level of care of an ICF/IID.
The 90-L Form must be completed, signed, and dated by the individual’s Louisiana licensed
primary care physician. A licensed advanced nurse practitioner, or a licensed physician’s assistant
may sign the 90-L, but the supervising or collaborating physician’s name and address must be
listed. The 90-L Form must be submitted with the individual’s initial or annual plan of care (POC)
to the LGE. The LGE is responsible for determining that the required level of care is met for each
beneficiary.
The applicants/authorized representatives are ultimately responsible for obtaining the completed
90-L Form from the applicant’s primary care physician. This form must be obtained prior to
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linkage to a support coordination agency for an initial POC and no more than 180 days before the
annual POC start date.
Beneficiary Discharge Criteria
Beneficiaries will be discharged from the SW if one or more of the following criteria is met:
1. Loss of Medicaid eligibility as determined by the parish Medicaid Office;
2. Loss of eligibility for an ICF/IID level of care as determined by the LGE;
3. Incarceration or placement under the jurisdiction of penal authorities, courts or state
juvenile authorities;
4. Change of residence to another state with the intent to become a resident of that
state;
5. Admission to an ICF/IID or nursing facility, without the intent to return to waiver
services. The waiver beneficiary may return to waiver services when
documentation is received from the treating physician that the admission is
temporary and shall not exceed 90 days. The beneficiary will be discharged from
the waiver on the 91st day if the beneficiary is still in the ICF/IID facility. Payment
for SW services will not be authorized while the beneficiary is in an ICF/IID facility
or nursing facility;
6. Determination by the LGE that the beneficiary’s health and welfare cannot be
assured in the community through the provision of reasonable amounts of waiver
services, i.e. the beneficiary presents a danger to themselves or others;
7. Failure to cooperate in any eligibility determination process, the initial or annual
implementation of the approved POC, or the responsibilities of the SW beneficiary;
or
8. Continuity of stay is interrupted as a result of the beneficiary not receiving SW
services for a period of 30 or more consecutive days. Continuity of stay will not
apply to interruptions in waiver services because of hospitalization or
institutionalization (such as admission to an ICF/IID or nursing facility) as long as
there is documented expectation from the treating licensed physician that the
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beneficiary will return to waiver services no later than 90 days from admission to
the hospital or institution.
In the case of an event or effect that cannot be reasonably anticipated or controlled (Force
Majeure), support coordination agencies, service providers, and beneficiaries, whenever possible,
will be informed in writing, and/or by phone, and/or via the Medicaid website, of interim
guidelines and timelines for retention of waiver opportunities and/or temporary suspension of
continuity of stay.
The service provider is required to notify the support coordination agency within 24 hours if the
beneficiary has met any of the above stated discharge criteria.
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RIGHTS AND RESPONSIBILITIES
Beneficiaries of Supports Waiver (SW) services are entitled to the specific rights and
responsibilities that accompany eligibility and participation in Medicaid and Medicaid waiver
programs, and those contained in the Louisiana Developmental Disability Law of 2005 (Louisiana
R.S. 28:452.1).
Support coordinators and service providers must assist beneficiaries with exercising their rights
and responsibilities. Every effort must be made to ensure that applicants or beneficiaries
understand their available choices and the consequences of those choices. Support coordinators
and service providers are bound by their provider agreement with Medicaid to adhere to the
following policies regarding beneficiary rights.
Additional Rights
Beneficiaries have the right to control their personal resources, engage in community life, and
receive services in the community to the same degree of access as individuals not receiving
home and community-based services (HCBS), including employment. Individuals have a choice
regarding services and supports, and who provides them.
Additional rights include, but are not limited to, the following:
1. Freedom and support to control their own schedule and activities;
2. Access to food at any time, unless contraindicated due to health and safety and
documented in the plan of care;
3. Freedom to furnish and decorate their sleeping or living units within the lease or
other agreement;
4. Visitors of their choosing at any time;
5. Setting must be physically accessible to the individual; and
6. Control of personal resources, including wages earned from employment.
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Rights and Responsibilities Form
For a complete list of the beneficiary’s rights and responsibilities, refer to Appendix D. The
support coordinator must review these rights and responsibilities with the beneficiary and their
authorized representative as part of the initial intake process into waiver services and at least
annually thereafter.
Freedom of Choice
Applicants/beneficiaries who qualify for an intermediate care facility for individuals with an
intellectual disability (ICF/IID) level of care, have the freedom to select institutional or
community-based services. Applicants/beneficiaries have the responsibility to participate in the
evaluation process. This includes providing the medical and other pertinent information or
assisting in obtaining it for use in the person-centered planning process and certification for
services.
Notification of Changes
Support coordinators and service providers may not approve or deny eligibility for the waiver or
approve services in the waiver program.
The Louisiana Department of Health (LDH) - Bureau of Health Services Financing (BHSF) is
responsible for determining financial eligibility for the SW program. In order to maintain
eligibility, beneficiaries have the responsibility to inform BHSF of changes in their income,
address, and living situation.
LDH - Office for Citizens with Developmental Disabilities (OCDD), through the local governing
authority (LGE), is responsible for approving level of care and medical certification per the plan
of care (POC). In order to maintain this certification, beneficiaries have the responsibility to
inform OCDD, through their support coordinator, of any significant changes, which will affect
their service needs.
Participation in Care
Support coordinators and service providers shall ensure that beneficiaries/authorized
representatives participate in all person-centered planning meetings and any other meeting
concerning their services and supports. Person-centered planning will be utilized in developing
all services and supports to meet the beneficiary’s unmet needs. By taking an active part in
planning their services, the beneficiary is better able to utilize the available supports and services.
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In order for providers to offer the level of service necessary to ensure that the beneficiary’s health,
welfare, and support needs are met, the beneficiary must report any change in their service needs
or interests to the support coordinator and service provider(s).
The support coordinator must request changes in the amount of services at least ten (10) days
before the proposed changes take effect, expect in the case of emergencies. Service providers may
not initiate requests for change of service or modify the POC without the participation and consent
of the beneficiary.
Freedom of Choice of Support Coordination and Service Providers
Support coordinators should be aware that at the time of admission to the waiver and every six (6)
months thereafter, beneficiaries have the opportunity to change support coordination providers, if
one is available. Beneficiaries may request a change by contacting the LGE.
Support coordinators will provide beneficiaries with their choice of direct service providers and
help arrange for the services included in the POC. Beneficiaries have the opportunity to choose
service providers initially, and once every service authorization quarter (three months), unless a
change is requested for good cause.
Voluntary Participation
Providers must assure that the beneficiary’s health and welfare needs are met. As part of the
planning process, methods to comply with these assurances may be negotiated to suit the
beneficiary’s needs and outcomes. Beneficiaries have the right to refuse services, to be informed
of the alternative services available to them, and to know the consequences of their decisions.
Therefore, a beneficiary will not be required to receive services that they may be eligible for but
does not wish to receive. The intent of the SW program is to provide community-based services
to individuals who would otherwise require institutionalization.
Compliance with Civil Rights
Providers shall operate in accordance with Titles VI and VII of the Civil Rights Act of 1964, as
amended, the Vietnam Veterans Readjustment Act of 1974 and all requirements imposed by or
pursuant to the regulations of the U.S. Department of Health and Human Services. This means
that all services and facilities are available to persons without regard to race, color, religion, age,
sex, or national origin. Beneficiaries have the responsibility to cooperate with providers by not
requesting services which, in any way, violate state or federal laws.
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Quality of Care
Providers must be competent, trained, and qualified to provide services to beneficiaries as outlined
in the POC. In cases where services are not delivered according to the POC, or there is abuse or
neglect on the part of the provider, the beneficiary shall follow the complaint reporting procedure
and cooperate in the investigation and resolution of the complaint. Beneficiaries may not request
providers to perform tasks that are illegal or inappropriate, and beneficiaries may not violate the
rights of providers.
Grievances/Fair Hearings
Each support coordination/direct service provider shall have grievance procedures through which
beneficiaries may grieve the supports or services they receive. The support coordinator shall
advise beneficiaries of this right and of their rights to appeal any denial or exclusion from the
program or failure to recognize a beneficiary’s choice of a service and of their right to a fair hearing
through the Medicaid program. In the event of a fair hearing, a representative of the service
provider and support coordination agency shall appear and participate in the proceedings.
The beneficiary has a responsibility to bring problems to the attention of providers or the Medicaid
program and to participate in the grievance or appeal process.
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SERVICE ACCESS AND AUTHORIZATION
Tiered Waiver Process
When funding is appropriated for an Office of Citizens with Developmental Disabilities (OCDD)
waiver opportunity or an existing opportunity is vacated and funded, the next individual on the
Developmental Disability Request for Services Registry (DDRFSR) with the highest urgency of
need screening score will receive a written notice indicating that a waiver opportunity is available.
That individual will receive a needs-based assessment and participate in a person centered planning
process. At the conclusion of that process, if it is determined that the Supports Waiver (SW) is the
most appropriate waiver for this individual, a SW offer will be extended.
The applicant will receive a waiver offer packet that includes a Support Coordination Agency
Freedom of Choice (FOC) form. The support coordinator is a resource to assist individuals in the
coordination of needed supports and services. The applicant must complete and return the packet
to the Medicaid data management contractor in order to be linked to a support coordination agency.
The packet should include a current 90-L form that has been signed and dated by their primary
care physician/nurse practitioner/physician’s assistance.
After the applicant is linked to a support coordination agency, the support coordinator will assist
the applicant in gathering the documents that may be needed for both the financial eligibility and
medical certification process for level of care determination. The support coordinator informs the
individual of the FOC of enrolled waiver providers and the availability of services, as well as the
assistance provided through the support coordination service.
SW is the first waiver that is offered to adults, aged 18 (if no longer in high school and wanting to
find employment) and older, in the tiered waiver process. When it has been determined the SW is
the most appropriate waiver, another home visit is made to finalize the plan of care (POC). The
following must be addressed in the POC:
1. Applicant’s assessed needs;
2. Types and quantity of services (including waiver and all other services, both paid
and unpaid) necessary to maintain the applicant safely in the community;
3. Individual cost of each waiver service; and
4. Total cost of waiver services covered by the POC.
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Provider Selection
The support coordinator must present the beneficiary with a list of providers who are enrolled in
Medicaid to provide those services that have been identified on the POC. The support coordinator
will have the beneficiary or responsible representative complete FOC form initially and annually
thereafter for each identified waiver service.
Initial Plan of Care
The support coordinator is responsible for:
1. Notifying the provider that the beneficiary has selected their agency to provide the
necessary service;
2. Scheduling a meeting with the provider and the beneficiary to discuss services
needed by the beneficiary;
3. After the meeting, forwarding a copy of the draft POC and request the provider
sign and return the following:
a. Budget pages; and
b. Required POC provider attachments as indicated in the POC.
4. Forwarding the initial POC packet, including provider attachments, to the local
governing entity (LGE) for review and approval.
Annual Plan of Care
Annual POCs follow the same process as the initial POC except for the following:
1. Support coordinator supervisors are allowed to approve an annual POC based on
OCDD policy; and
2. A copy of any POC approved by the Support coordinator Supervisor and supporting
documentation will be forwarded to the LGE office.
NOTE: The authorization to provide a service is contingent upon approval by the LGE or support
coordination supervisor.
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Prior Authorization
All services in the SW program must receive prior authorization. Prior authorization (PA) is the
process to approve specific services prior to service delivery and reimbursement for an enrolled
Medicaid beneficiary by an enrolled Medicaid provider. The purpose of PA is to validate the
service requested as being medically necessary and to verify that it meets the criteria for
reimbursement. PA does not guarantee payment for the service as payment is contingent upon
passing all the edits contained within the claims payment process, the beneficiary’s continued
Medicaid eligibility, the provider’s continued Medicaid eligibility, and the ongoing medical
necessity for the service.
PA is performed by the Medicaid data management contractor and is specific to a beneficiary,
provider, service code, established quantity of units, and for specific dates of service. PAs are
issued in quarterly intervals directly to the provider, with the last quarterly authorization ending
on the POC end date.
PA revolves around the POC document and any subsequent revision, which means that only the
service codes and units specified in the approved POC will be considered for PA. Services
provided without prior authorization are not eligible for reimbursement.
The service provider is responsible for the following activities:
1. Checking PAs to ensure that all PAs for services match the approved services in
the beneficiary’s approved POC. Any mistakes must be corrected immediately to
match the approved services in the POC;
2. Verifying that the direct service worker’s timesheet or electronic clock in/out is
completed correctly and services were delivered according to the beneficiary’s
approved POC before billing for the service;
3. Verifying that services were documented as evidenced by timesheets or electronic
clock in/out and progress notes and are within the approved service limits as
identified in the beneficiary’s POC;
4. Verifying service data in the electronic visit verification (EVV) system or LaSRS
depending on the service and modifying the data, if needed, based on actual service
delivery;
5. Inputting the correct date(s) of service, authorization numbers, provider number,
and beneficiary number in the billing system;
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a. It is the provider’s responsibility to ensure that billing information for the
dates of service, procedure codes, and number of units delivered is correct
and matches the information in LaSRS. Inconsistencies between LaSRS and
provider’s billing system may result in recoupment;
6. Billing only for the services that were approved in the beneficiary’s POC and
delivered to the beneficiary;
7. Reconciling all remittance advices issued by the Louisiana Department of Health
(LDH) fiscal intermediary (FI) with each payment; and
8. Checking billing records to ensure the appropriate payment was received.
NOTE: Service providers have a one-year timely filing billing requirement under Medicaid
regulations.
In the event that reimbursement is received without an approved PA, the amount paid is subject to
recoupment.
NOTE: Authorization for services will not be issued retroactively unless approved due to special
circumstances by the OCDD waiver director/designee.
Post Authorization
To receive post authorization, a service provider must ensure that service delivery is reported and
enter the required information into the billing system maintained by the Medicaid data
management contractor. The Medicaid data management contractor checks the information
entered into the billing system by the service provider against the prior authorized unit(s) of
service. Once post authorization is granted, the service provider may bill the LDH FI for the
appropriate unit(s) of service. Providers must use the correct PA number when filing claims for
services rendered. Claims with the incorrect PA number will be denied.
Changes in Service Needs
All requests for changes in services and/or service hours must be made by the beneficiary or their
personal representative to their support coordinator.
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Changing Direct Service Providers
Beneficiaries/families may change direct service providers with the effective date being the
beginning of a quarter. All requests for changes in services and/or service hours must be made by
the beneficiary/family through the support coordinator.
Direct service providers may be changed at any time for good cause as approved by the LGE.
Examples of good cause reasons include:
1. Beneficiary/family moving to another region in the state where the current direct
service provider does not or cannot provide services;
2. Beneficiary/family and the direct service provider have unresolved difficulties and
mutually agree to a transfer;
3. Beneficiary’s health, safety or welfare have been compromised; or
4. Direct service provider has not rendered services in a manner satisfactory to the
beneficiary/family.
The beneficiaries/families must contact their support coordinator to change direct service
providers. The support coordinator will assist in facilitating a team meeting involving the current
direct service provider(s) if agreed upon by the beneficiary/family.
This meeting will address the reason for wanting to terminate services with the current service
provider(s). Whenever possible, the current service provider will have the opportunity to submit a
corrective action plan with specific time lines, not to exceed 30 days, to attempt to meet the needs
of the beneficiary.
If the beneficiary/family refuses a team meeting, the support coordinator and the LGE determines
that a meeting is not possible or appropriate, or the corrective action plan and timelines are not
met, the support coordinator will:
1. Provide the beneficiary/family with the current FOC list of service providers in
their region;
2. Assist the beneficiary/family in completing the FOC and release of information
form;
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3. Ensure the current provider is notified immediately upon knowledge of the request
and prior to the transfer; and
4. Obtain the case record from the releasing provider which must include:
a. Progress notes from the last six (6) months, or if the beneficiary has received
services from the provider for less than six (6) months, all progress notes
from date of admission;
b. Written documentation of services provided, including monthly and
quarterly progress summaries;
c. Current POC;
d. Records tracking beneficiary’s progress towards POC goals and objectives;
e. Behavior management plans, current and past if applicable;
f. Documentation of the amount of authorized services remaining in the POC,
including applicable time sheets; and
g. Documentation of exit interview.
The support coordinator will forward copies of the following to the new service provider:
1. Most current POC;
2. Current assessments on which POC is based;
3. Number of services used in the calendar year;
4. Records from the previous service provider; and
5. All other waiver documents necessary for the new service provider to begin
providing supports and services.
NOTE: Transfers must be made at least seven days prior to the end of the service authorization
quarter. The start date should be effective the first day of the new quarter in order to coordinate
services and billing. The LGE may waive this requirement in writing due to good cause, at which
time the start date will be the first day of the first full calendar month.
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The new service provider must bear the cost of copying, which cannot exceed the community’s
competitive copying rate. If the existing provider charges a rate that exceeds the competitive
copying rate, then the provider should contact the support coordinator to resolve the issue.
Prior Authorization for New Service Providers
The support coordinator will complete the POC revision form with the start date for the new
provider and the end date for the transferring provider, and will submit the revision request to the
LGE for approval.
Upon approval, a new PA number will be issued to the new provider with the effective start date
agreed upon. The transferring agency’s PA number will expire on the date immediately preceding
the PA date for the new provider. New providers who provide services prior to the start date on
the new PA will not be reimbursed.
Exceptions to the existing service provider end date and the new service provider begin date may
be approved by the LGE when the reason for the change is due to good cause.
Changing Support Coordination Agencies
A beneficiary has the option to change support coordination agencies once every 6 months or at
any time if there is "good cause." The beneficiary should notify the LGE office or contact the
Medicaid data management contractor to request this change. Good cause is defined as:
1. Beneficiary/family moving to another region in the state;
2. Beneficiary/family and the support coordination agency have unresolved
difficulties and mutually agree to a transfer;
3. Beneficiary’s health, safety or welfare have been compromised; or
4. Support coordination agency has not rendered services in a manner satisfactory to
the beneficiary/family.
Participating support coordination agencies should refer to the Support Coordination section in
this manual, which provides a detailed description of their roles and responsibilities.
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COVERED SERVICES
Supports Waiver (SW) services are designed to enhance the beneficiary’s independence through
involvement with employment and other community activities. All services must be based on need
documented in the approved plan of care (POC), and provided within the state of Louisiana. The
services that are available include:
1. Supported employment;
a. Individual supported employment:
i. Virtual delivery of supported employment.
b. Group employment.
2. Day habilitation;
a. Community life engagement (1:2-4, 1:1); and
b. Onsite day habilitation (1:5-8).
i. Virtual delivery of onsite day habilitation.
3. Prevocational;
a. Community life engagement (1:2-4, 1:1); and
b. Onsite prevocational (1:5-8).
i. Virtual delivery of onsite prevocational.
4. Respite;
a. Center-based; and
b. In-home.
5. Habilitation;
6. Housing stabilization transition;
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7. Housing transition;
8. Support coordination;
9. Personal Emergency Response System (PERS); and
10. Extended dental services.
The use of the electronic visit verification (EVV) system is mandatory for all supported
employment services. The EVV system requires the electronic check in/out in the Louisiana
Services Reporting System (LaSRS).
Supported Employment
Supported employment (SE) services are designed to support a beneficiary in community-based
employment who, because of their disability, require ongoing support and extended follow-along
to obtain and maintain a job in an integrated competitive work setting, including:
1. Customized employment or self- employment;
2. Compensation at or above the minimum wage, but not less than the customary
wage; and
3. Level of benefits paid by the employer for the same or similar work performed by
individuals without disabilities.
SE services significantly expand available options for a beneficiary who requires services to
achieve and maintain integrated, competitive employment in the community. These services
include ongoing support and follow-along services, either through paid services, unpaid natural
supports such as co-workers, family, friends, and/or other comparable services as appropriate.
Beneficiaries who have the most significant disabilities may require long-term employment
supports to successfully maintain a job due to the ongoing nature of the beneficiary’s support
needs, changes in life situations or evolving and changing job responsibilities, and where natural
supports would not meet this need.
Competitive employment is work performed, on a full time or part time basis, in an integrated
setting which an individual is compensated at or above minimum wage, but not less than the
customary wage and level of benefits paid by an employer for the same or similar work performed
by individuals without disabilities.
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An integrated work setting is a job site in the community where most employees do not have a
disability and individuals with significant disabilities interact on a regular basis with individuals
without disabilities in performing their job duties.
Ongoing supports and follow-along are services that are needed to support or maintain a
beneficiary with a disability in employment, based upon the needs of the beneficiary and continue
indefinitely.
SE services may be utilized to:
1. Support a beneficiary in an employment opportunity in the community;
2. Support a beneficiary in establishing and/or maintaining self-employment,
including home based self-employment; and
3. Support a group of no more than eight beneficiaries in an employment opportunity
in the community.
Supported employment services do not support the following:
1. A beneficiary in a volunteer job. This should be completed under prevocational
services or day habilitation services; and
2. Facility-based employment furnished in specialized facilities that are not a part of
the general work place and do NOT include people who do not have a disability.
These services are divided into two categories:
1. Individual employment, including self-employment or microenterprise:
a. Job assessment, discovery and development; and
b. Initial job support and job retention.
2. Group employment:
a. Job assessment, discovery and development; and
b. Initial job support and job retention.
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The job assessment, discovery and development process includes:
1. Identifying specific career interests of a beneficiary;
2. Identifying appropriate community employment options that match information
gained from a beneficiary’s assessment, profile and/or plan;
3. Ensuring the identified position will meet the occupational, physical, and financial
requirements of the beneficiary; and
4. Assisting the beneficiary and employer in achieving a successful job match,
placement, and sustaining employment.
The outcome of job assessment, discovery and development is sustained paid employment in an
integrated setting in the general workforce in the community in a job that meets personal and career
goals.
Job Assessment
Job assessment is the evaluation of a beneficiary’s skills and interests, and consists of a
combination of assessment activities including:
1. Vocational assessments to determine a beneficiary’s career interests;
2. Job analysis for each job the beneficiary is interested in obtaining;
3. Community-based situational assessments;
4. Facility-based situational assessments;
5. Placement plan;
6. Assisting with personal care in activities of daily living; and
7. Ongoing career planning.
Examples of career planning activities include, but are not limited to, the following:
1. Ongoing career counseling:
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Ongoing discussions should be conducted with the beneficiary to help answer their
questions and/or to assist them in any aspect of defining a career goal.
2. Benefits planning:
Benefit planning should be completed by a certified work incentive coordinator to
assist the beneficiary in answering questions regarding Social Security benefits
and working.
3. Financial literacy:
Financial literacy is intended to assist the beneficiary in gaining skills and
knowledge in the area of their personal finances which will help them in making
more cost-conscious decisions.
4. Assistive technology (AT) assessments:
These assessments are conducted as needed to enhance a beneficiary’s
employability.
5. Other activities that may assist the beneficiary in increasing their knowledge in
areas that enhance their decision-making to obtain an employment goal and career
path.
Job assessment will not be authorized for services that include teaching concepts such as
compliance, attendance, task completion, problem-solving, and safety that are associated with
performing compensated work, as well as, activities aimed at a generalized outcome.
Note: These activities should be completed under prevocational services.
Documentation Requirements
To receive post-authorization for job assessment, one or more of the following documents must be
submitted to the beneficiary’s support coordinator for approval:
1. Completed vocational assessment;
2. Completed job analysis;
3. Notes from community-based/situational assessments;
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4. Placement plan;
5. Career planning activities documentation;
6. Assistive technology (AT) assessments;
7. Benefits planning documentation;
8. Documentation of job internship;
9. Documentation of job shadowing experience; and
10. Additional documentation that substantiates other assessment activity.
Approval of job assessment documents will be based on the following information:
1. Objectives and time lines outlined in the individualized service plan (ISP) were met
timely; and
2. The written assessment that includes, at a minimum, the following information and
the identification of:
a. Specific career interest(s);
b. Assets and abilities regarding employment;
c. Potential targeted job tasks;
d. Job conditions;
e. Anticipated support needs;
f. Potential employers;
g. Maximum hours per week and times of day the beneficiary will consider
working;
h. Minimum rate of pay the beneficiary will accept;
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i. Benefits that might impact the beneficiary’s earnings, in particular
Supplemental Security Income (SSI) and/or Social Security Disability
Insurance (SSDI) benefits;
j. Areas of town, city or parish(s) the beneficiary will consider working;
k. Transportation options and selection;
l. Identification of current work strengths/skills of the beneficiary to achieve
their job choice;
m. Identification of current barriers to the beneficiary job choice; and
n. Identification of the anticipated support needs for the beneficiary.
Job Discovery and Development
Job discovery and development consists of one or more of the following activities:
1. Marketing agency services to employers that match the beneficiary’s interest in
order to establish business relationships that could result in job opportunities for
the beneficiary;
2. Assisting the beneficiary to make use of all available job services through one-stop
career centers;
3. Contacting specific employers whose business matches the beneficiary’s career
interests, or who are advertising for open positions through newspaper
advertisements, websites, or word of mouth;
4. Assisting the beneficiary in creating a resume;
5. Assisting the beneficiary in preparing for a job interview;
6. Transporting the beneficiary to a job interview;
7. Accompanying the beneficiary to a job interview, if requested;
8. Referring the beneficiary to work incentives, planning, and assistance
representatives when necessary, or as requested;
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9. Reconfiguring an existing position to fit the employer and beneficiary’s needs, also
known as job restructuring;
10. Consulting and/or negotiating as needed and/or requested with employer on rate of
pay, benefits, and employment contracts;
11. Restructuring a work site to maximize a beneficiary’s ability to perform the job,
also known as job accommodations;
12. Training to enable a beneficiary to independently travel from their home to place
of employment;
13. Providing employee education and training, as requested by employer on disability
issues;
14. Providing employers with information on benefits available when hiring a person
with a developmental disability, such as on the job training (OJT) or Work
Opportunities Tax Credit (WOTC);
15. Assisting with personal care activities of daily living; and
16. Planning ongoing career activities.
The following activities, in addition to the activities listed above, may be included for self-
employment/microenterprise:
1. Coordinating access to grants and other resources needed to begin and/or sustain
the enterprise;
2. Identifying equipment and supplies needed;
3. Facilitating consultation with groups able to offer guidance, such as Louisiana
Economic Development (LED)and the Small Business Administration (SBA);
4. Assisting with creation of a business plan;
5. Facilitating interactions with required legal entities such as necessary business
licensing agencies, fire marshals and building inspectors; and
6. Assisting with hiring, training, and retaining appropriate employees.
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NOTE: Funds for self-employment may not be used to defray any expenses associated with setting
up or operating a business.
Documentation Requirements
The following documentation reflecting the beneficiary’s choice of occupation as documented on
the ISP, must be submitted to the beneficiary’s support coordinator for approval. These elements
can be listed or contained in a narrative report:
1. All objectives and timelines related to job discovery and development outlined in
the ISP were met timely. If changes were made, the revised ISP and new signature
page with dates must be attached;
2. Dates, times, names and addresses of companies contacted and method of contact
(e.g. in-person, by phone, letter, e-mail or through employer’s website);
3. Job restructuring activities, including meetings specific to an identified position in
a community business including date, time, and names and job titles of community
business staff in attendance. If meeting(s) occurred, meeting minutes must be
submitted;
4. Community business education and/or trainings specific to an identified job in a
community business, including date, time, names and job titles of community
business staff in attendance, and content of education and/or training session(s);
5. Job accommodation, travel training, and any other employment related activities
specific to an identified job in a community business;
6. Amount of time spent in discovery and development per day;
7. Confidentiality release forms in the beneficiary’s native language, if applicable,
that they approved contacts, meetings, education or training to occur in their
absence; and
8. Other documentation related to job discovery and development activities.
The beneficiary may or may not be present during the job discovery and development activities.
If the beneficiary is not present, a signed and dated confidentiality release form must be completed.
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Staffing Ratios for Job Assessment, Discovery and Development
Job Assessment
The beneficiary must be present in order to receive individual, self-employment/microenterprise
or group employment job assessment services. Individual or self-employment/microenterprise job
assessments must be conducted on a one staff to one beneficiary ratio. For group employment,
rates for job assessment are paid per beneficiary, not per group.
Job Discovery and Development
Individual and group employment job discovery and development may be billed on a one staff to
multiple beneficiary ratio. The staff ratio needed to support the beneficiary must be documented
on the plan of care (POC).
When individual job discovery and development is billed on one staff to multiple beneficiary
ratios, post authorization documentation must show individual outcomes. For example, if an
employer bills for two beneficiaries on the same day for the same time period, post authorization
documentation must show that job development efforts were made for each individual according
to their identified specific career interests.
Scenario: If more than one beneficiary’s identified career interest is childcare, then billing could
reflect a visit to one childcare facility on behalf of both beneficiaries. However, if a beneficiary’s
identified career interest is childcare and the other beneficiary wishes to work in a medical setting,
documentation must show visits to the specific type of business for each beneficiary.
Service Limits for Individual Job Assessment, Discovery and Development
Activities will be authorized for a maximum of 2880 standard units in a service year for individual
job assessment, discovery and development.
A standard unit of service is 15 minutes (¼ hour) in job assessment, discovery, and development.
Utilization of job assessment units will be counted towards the total available units for job
assessment, discovery and development for a service year. Therefore, if 2880 standard units are
utilized in a service year, job discovery and development could not begin until the next service
year. If all available units in job assessment, discovery and development are used only for job
assessment for a beneficiary in one service year, only job discovery and development activities
and not job assessment will be authorized for the next service year.
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Authorization of Services
To receive prior-authorization for job assessment, discovery and development services, the portion
of the ISP covering these services must be submitted to the beneficiary’s support coordinator with
measurable goals, objectives and time lines that address these services. The ISP must be signed
and dated by the beneficiary, their responsible representatives and the support team members
indicating agreement with the goals, objectives and timelines. The Job Assessment, Job
Discovery, Job Development form must be completed (see Appendix D).
Specific documentation that shows evidence that the goals, objectives and timelines on the ISP
related to those activities have been met must be submitted to the beneficiary’s support coordinator
for post-authorization. If an objective or timeline cannot be met timely, the provider must facilitate
changes prior to the end date of the objectives and timelines on the ISP and obtain team members’
dated signatures indicating agreement with the changes. Partial completion of job assessment,
discovery and/or development of ISP objectives and timelines will not qualify for post
authorization and payment.
Service Limits for Group Job Assessment, Discovery and Development
Activities will be authorized for a maximum of 480 standard units in a service year for group job
assessment, discovery and development.
A standard unit of service is 15 minutes (¼ hour) in job assessment, discovery, and development.
Utilization of job assessment units will be counted towards the total available units for job
assessment, discovery and development for a service year. Therefore, if 480 standard units are
utilized in a service year, job discovery and development could not begin until the next service
year.
Authorization of Services
To receive prior-authorization for job assessment, discovery and development services, the portion
of the ISP covering these services must be submitted to the beneficiary’s support coordinator with
measurable goals, objectives and time lines that address these services. The ISP must be signed
and dated by the individual, their responsible representatives and support team members indicating
agreement with the goals, objectives and time lines. The Job Assessment, Job Discovery, Job
Development form must be completed (see Appendix D).
Specific documentation that shows evidence that the goals, objectives and timelines on the ISP
related to those activities have been met, must be submitted to the beneficiary’s support
coordinator for post-authorization. If an objective or timeline cannot be met timely, the provider
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must facilitate changes prior to the end date of the objectives and timelines on the ISP and obtain
team members’ dated signatures indicating agreement with the changes. Partial completion of job
assessment, discovery and/or development of ISP objectives and timelines will not qualify for post
authorization and payment.
Individual Initial Job Support, Retention, and Follow-Along
Initial job support is provided to the beneficiary on or off the job site by provider staff. It may be
intensive, intermittent, short-term and/or ongoing.
Initial job support and retention consists of one or more of the following activities:
1. Provision of support at a job site by provider staff that ensures the beneficiary can
maintain and meet the expectations of the employer;
2. Assisting with personal care activities of daily living in the employment setting by
provider staff;
3. Face-to-face support off the job site by provider staff that is necessary for the
beneficiary to maintain gainful employment. Examples of this kind of contact
include, but are not limited to:
a. A beneficiary needing travel re-training to the work site due to changes in
transportation; and
b. A beneficiary needing assistance in setting up an alarm clock system at
home in order to be at work on time,
4. The beneficiary wishing to discuss a problem that involves personal issues that
could affect their ability to retain the job at a place other than the work site;
5. The beneficiary needing assistance with completing documentation required by the
employer or by an agency providing benefits that are affected by work income, such
as SSI;
6. Communications with the beneficiary by telephone, e-mail or fax that is necessary
for the beneficiary to maintain gainful employment; and
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7. Meetings with the community employer without the beneficiary present; which are
counted as part of the total maximum number of standard units available. Examples
of when such a meeting might occur include, but are not limited to:
a. Explanation and/or demonstration of significant change in job duties which
the employer feels may require re-training for the beneficiary to remain
successfully employed; or
b. Discussion of a behavioral issue that may adversely impact the beneficiary’s
ability to remain successfully employed.
If the beneficiary is not present at a meeting with the community employer, the provider will be
expected to have the following documentation as part of the case record and provide upon request
of the support coordinator, Office of Citizens with Developmental Disabilities (OCDD)/Waiver
Supports and Services (WSS) or Health Standards (HSS) staff:
1. Date, time, and names of persons in attendance at meeting;
2. Location and method of meeting (i.e. face-to-face with employer, by phone, or
internet/videoconference);
3. Reason for meeting without beneficiary and results of meeting;
4. Written documentation through applicable confidentiality release forms in the
beneficiary’s native language that the beneficiary approved contacts and/or
meetings to occur in their absence; and
5. Transportation to or from a community business site by provider staff in a staff or
provider-owned vehicle. However, the provider must produce documentation upon
request of the support coordinator or OCDD, WSS or HSS staff that all other
possible sources of transportation, including those incurring a charge or without
charge, have been exhausted.
NOTE: Under no circumstances may a provider charge a beneficiary, their responsible
representative(s), family members or other support team members a separate transportation fee.
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Self-Employment/Microenterprise, Initial Job Support, Retention Activities and Follow-
Along Activities
Initial job support is provided to the beneficiary, on or off the job site, by provider staff. It may be
intensive, intermittent, short-term and/or ongoing. These activities can include, but are not limited
to, the following activities:
1. Provision of support by provider staff at their job site that ensures the beneficiary
can maintain and meet the expectations of the job;
2. Assistance with personal care activities of daily living in the employment setting
by provider staff;
3. Face-to-face support off the job site by provider staff that is necessary for the
beneficiary to maintain gainful employment. Examples of this kind of contact
include, but are not limited, to the following:
a. Beneficiary needing travel re-training to the work site due to changes in
transportation;
b. Beneficiary needing assistance in setting up an alarm clock system at home
in order to be at work on time;
c. The beneficiary wishing to discuss a problem that involves personal issues
that could affect their ability to retain the job at a place other than the work
site;
d. Beneficiary needing assistance with completing documentation required by
the job or by an agency providing benefits that are affected by work income,
such as SSI; and
e. Communications with the beneficiary by telephone, e-mail or fax that is
necessary for the beneficiary to maintain their employment.
4. Assistance acquiring skills necessary for operation of the business including
clerical, payroll, tax functions, and inventory tracking system;
5. Assistance with interviewing, hiring or terminating employees;
6. Assistance with communications with vendors and customers; and
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7. Assistance with all functions of business operations.
Initial job support and retention will be authorized for a job a beneficiary holds in a provider-
owned/controlled business when the following occurs:
1. Beneficiary is paid the same wage as a typical employee that doesn’t have a
disability of that business, but at least minimum wage;
2. There is a job description for the position that would be utilized to hire a person
without a disability; and
3. Beneficiary is paid all benefits, including holidays, absentee and vacation time that
other employees without disabilities would receive in a comparable position.
Follow-along services in a provider owned/controlled business is not allowed after the initial job
support and retention phase is completed.
Initial job support and retention will only be authorized for individual job, self-
employment/microenterprise or group employment for which the beneficiary is paid in accordance
with the United States Fair Labor Standards Act of 1985 as amended.
In-person visits for individual job follow-along services are required in the following
circumstances as outlined:
1. An initial assessment of beneficiary on the job site; and
2. Discussion of HIPAA compliance prior to beginning virtual services.
Individual job follow-along services may be delivered virtually following the guidelines below.
Specific circumstances should be present for virtual follow-along services to occur and those
circumstances are defined in the OCDD Policy and Procedures Manual. Individual SE follow-
along services can be delivered virtually in a 1:1 ratio if requested by the individual or the employer
and meet the criteria. These services are delivered based on the already determined amount of
follow-along services necessary for the individual to maintain their employment. There is not a
predetermined percentage of time that virtual services will occur, as this is an individual choice.
Virtual delivery of one to one ongoing supported employment follow-along is based on the
beneficiary’s needs for what is required to support the beneficiary on the job.
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When using virtual delivery, providers are expected to follow these guidelines:
1. Receive written instructions on the delivery of virtual services based on the HIPAA
compliance officer’s instructions;
2. Ensure beneficiaries understand the guidelines for participation in a virtual service
delivery, HIPAA, and the use of the technology. Written instructions and guidelines
will be provided to each beneficiary;
3. In all circumstances, the employer/supervisor and the beneficiary must be in
agreement with a virtual visit and if the beneficiary needs a means to conduct the
virtual visit, the employer/supervisor must be willing to assist the beneficiary in
doing a virtual visit if they require assistance;
4. Visit should be coordinated with the employer/supervisor and the beneficiary;
5. Confidentiality still applies for services delivered through virtual delivery. The
session must not be recorded without consent from the beneficiary or authorized
representative;
6. Develop a back-up plan (e.g., phone number where beneficiary can be reached) to
restart the session or to reschedule it in the event of technical problems;
7. Develop a safety plan that includes at least one emergency contact and the closest
emergency room (ER) location, in the event of a crisis;
8. Verify beneficiary’s identity, if needed;
9. Providers need the consent of the beneficiary and the beneficiary’s parent or legal
guardian (and their contact information) prior to initiating a telemedicine/telehealth
service with the beneficiary if the beneficiary is 18 years old or under;
10. Beneficiary must be informed of all persons who are present and the role of each
person;
11. Beneficiaries may refuse services delivered through telehealth; and
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12. It is important for the provider and the beneficiary and the employer to be in a quiet,
private space that is free of distractions during the session. Beneficiaries and
employer will be instructed on the following:
a. Finding a space that allows for privacy while participating in the virtual
delivery of the service;
b. Turn the camera off and mute the session if the beneficiary leaves the room
while participating in the session, or if someone who is not part of the
session enters the room;
c. Utilizing the technology required to participate in the virtual delivery of this
service, including how to utilize the specific format, signing in and out, etc.
The provider will also provide written instructions to the beneficiary;
d. Scheduling the delivery of services; and
e. Instructions if a job coach is needed onsite.
The beneficiary’s need for hands on/physical assistance on the job will already be established
and therefore if the beneficiary requires hands on assistance, someone will be present to provide
assistance to the beneficiary. If the need for virtual delivery of job coaching services arises, a
process will be in place with the support worker and the job coach in order for the beneficiary to
receive the assistance required on the job, but that both services will not be billed at the same
time.
Requirements for virtual visits of job coaching include:
1. Must utilize some type of format that allows for face-to-face interaction;
2. Must be approved by LGE or OCDD State Office;
3. Utilize the Virtual Supported Employment Follow-along Services Report; and
4. This service cannot be utilized at the same time another service.
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Restrictions with Other Services
Beneficiaries receiving individualized supported employment services may also receive day
habilitation or prevocational services, and these services can be billed for during the same service
day, but cannot equal more than five hours combined.
Staffing Ratios for Individual Initial Job Support, Retention and Follow-Along
Individual self-employment/ microenterprise initial job support and retention must be provided
with a one staff to one beneficiary ratio.
Service Limits for Individual Initial Job Support, Retention and Follow-Along:
Activities will be authorized for a maximum of 960 standard units in a service year for initial job
support, retention and follow-along.
A standard unit of service is 15 minutes (¼ hour).
Group Employment Initial Job Support, Retention and Follow-Along
Group employment initial job support, retention and follow-along activities may be authorized in
a provider-owned business or other business when the following occurs:
1. Waiver beneficiary earns at least minimum wage and/or the going rate for the job
for people without disabilities;
2. Waiver beneficiary has the same or similar interactions with the public as people
without disabilities;
3. Waiver beneficiary participates in quarterly discussion about individual job
opportunities in the community; and
4. Must have a job description and a person without a disability could be hired for the
same job.
In addition to the items listed above, if the business is a provider owned/operated business (i.e.
thrift store, bakery, restaurant, etc.) the following must occur:
1. The business must meet the criteria that a typical business is required to meet (i.e.
license to operate, etc.);
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2. The building in which the business operates from must be a separate physical location
from the rest of the provider facility and cannot coexist where other services, such as
onsite day habilitation, are delivered; and
3. Members of the public are the primary customers who utilize the services of the
business.
Service Limits for Group Employment Initial Job Support, Retention and Follow-
Along
Group employment services are provided in regular business, industry, and community settings
for groups of two to eight beneficiaries with disabilities. Supported employment group services
must be provided in a manner that promotes integration into the workplace and interaction
between, coworkers without disabilities in those workplaces, and customers. Provider owned
businesses should be operated as a regular business as described above.
The outcome of this service is sustained paid employment and work experience leading to further
career development and individual integrated community–based employment for which
beneficiary is compensated at or above 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 individuals
without disabilities.
Group employment does not include:
1. Vocational services provided in facility based work settings; and
2. Volunteer work.
Career planning may be included as part of this service as well so that beneficiaries can further
plan for individual employment.
Group employment initial job support, retention and follow-along activities may be authorized for
only 240 standard units in a service year. Rates are paid per beneficiary, not per group. A standard
unit of service is paid as a daily rate, and must be at least one hour or more per day to get paid.
Staffing Ratios for Group Supported Employment
Group employment initial job support and retention must have one of the following staff to
beneficiary ratios in order to receive payment:
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1. One staff to one beneficiary (1:1);
This option is only available when the staff providing the one-to-one support is in
addition to a crew supervisor and is in attendance for the entire shift.
2. One staff to two beneficiaries (1:2);
3. One staff to three to four beneficiaries (1:3-4); or
4. One staff to five to eight beneficiaries (1:5-8).
The maximum ratio for group employment is one staff to eight beneficiaries (1:5)-8.
Restrictions with Other Services
Beneficiaries receiving group supported employment follow-along services may also receive day
habilitation or prevocational services, but these services cannot be billed for on the same service
day.
Additional Requirements for Individual and Group Supported Employment
Prior to receiving individual SE services, the beneficiary must apply for, and exhaust any similar
services available through Louisiana Rehabilitation Services (LRS) or the Individuals with
Disabilities Education Act (IDEA) if the beneficiary is still attending high school. LRS services
will be considered unavailable if a beneficiary applies, is eligible and qualifies for LRS services
but is put on a waiting list or has not received timely services from LRS (within 90 days of
eligibility) at which time, waiver services can be utilized for individual SE services.
For individuals choosing group employment services, they do not have to apply for LRS, as LRS
does not fund group employment.
There must be documentation in the beneficiary’s file that individual SE services are not available
from programs funded under the Rehabilitation Act of 1973, the IDEA or Medicaid State Plan, if
applicable.
Place of Service
Individual supported employment is conducted in a variety of settings, in particular at work sites
in which persons without disabilities are employed. When services are provided at a work site in
which persons without disabilities are employees, payment will be made only for the adaptations,
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supervision, and training required by beneficiaries receiving waiver services as a result of their
disabilities, and will not include payment for the supervisory activities rendered as a normal part
of the business setting.
Transportation
Transportation is included in the rates for group SE, but whenever possible, family, neighbors,
friends, co-workers or community resources that can provide transportation without charge should
be utilized. Under no circumstances may a provider charge a beneficiary, their responsible
representative(s), family members or other support team members a separate transportation fee.
Provider Qualifications
Providers of both individual and group SE services must meet the following requirements:
1. Possess and maintain a 40-hour SE certificate of completion from an approved
program as a community rehabilitation provider and maintain this certificate and
provide documentation to the local governing entity (LGE) office;
2. Complete 20 hours of approved employment related training every two years and
provide proof to the local LGE office; and
3. Meet all requirements in the Standards for Participation for Medicaid Home and
Community-Based Waiver Services and other home and community-based services
(HCBS) guidance as provided.
In addition to the requirements listed above, providers of group SE services must meet the
following requirements.
1. Be licensed as an adult day care provider by the Louisiana Department of Health
(LDH); and
2. Group employment supervisor receives 20 hours of employment related training
every two years and provide proof to the local LGE office.
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Day Habilitation
Day habilitation services should focus on the beneficiary, using the person-centered planning
process thereby assisting the beneficiary to develop their meaningful day, that supports the
beneficiary in how they spend their time, and what’s important to each beneficiary.
The integration with individuals without disabilities is expected and should not just include people
who are paid to support the beneficiary. Activities should not be created for the sole purpose of
serving beneficiaries with developmental disabilities. Beneficiaries should participate in activities
and events that are already established in the community.
Day habilitation activities should focus on assisting the beneficiary to gain their desired
community living experience, including the acquisition, retention, or improvement in self-help,
self-advocacy, socialization and/or adaptive skills, increasing independence, and/or to provide
the beneficiary an opportunity to contribute to their community. Day habilitation activities may
be educational or recreational in nature, which would include activities that are related to the
beneficiary’s interests, hobbies, clubs, or sports. Day habilitation can assist a beneficiary in
exploring the community and in making community connections. Volunteering in the
community is encouraged and should be provided under the guidelines of the United States Fair
Labor Standards Act of 1985 as amended.
NOTE: Volunteering for the provider agency or provider-owned business is not allowed.
Day habilitation services may be coordinated with needed therapies in the beneficiary’s person-
centered POC, such as physical therapy. The beneficiary, who is of retirement age, may also be
supported in senior community activities or other meaningful retirement activities in the
community, such as the local council on aging or senior centers.
Assistance with personal care may be a component part of day habilitation services, as necessary,
to meet the needs of a beneficiary, but may not comprise the entirety of the service. Day
habilitation is to be furnished in a variety of community settings (i.e., local recreation
department, garden clubs, libraries, etc.) other than the person’s residence and is not to be limited
to a fixed-site.
Day habilitation may not provide for the payment of services that are ‘vocational’ in nature
– for example, the primary purpose of producing goods or performing services for
payment.
Under the service umbrella of ‘day habilitation’, there are two (2) distinct services that may be
delivered. Both services may be delivered on the same day in order to support the beneficiary to
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have the day that they desire. The goal is to support the beneficiary to make choices of how they
spend their day, both in the community and onsite, in order to help the beneficiary create their
meaningful day. Beneficiaries should be involved in making choices and guiding the inclusion of
new activities. Discussions should be occurring at least quarterly to ensure that the beneficiary is
receiving the supports they need and engaging in activities that are important to them.
The two day habilitation services that are available are described in detail below.
Community Life Engagement
Community life engagement (CLE) refers to services that help support beneficiaries with
disabilities to access and participate in purposeful and meaningful activities in their community.
The activities may include such things as volunteering, hobbies, shopping, or club participation.
The role of CLE varies depending on the particular needs of the beneficiary. This service
promotes opportunities and support for community inclusion by building interests and
developing skills and potential for not only meaningful community engagement, but it can also
help the beneficiary in figuring out areas of interests that could lead to possible competitive
integrated employment in the community. Services should be completed in the community in
small groups, which allows for a more person-centered planning of activities. Services should
result in active, valued participation and engagement in a broad range of integrated activities that
build on the beneficiary’s interests, preferences, gifts, and strengths, while reflecting their
desired outcomes related to community involvement and membership.
This service involves participation in integrated community settings, in activities that include
persons without disabilities and with people who are not paid or unpaid caregivers. This service
is expected to result in the beneficiary developing and maintaining social roles and relationships,
building natural supports, increasing independence, increasing potential for employment, and/or
experiencing meaningful community participation and inclusion. Volunteering is expected to be
a part of this service as well.
Providers must use an approved activity log to document activities done in the community and
frequency. Services may be delivered during the days and times that activities are available and
there are no limits to the days or times.
Onsite Day Habilitation
Onsite day habilitation are services that are typically delivered onsite, inside of a day program
building. This service should focus on the person-centered planning process, which allows the
beneficiary a choice in how they spend their day when onsite and should also consider how to
assist the beneficiary to support their time spent in CLE services.
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Onsite day habilitation activities should be consistent with the individual's interests, skills, and
desires, and should assist the beneficiary to gain their desired meaningful day. Onsite day
habilitation should be individualized and have choices of activities available that can contribute
to a meaningful day for each person. Individual discussions should occur, at least quarterly, to
discover new interests and to see how those interests can be incorporated into the day center.
Exploring future CLE activities and doing any preparation for those activities is a great way to
utilize onsite day habilitation.
Onsite day habilitation can also be offered in a variety of community settings in the ratio of 1:5-
8, but should just be in addition to the CLE in a 1:2-4 delivered in the community. The
community should be a regular part of Onsite day habilitation activities including volunteers and
community partnerships and engagement both onsite and in the community. The use of ‘reverse
integration’ does not supplant the inclusion of CLE, but should support a meaningful day.
NOTE: If a beneficiary is already approved to receive 1:1 or 1:2-4 services for day habilitation,
those individuals may continue to receive that service ratio even when participating in onsite day
habilitation.
Virtual delivery of onsite day habilitation should be utilized during times that does not allow the
beneficiary to attend in person (i.e. medical issues/surgery, an emergency where a provider
agency may be closed) or when the beneficiary chooses to not attend in person. Virtual delivery
is not the typical delivery method. In order to participate in virtual delivery of the service, the
beneficiary should be independent or have natural supports, as this service cannot be billed at the
same time as another service. The beneficiary should also have the technology necessary to
participate in the virtual service (i.e., internet connection, laptop, smartphone, and/or tablet).
Prior to the beginning of virtual delivery, the following in-person visits are required:
1. Initial assessment of beneficiary and home to determine if it’s feasible; and
2. HIPPA compliance training prior to beginning virtual delivery.
Beneficiaries are encouraged to participate in the community through CLE services or onsite day
habilitation services in person. Virtual delivery of day habilitation will be discussed with each
beneficiary, by the support coordinator, as well as with the service provider and will be included
in the plan of care if chosen by the beneficiary.
Providers will receive written instructions on the delivery of virtual services based on the HIPAA
compliance officer’s instructions.
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When using virtual delivery, providers will follow these guidelines:
1. Confidentiality still applies for services delivered through virtual delivery. The
session must not be recorded without consent from the beneficiary or authorized
representative;
2. Develop a back-up plan (e.g., phone number where beneficiary can be reached) to
restart the session or to reschedule it, in the event of technical problems;
3. Develop a safety plan that includes at least one emergency contact and the closest
ER location, in the event of a crisis;
4. Verify beneficiary’s identity, if needed;
5. Providers need the consent of the beneficiary and the beneficiary’s parent or legal
guardian (and their contact information) prior to initiating a telemedicine/telehealth
service with the beneficiary if the beneficiary is 18 years old or under;
6. Beneficiary must be informed of all persons who are present and the role of each
person;
7. Beneficiaries may refuse services delivered through telehealth; and
8. It is important for the provider and the beneficiary to be in a quiet, private space
that is free of distractions during the session.
Providers will ensure that beneficiaries understand the guidelines for participation in a virtual
service delivery and HIPAA. Written instructions and guidelines will be provided to each
beneficiary.
Beneficiaries and natural supports will be instructed on the following:
1. Finding a space that allows for privacy while participating in the service;
2. Turning the camera off and mute the session if they leave to go to the bathroom or
leave the room while participating in the session, or if someone who is not part of
the group comes into the room; and
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3. How to utilize the technology required to participate in the virtual delivery of day
habilitation, including how to utilize the specific format, signing in and out, etc.
The provider will also provide written instructions.
To ensure that virtual delivery of day habilitation facilitates community integration, the provider
agency will continue to incorporate already established community partners into the virtual
delivery of day habilitation. For instance, if a meeting that is typically attended in the community
with community participation occurring, the beneficiary will join via a face-to-face format
virtually and therefore still be included in the meeting. Providers will also seek opportunities for
beneficiaries to join community online groups in a face-to-face format and seek out such
activities as online church services and groups, exercise classes, cooking, and drawing classes.
Through virtual delivery of this service, beneficiaries can continue to interact with their friends
and community connections during the times when the beneficiary is not participating in person.
If the beneficiary is able to be unsupported during this service, an existing protocol is in place for
the person if a health and safety issue arises during this virtual service. The provider agency
staff, who is conducting the virtual delivery of this service, will be able to support the beneficiary
through any health and safety situation that might arise during the virtual delivery of day
habilitation. If the beneficiary is participating in virtual services with the assistance of natural
supports, the natural supports will ensure the health and safety of the beneficiary.
All virtual day habilitation services must be on the approved Plan of Care and should be
delivered as outlined in the OCDD Policy and Procedures manual.
Minimum Requirements for VDH:
1. Must utilize a virtual format that allows for face-to-face interaction;
2. Must utilize EVV to check in and out of VDH; and
3. Must utilize an approved activity log to track the days, times and activities that the
participant is utilizing VDH.
Place of Service
Community Life Engagement is delivered in the community and outside of the day habilitation
center.
Onsite Day Habilitation is not limited to a fixed-site building, as it can be furnished in a variety of
community settings, other than the person’s residence.
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Restrictions with Other Services
Beneficiaries receiving day habilitation/community life engagement services may also receive
prevocational or supported employment services, but these services cannot be provided during the
same time period and cannot be billed for more than 5 hours per day of combined day and
employment services.
Day habilitation/community life engagement services begin when the beneficiary arrives at the
site where the activity will take place, which could include the onsite building or if going straight
to an activity, when they arrive at the site where the activity will take place.
Staffing Ratios
Community Life Engagement activities may occur with the following staff ratios:
1. One staff to one beneficiary (1:1); or
2. One staff to two to four beneficiaries (1:2-4).
Onsite Day Habilitation activities may occur with one of the following staff ratios:
1. One staff to one beneficiary (1:1);
2. One staff to two to four beneficiaries (1:2-4); or
3. One staff to five to eight beneficiaries (1:5-8).
NOTE: If a beneficiary is already approved to receive 1:1 or 1:2-4 services for day habilitation,
those individuals may continue to receive that service ratio even when participating in onsite day
habilitation.
Transportation
All transportation costs are included in the reimbursement for day habilitation services. If a
beneficiary needs transportation, the provider must provide, arrange or pay for appropriate
transport to and from a central location convenient for the beneficiary and agreed upon by the
team. The need for transportation and the location must be documented on the ISP. Beneficiaries
must be present to receive this service. Under no circumstances shall a provider charge a
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beneficiary, their responsible representative(s), family members or other support team members a
separate transportation fee.
Service Limits
Day habilitation and community life engagement must be scheduled on the service plan for one or
more days per week and may be prior authorized for up to 4800 standard units of service in a POC
year. A standard unit of service is 15 minutes (¼ hour).
Provider Qualifications
Onsite day habilitation/community life engagement providers must meet the following
requirements:
1. Be licensed as an Adult Day Care provider by the LDH; and
2. Meet all requirements in the Standards for Participation for Medicaid Home and
Community-Based Waiver Services and other HCBS guidance as provided.
Prevocational Services
All Prevocational services are designed to create a path to integrated, individual, community
employment, in typical businesses, for which a beneficiary is compensated at or above 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 individuals without disabilities.
Good candidates for all prevocational services may include, but are not limited to, beneficiaries
who have never worked, beneficiaries who have only worked in ‘sheltered employment’,
beneficiaries who have worked as part of a group model, or beneficiaries who are unsure of what
career path they want to choose and need to explore further options.
This service is not a required pre-requisite for individual supported employment services and at
any time during this service, one may choose to leave this service to seek employment or
because they are no longer interested in working. The outcome of this service should be the
creation of an individual career profile that will provide valuable information for the next phase
of the career path.
This service should be delivered in practical situations in the community, including businesses,
job centers, and/or in conjunction with Louisiana Rehabilitation Services.
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Examples of career planning activities include, but are not limited, to the following:
1. Self-exploration activities that help the beneficiary become aware of their
interests, skills, and values that can help guide the career
exploration/development;
2. Vocational Assessments used to further develop the career goal;
3. Career exploration activities that help the beneficiary learn how to identify career
and life goals that are consistent with their interests, skills and values. It also
involves opportunities to learn about the skills and qualities required to be
successful in various career and the education and training needed to pursue the
career;
4. Volunteering in the community in the areas identified in career exploration
activities. This will help to further define a career;
5. Ongoing career counseling discussions with the beneficiary to help them answer
questions they may have or to assist them in any aspect of defining a career goal;
6. Benefits planning completed by a Certified Work Incentive Coordinator to assist
the beneficiary in answering any questions regarding Social Security benefits and
working;
7. Financial literacy intended to assist the beneficiary in gaining skills and
knowledge in the area of their personal finances which will help them in making
more cost-conscious decisions;
8. Assistive technology (AT) assessments as needed to enhance a beneficiaries’
employability;
9. Job shadowing work based learning which allows beneficiaries to ‘shadow’
someone who works in a particular area of interests for a short period of time to
gain a better understanding of what the duties are of a specific type of job;
10. Tours of businesses and meetings to learn about what businesses do and career
opportunities. This work-based learning allows beneficiaries to meet with
employers in specific businesses to find out more about a business that they may
be interested in working;
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11. Internship work-based learning which allows beneficiaries to secure internships
(either paid or unpaid) in a business in order to learn more in depth aspects of the
particular job they are interested in doing;
12. Apprenticeship work-based learning which allows beneficiaries to secure
apprenticeships that will help them develop skills in a particular area and further
define a career goal; and
13. Any other activities that may assist the beneficiary in increasing their knowledge
in areas that can assist the beneficiary in making decisions which leads to an
employment goal and career path.
Every beneficiary would benefit from volunteering in the community to gain valuable experience
that could be beneficial in the career path determination. Volunteering will provide a beneficiary,
especially someone who has never worked, an opportunity to gain insight into being a
responsible employee, provides them with valuable knowledge and experience which will allow
them to add skills to their resume’, as well as, help them to decide the type of job they desire.
Volunteer activities are to be provided under the guidelines of the United States Fair Labor
Standards Act of 1985 as amended.
All prevocational service activities are time limited to one year, with a targeted service for
beneficiaries who think they want to become employed in an individual job in the community
but may need additional information and experiences in order to determine such things as their
areas of interests for work, skills, strengths, and conditions needed for successful employment.
Assistance with personal care may be a component of all prevocational services, but may not
comprise the entirety of the service.
Under the service umbrella of ‘Prevocational’, there are two distinct services that may be delivered
during the same day in order to support the beneficiary in their career discovery path. The goal is
to support the beneficiary in creating a career profile that will further their goal of individual
employment. Beneficiaries should be involved in making choices and guiding the inclusion of
new activities in their job discovery process. Discussions should be on-going to ensure that the
individual is receiving the supports they need to do develop the profile to assist in going to work.
The two services available under Prevocational Services are described below.
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Community Career Planning
Community career planning is an individualized, person-centered, comprehensive service that
assists the beneficiary in establishing their path to obtain individual, competitive, integrated
employment in the community. The outcome of this service is to create an ‘Individual Career
Profile’ that can be utilized to create their employment plan. Community career planning
services may be provided in a variety of settings including home visits conducted as part of
individual discovery and getting to know the beneficiary in their day-to-day life.
Career planning services are intended to use the person-centered planning process to discover the
various interest, skills, and general information about each beneficiary that will assist in
developing a path to employment in the community. Based off the person-centered planning,
activities should be tailored for each beneficiary in preparing them for paid employment in the
community.
Community career planning services should be delivered in the community, in practical
situations, alongside people without disabilities who may be exploring their career path as well.
Services should be delivered in typical businesses and industries or in typical agencies that
provide career resources/training activities.
Onsite Prevocational
Onsite prevocational services, also referred to as ‘onsite career planning’ services, are intended
to support the beneficiary in developing general, non-job-task-specific strengths and skills that
contribute to employability in paid employment in integrated community settings.
Onsite prevocational services could consist of activities such as:
1. Making contact with businesses via phone or email that might have opportunities
for internships, mentoring programs, etc.;
2. Research via the internet for opportunities volunteer positions;
3. Preparing/planning for community exploration activities; and
4. Development of an ‘Individual Career Profile’ for each beneficiary.
Onsite career planning services should consider the community career planning services and
should work together to accomplish the goals set forth.
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Virtual delivery of onsite prevocational services in a 1:5-8 ratio may occur.
There is not a predetermined percentage of time that virtual delivery of services will occur as this
is an individual choice to participate in this delivery method or not. Virtual service delivery is an
option during times that does not allow the beneficiary to attend in person (i.e. medical
issues/surgery), an emergency, or when the beneficiary chooses to not attend in-person for
personal reasons. The beneficiary should be independent or have natural supports, as this service
cannot be billed at the same time as another service. The beneficiary must have the means
necessary to participate in the virtual service (i.e., laptop, tablet, etc.).
Virtual delivery is not the preferred method as beneficiaries are encouraged to participate in the
community through either onsite prevocational or community career planning services and are
offered these options as well. Virtual delivery will be included in the discussion with each
beneficiary by the support coordinator and the service provider and will only be included in the
plan of care if chosen by the beneficiary.
Prior to the beginning of virtual delivery the following in-person visits are required:
1. An initial assessment of beneficiary and home to determine if it’s feasible; and
2. HIPPA compliance training prior to beginning virtual delivery.
Providers will receive written instructions on the delivery of virtual services based on the HIPAA
compliance officer’s instructions.
When using virtual delivery, providers will follow these guidelines:
1. Confidentiality still applies for services delivered through virtual delivery. The
session must not be recorded without consent from the beneficiary or authorized
representative;
2. Develop a back-up plan (e.g., phone number where beneficiary can be reached) to
restart the session or to reschedule it, in the event of technical problems;
3. Develop a safety plan that includes at least one emergency contact and the closest
ER location, in the event of a crisis;
4. Verify beneficiary’s identity, if needed;
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5. Providers need the consent of the beneficiary and the beneficiary’s parent or legal
guardian (and their contact information) prior to initiating a
telemedicine/telehealth service with the beneficiary if the beneficiary is 18 years
old or under;
6. The beneficiary must be informed of all persons who are present and the role of
each person;
7. Beneficiaries may refuse services delivered through telehealth; and
8. It is important for the provider and the beneficiary to be in a quiet, private space
that is free of distractions during the session.
Providers will ensure that beneficiaries understand the guidelines for participation in a virtual
service delivery and HIPAA. Written instructions and guidelines will be provided to each
beneficiary.
Beneficiaries and natural supports will be instructed on the following:
1. Finding a space that allows for privacy while participating in the service;
2. Turning the camera off and mute the session if they leave to go to the bathroom or
leave the room while participating in the session, or if someone who is not part of
the group comes into the room; and
3. How to utilize the technology required to participate in the virtual delivery of day
habilitation, including how to utilize the specific format, signing in and out, etc.
The provider will also provide written instructions.
To ensure that virtual delivery of this service facilitates community integration, the provider
agency will continue to incorporate already established community partners into the virtual
delivery of the service. For instance, if the beneficiary typically attends a career exploration
class in the community with community participation occurring, the beneficiary will join via a
face-to-face format virtually and therefore still be included in the meeting. Providers will also
seek opportunities for beneficiaries to join community online groups in a face-to-face format and
seek out such activities as career preparation, mock interview sessions, etc. Through virtual
delivery of this service, beneficiaries can continue to interact with their friends and community
connections during the times when the beneficiary is not participating in person, but will allow
for the beneficiary to not miss out on opportunities for inclusion.
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If the beneficiary is able to be unsupported during this service, an existing protocol is in place for
the beneficiary if a health and safety issue arises during this virtual service. The provider agency
staff, who is conducting the virtual delivery of this service, will be able to support the beneficiary
through any health and safety situation that might arise during the virtual delivery of
prevocational services. If the beneficiary is participating in virtual services with the assistance of
natural supports, the natural supports will ensure the health and safety of the beneficiary.
All virtual delivery of onsite prevocational services must be on the approved Plan of Care.
Minimum Requirements for virtual delivery:
1. Must utilize a virtual format that allows for face-to-face interaction;
2. Must utilize EVV to check in and out of VDH; and
3. Must utilize an approved Activity Log to track the days, times and activities that
the participant is utilizing VDH.
Prevocational services is not a requirement to find individual employment, but rather a tool to
assist in the career path. If at any point the beneficiary has decided that individual employment is
not their end goal, the beneficiary should be referred to their support coordinator and be given the
option to choose other day and/or employment services.
The end goal of all prevocational services, is individual community employment. These services
are time limited to one year, with the ability to request additional time from the LGE if needed. At
the end of this service, the beneficiary should have developed an individual career profile and be
prepared to move into the next phase of the career path in finding employment.
Place of Service
All Community Career Planning/Onsite Prevocational services are provided in a variety of
locations in the community, integrated alongside individuals without disabilities. During onsite
prevocational services, the beneficiary can be at the provider facility.
Staffing Ratios
Community career planning may occur with one of the following staff ratios:
1. One staff to one beneficiary (1:1); or
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2. One staff to two to four beneficiaries (1:2-4).
Onsite Prevocational may occur in the following staff ratios:
1. One staff to one beneficiary (1:1);
2. One staff to two to four beneficiaries (1:2-4); or
3. One staff to five to eight beneficiaries (1:5-8).
NOTE: If a beneficiary is already approved to received 1:1 or 1:2-4 services for prevocational,
those individuals may continue to receive that service ratio even when participating in onsite
prevocational.
Transportation
All transportation costs are included in the reimbursement for prevocational/community career
planning services. Transportation needed by the beneficiary must be documented on the POC. The
beneficiary must be present to receive this service. If the beneficiary needs transportation, the
provider must physically provide, arrange, or pay for appropriate transport to and from a central
location convenient for the beneficiary and agreed upon by the team. This location shall be
documented in the service plan.
NOTE: Under no circumstances shall a provider charge a beneficiary, their responsible
representative(s), family members or other support team members a separate transportation fee.
Restrictions with Other Services
Beneficiaries receiving prevocational/community career planning services may also receive day
habilitation/community life engagement, individual supported employment or group employment
assessment services, however these services cannot be provided during the same time period and
the total of the services cannot equal more than five hours per day. Beneficiaries may receive group
supported employment follow-along services, however, these services cannot be on the same
service day.
There must be documentation in the beneficiary’s file that this service is not available from
programs funded under Section 110 of the Rehabilitation Act of 1973 or Sections 602 (16) or (17)
of the Individuals with Disabilities Education Act (23 U.S.C. 1401) (16 and 71) and those covered
under the State Plan, if applicable.
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Service Limits
Prevocational/community career planning services must be scheduled and documented on the
service plan for one or more days per week and may be prior authorized for up to 4800 standard
units of service in a POC year. A standard unit of service is 15 minutes (¼ hour).
Provider Qualifications
Providers of prevocational/community career planning services must meet the following
requirements:
1. Possess and maintain a certificate of completion of a 40 hour approved Supported
Employment certification program and provide documentation to the local LGE
office;
2. Complete 20 hours of employment related training every two years and provide
proof of completion to the local LGE office; and;
3. Meet all requirements in the Standards for Participation for Medicaid Home and
Community-Based Waiver Services and other HCBS guidance as provided.
OR
1. Be licensed as an Adult Day Care provider by the LDH;
At least one supervisor receives 20 hours of employment related training every two years
and provide proof of completion to the local LGE office; and
2. Meet all requirements in the Standards for Participation for Medicaid Home and
Community-Based Waiver Services and other HCBS guidance as provided.
Respite
Respite is a service provided on a short-term basis to a beneficiary unable to care for themselves
because of the absence of or need for relief of those unpaid caregivers/persons normally providing
care for the beneficiary. Services may be provided in the beneficiary’s home or private residence,
or in a licensed respite care facility determined appropriate by the beneficiary or responsible party.
Respite services may be preplanned on the POC; however, if a beneficiary anticipates needing
respite in the POC year, but does not know when this will occur, they and their responsible party
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should receive a Freedom of Choice (FOC) list of respite providers and interview these providers.
In this manner, the beneficiary and their responsible party(ies) and the provider chosen will be
familiar with each other. When a situation occurs during the POC year in which respite will be
needed, a revision to the POC will be done by the support coordinator and the beneficiary will be
able to access the service in a timely manner.
Restrictions with Other Services
Beneficiaries receiving respite may use this service in conjunction with other SW services as long
as services are not provided during the same period in a day.
Service Limits
The need for respite must be documented in the POC. Respite shall not exceed 428 standard units
of service in a plan year. A standard unit of service is 15 minutes (¼ hour).
Provider Qualifications
Respite service providers must meet the following requirements:
1. Be licensed as a respite care service provider; and/or
2. Be a licensed personal care attendant service provider by LDH; and
3. Meet all requirements in the Standards for Participation for Medicaid Home and
Community-Based Waiver Services and other HCBS guidance as provided.
Habilitation
Habilitation services are designed to assist beneficiaries in acquiring, retaining and improving the
self-help, socialization and adaptive skills necessary to reside successfully in home and/or in
community settings.
These services are educational in nature and focus on achieving a goal utilizing specific teaching
strategies. Goals may cover a wide range of opportunities including, but not limited to, learning
how to clean house, do laundry, wash dishes, grocery shop, bank, cook meals, shop for clothing
and personal items, become involved in community recreational and leisure activities, do personal
yard work, and utilize transportation to access community resources.
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Habilitation services include, but are not limited to, the following:
1. Participation in activities in the community to enhance their social skills;
2. Learning how to make choices about their day. For example, going to a restaurant,
making choices about what they want to order and learning to place their order;
3. Learning to use the bus system or other public transportation sources and learns
how to get about in their community including getting to their own individual job;
4. Participation in clubs or organizations which are related to their hobbies, sports or
other areas of interest, such as political or civic events and learns how to be a
contributing member of their community;
5. Assistance in learning how to maintain their home including, washing dishes,
laundry, vacuuming, mopping and other household tasks;
6. Acquiring skills needed to cook/prepare nutritional meals in their home;
7. Assistance in learning how to grocery shop in the community as well as other
community activities such as going to the bank, library and other places in the
community;
8. Assistance and prompting with personal hygiene, dressing, grooming, eating,
toileting, ambulation or transfers, other personal care and behavioral support needs,
and any medical task which can be delegated. However, personal care assistance
may not comprise the entirety of this service; and
9. Learning how to observe basic personal safety skills in the community.
Habilitation services may be provided at any time of day or night on any day of the week, as needed
by the beneficiary, to achieve a specified goal.
Beneficiaries in habilitation services are reasonably expected to independently achieve the goal(s)
identified on their service plan within measurable timelines, as evidenced by information from
their standardized assessment, personal outcome interviews, and information from their support
team members.
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Place of Service
Habilitation services are provided in the home or community with the beneficiary’s place of
residence as the primary setting, and include the necessary transportation.
Staffing Ratio
Habilitation services may only be provided on a one staff to one (1:1) beneficiary ratio.
Family members who provide habilitation services must meet the same standards as providers
who are unrelated to the beneficiary and must be employed by a provider agency. Service hours
shall be capped at 40 hours per week/per staff, Sunday to Saturday, for services delivered by
family members living in the home. Legally responsible individuals (such as a parent or spouse)
and legal guardians may provide habilitation services for a beneficiary.
Restrictions with Other Services
Beneficiaries receiving habilitation may use this service in conjunction with other Supports Waiver
services as long as services are not provided during the same time period in a day.
Travel training to places in the community, where the beneficiary’s life activities take place, is
considered a service; however, travel training to the beneficiary’s group supported employment,
day habilitation, or prevocational sites is not considered a habilitation service.
Authorization of Services
To receive PA when day habilitation and habilitation services are chosen in conjunction with one
another, the provider must submit specific educational strategies and timelines for each service
that will be used to achieve the goals and timelines as outlined on the POC. This documentation
must be submitted to the support coordinator within five working days after receiving the
completed POC. This process must occur regardless of whether the same provider is chosen by the
beneficiary for both services or different providers are chosen for each service.
Day habilitation ISP recreational goals, strategies and timelines should not be submitted. If the day
habilitation ISP contains only recreational goals, the habilitation portion of the ISP is the only
document that needs to be submitted to the support coordinator.
The support coordinator will:
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1. Facilitate development of a POC that specifies but does not duplicate the training,
supports and staff ratio, and timelines for Day Habilitation and Habilitation
services;
2. Cross reference the POC and the provider(s) ISP(s) to ensure that no duplication of
services will occur;
3. Approve prior authorization; and
4. Forward the approved provider(s)’ ISP(s) to the OCDD/WSS Regional Office the
same or next business day after completing the cross checks.
Service Limits
Habilitation shall not exceed 285 standard units of service in a plan year. A standard unit of service
is 15 minutes (¼ hour).
Provider Qualifications
Providers of Habilitation services shall meet all requirements in the Standards for Participation
for Medicaid Home and Community-Based Waiver Services and one of the following two
requirements:
1. Be licensed as a respite care service provider and/or a personal care attendant
service provider by the LDH;
OR
2. Be a licensed occupational therapist in the State of Louisiana, or a licensed physical
therapist in the State of Louisiana or certified through the National Council for
Therapeutic Recreation as a therapeutic recreational specialist, and be an employee
of an agency holding a personal care attendant and/or adult day care license through
the LDH Health Standards Section.
Housing Stabilization Transition Services
Housing stabilization transition services enable beneficiaries who are transitioning into a
permanent supportive housing (PSH) unit, including those transitioning from institutions to secure
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their own housing. The service is provided while the beneficiary is in an institution and preparing
to exit the institution using the waiver. The service includes the following components:
1. Conducting a housing assessment that identifies the beneficiary’s preferences
related to housing (type and location of housing, living alone or living with
someone else, accommodations needed, and other important preferences), and
identifying the beneficiary’s needs for support to maintain housing including:
a. Access to housing;
b. Meeting the terms of a lease;
c. Eviction prevention;
d. Budgeting for housing/living expenses;
e. Obtaining/accessing sources of income necessary for rent;
f. Home management;
g. Establishing credit; and
h. Understanding and meeting the obligations of tenancy as defined in the lease
terms.
2. Assisting the beneficiary with viewing and securing housing as needed. This may
include:
a. Arranging or providing transportation;
b. Assisting in securing supporting documentation/records;
c. Assisting with completing/submitting applications;
d. Assisting in securing deposits; and
e. Assisting with locating furnishings.
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3. Developing an individualized housing support plan based upon the housing
assessment that:
a. Includes short and long term measurable goals for each issue;
b. Establishes the beneficiary’s approach to meeting the goal; and
c. Identifies where other provider(s) or services may be required to meet the
goal.
4. Participating in the development of the POC and incorporating elements of the
housing support plan; and
5. Exploring alternatives to housing if PSH is unavailable to support completion of
transition.
Standards
Housing stabilization transition services may be provided by PSH agencies that are enrolled in
Medicaid to provide this service, comply with LDH rules and regulations, and are listed as a
provider of choice on the FOC form.
Service Exclusions
No more than 165 units of combined housing stabilization transition services and housing
stabilization services (see definition) may be used per POC year without written approval from the
OCDD state office.
Service Limitations
This service is only available upon referral from the support coordinator and is not duplicative of
other waiver services, including support coordination. This service is only available to persons
who are residing in, or who are linked for, the selection process of a State of Louisiana PSH unit.
No more than 72 units of housing stabilization services may be used per POC year without
approval from the OCDD state office. A standard unit of service is equal to 15 minutes (1/4 hour).
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Reimbursement
Payment will not be authorized until the LGE gives final POC approval.
The OCDD state office reviews and ensures that all requirements are met. If all requirements are
met, the POC is approved and the payment is authorized. The PSH provider is notified of the
release of the PA and can bill the Medicaid fiscal intermediary for services provided.
Housing stabilization transition services will be reimbursed at a prospective flat rate for each
approved unit of service provided to the beneficiary.
Housing Stabilization Services
Housing stabilization services enable waiver beneficiaries to maintain their own housing as set
forth in the beneficiary’s approved POC. Services must be provided in the home or a community
setting. This service includes the following components:
1. Conducting a housing assessment that identifies the beneficiary’s preferences
related to housing (type and location of housing, living alone or with someone else,
accommodations needed, and other supportive preferences), and identifying the
beneficiary’s needs for support to maintain housing, including:
a. Access to housing;
b. Meeting the terms of a lease;
c. Eviction prevention;
d. Budgeting for housing/living expenses;
e. Obtaining/accessing sources of income necessary for rent;
f. Home management;
g. Establishing credit; and
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h. Understanding and meeting the obligations of tenancy as defined in the
lease terms.
2. Participating in the development of the Plan of Care, incorporating elements of the
housing support plan;
3. Developing an individualized housing stabilization service provider plan based
upon each assessment that:
a. Includes short and long-term measurable goals for each issue;
b. Establishes the beneficiary’s approach to meeting the goal; and
c. Identifies where other provider(s) or service may be required to meet the
goal.
4. Providing supports and interventions according to the individualized housing
support plan. If additional supports or services are identified as needed outside the
scope of housing stabilization service, the needs must be communicated to the
support coordinator;
5. Updating the housing support plan annually or as needed due to changes in the
beneficiary’s situation or status; and
6. Providing ongoing communication with the landlord or property manager
regarding:
a. The beneficiary’s disability;
b. Accommodations needed; and
c. Components of emergency procedures involving the landlord or property
manager.
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If at any time the beneficiary’s housing is placed at risk (eviction, loss of roommate or income),
housing stabilization services will provide supports to retain housing or locate and secure housing
to continue community-based supports, including locating new housing, sources of income, etc.
Standards
Housing stabilization services may be provided by PSH agencies that are enrolled in Medicaid to
provide this service, comply with LDH rules and regulations, and are listed as a provider of choice
on the FOC form.
Service Exclusions
No more than 165 units of combined housing stabilization transition or housing stabilization
services (see definition) can be used per POC year without written approval from the OCDD state
office.
Service Limitations
This service is only available upon referral from the support coordinator. This service is not
duplicative of the other waiver services including support coordination. This service is only
available to persons who are residing in a state of Louisiana PSH unit.
No more than 93 units of housing stabilization services can be used per year without written
approval from the support coordinator. A standard unit of service is equal to 15 minutes (1/4 hour).
Reimbursement
Payments will not be authorized until the OCDD state office gives final POC approval.
OCDD state office reviews all documents to ensure all requirements are met. If all requirements
are met, the LGE approves the POC and authorizes the payment.
The PSH provider is notified of the release of the PA and can bill the Medicaid fiscal intermediary
for services provided.
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Housing stabilization services will be reimbursed at a prospective flat rate for each approved unit
of service provided to the beneficiary.
Personal Emergency Response Systems
A Personal Emergency Response System (PERS) is a rented electronic device that enables
beneficiaries to secure help in an emergency.
The beneficiary may wear a portable "help" button to allow for mobility. The PERS is connected
to the beneficiary’s phone and programmed to signal a response center once the "help" button is
activated. The response center is staffed by trained professionals.
Service Limits
Coverage of the PERS is limited to the rental of the electronic device. The monthly rental fee,
regardless of the number of units in the household, must include the cost of maintenance and
training the beneficiary on how to use the equipment.
Reimbursement will be made for a one-time installation fee for the PERS unit.
Agency Provider Type
Providers must be enrolled as a Medicaid Home and Community-Based Services Waiver service
provider of Personal Emergency Response Systems (PERS). The provider shall install and support
PERS equipment in compliance with all applicable federal, state, parish and local laws, and meet
manufacturer’s specifications, response requirements, maintenance records, and beneficiary
education requirements.
Support Coordination
Support coordination is a service that will assist beneficiaries in gaining access to all of their
needed support services, including medical, social, educational, employment and other services,
regardless of the funding source for the services.
At a minimum, Support Coordinators (SCs) are required to make the following contacts with each
beneficiary:
1. Monthly telephone phone calls; and
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2. Quarterly face-to-face visits.
At a minimum, all initial and annual plan of care meetings and one additional visit must be
delivered face-to-face in the beneficiary’s home during each plan of care year. If a beneficiary
participates in day service and/or employment service, the SC should observe the beneficiary in
the environment during one of the quarterly face-to-face visits. The two additional required face-
to-face visits may be delivered virtually if agreed upon by the beneficiary and/or legal guardian
and all of the requirements necessary for virtual visits are met.
Support Coordination activities include, but are not limited to, the following:
1. Convening and facilitating the person-centered planning team meetings, that are
run by the beneficiary and consists of whomever the beneficiary chooses to invite,
but could include: the beneficiary, beneficiary’s family, direct service providers,
medical and social work professionals, as necessary, and advocates, who assist in
determining the appropriate supports and strategies needed in order to meet the
beneficiary’s needs and preferences;
2. Offering Freedom of Choice of providers that include non-disability specific
settings;
3. Ongoing coordination and monitoring of supports and services included in the
beneficiary’s approved POC;
4. Ongoing discussions with the beneficiary about employment including identifying
barriers to employment and working to overcome those barriers, connecting the
beneficiary to certified work incentive coordinators (CWIC) to do benefits
planning, referring the beneficiary to Louisiana Rehabilitation Services (LRS) and
following the case through closure with LRS, and other activities of the
employment process as identified. This includes the quarterly completion of and
data input using the Path to Employment form;
5. Building and implementing the supports and services as described in the POC;
6. Assisting the beneficiary to use the findings of formal and informal assessments to
develop and implement support strategies to achieve the personal outcomes defined
and prioritized by the beneficiary in the POC;
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7. Providing information to the beneficiary on potential community resources,
including formal resources and informal/natural resources, which may be useful in
developing strategies to support the beneficiary in attaining their desired personal
outcomes;
8. Assisting with problem solving with the beneficiary, supports, and services
providers;
9. Assisting the beneficiary to initiate, develop and maintain informal and natural
support networks and to obtain the services identified in the POC assuring that they
meet their individual needs;
10. Advocacy on behalf of the beneficiary to assist them in obtaining benefits, supports
or services (i.e., to help establish, expand, maintain and strengthen the beneficiary’s
information and natural support networks). This may involve calling and/or visiting
beneficiaries, community groups, organizations, or agencies with or on behalf of
the beneficiary;
11. Training and supporting the beneficiary in self-advocacy (i.e., the selection of
providers and utilization of community resources to achieve and maintain their
desired outcomes);
12. Oversight of the service providers to ensure that their beneficiary receives
appropriate services and outcomes as designated in the POC;
13. Assisting the beneficiary to overcome obstacles, recognize potential opportunities
and developing creative opportunities;
14. Meeting with the beneficiary in face-to-face meetings as well as phone contact as
specified. This includes meeting them where the services take place;
15. Reporting and documenting any incidents/complaints/abuse/neglect according to
the OCDD policy;
16. Arranging any necessary professional/clinical evaluations needed and ensure
beneficiary choice;
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17. Identifying, gathering and reviewing the array of formal assessments and other
documents that are relevant to the beneficiary’s needs, interests, strengths,
preferences and desired personal outcomes;
18. Preparing the annual social summary; and
19. Developing an action plan in conjunction with the beneficiary to monitor and
evaluate strategies to ensure continued progress toward the beneficiary’s personal
outcomes.
NOTE: Advocacy is assuring that the beneficiary receives appropriate supports and services of
high quality and locating additional services not readily available in the community.
Service Limits
Support Coordination shall not exceed 12 units in a POC year. A standard unit of service for
support coordination is one (1) month.
Provider Qualifications
Support coordination providers must meet the following requirements:
1. Be licensed as a support coordination provider; and
2. Meet all requirements in the Standards for Participation for Medicaid Home and
Community-Based Waiver Services and other HCBS guidance as provided.
NOTE: See SW Section 43.8, Support Coordination, for additional guidance.
Expanded Dental Services for Adult Waiver Beneficiaries
Please refer to the Dental Benefit Program Manager Manual:
https://ldh.la.gov/assets/medicaid/DBPMP/DBPM_Manual_2022-04-01.pdf
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PROGRAM MONITORING
Services offered through Supports Waiver are closely monitored to assure compliance with
Medicaid’s policy as well as applicable state and federal regulations.
Health Standards Section (HSS) staff or its designee conducts on-site reviews of the Home and
Community-Based Waiver (HCBS) provider agencies who are licensed through this agency.
These reviews are conducted to monitor the provider agency’s compliance with Medicaid’s
provider enrollment participation requirements, continued capacity for service delivery, quality
and appropriateness of service provision to the waiver group, and the presence of the personal
outcomes defined and prioritized by the individuals served.
HSS reviews include a review of administrative records, personnel records, and a sample of
beneficiary records. In addition, provider agencies are monitored with respect to the following:
1. Beneficiary’s access to needed services identified in the service plan;
2. Quality of assessment and service planning;
3. Appropriateness of services provided including content, intensity, frequency and
beneficiary input and satisfaction;
4. The presence of the personal outcomes as defined and prioritized by the beneficiary
and/or responsible representative; and
5. Internal quality improvement.
A provider’s failure to follow State licensing standards and Medicaid policies and practices could
result in the provider’s removal from Medicaid participation, federal investigation, and prosecution
in suspected cases of fraud.
On-Site Reviews
On-site reviews with the provider agency are unannounced and conducted by HSS staff to:
1. Ensure compliance with program requirements; and
2. Services provided are appropriate to meet the needs of the beneficiaries served.
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Administrative Review
The Administrative Review includes the following:
1. A review of administrative records;
2. A review of other provider agency documentation; and
3. Provider agency staff interviews, as well as interviews with a sampling of
beneficiaries, to determine continued compliance with provider participation
requirements.
Failure to respond promptly and appropriately to the HSS monitoring questions or findings may
result in sanctions, liquidated damages, and/or recoupment of payment.
Interviews
As part of the on-site review, the HSS staff will interview:
1. A representative sample of the individuals served by each provider agency
employee;
2. Members of the beneficiary’s circle or network of support, which may include
family and friends;
3. Service providers; and
4. Other members of the beneficiary’s community. This may include support
coordinators, support coordinator supervisors, other employees of the support
coordination agency, and direct service providers and other employees of the direct
service provider agency.
This interview process is to assess the overall satisfaction of beneficiaries regarding the provider
agency’s performance, and to determine the presence of the personal outcomes defined and
prioritized by the beneficiary/guardian.
Personnel Record Review
The Personnel Record Review includes the following:
1. A review of personnel files;
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2. A review of Electronic Visit Verification (EVV) record/time sheets; and
3. A review of the current organizational chart.
Beneficiary Record Review
A representative sample of beneficiary records are reviewed to ensure the services and supports
delivered to beneficiaries are rendered according to the beneficiary’s approved Plan of Care
(POC). The case record must indicate how these activities are designed to lead to the desired
personal outcomes, or how these activities are associated with organizational processes leading to
the desired personal outcomes of the beneficiaries served.
Beneficiary records are reviewed to ensure that the activities of the provider agency are correlated
with the appropriate services of intake, ongoing assessment, planning (development of the POC),
transition/closure, and that these activities are effective in assisting the beneficiary to attain or
maintain the desired personal outcomes.
Documentation is reviewed to ensure that the services reimbursed were:
1. Identified in the POC;
2. Provided;
3. Documented properly;
4. Appropriate in terms of frequency and intensity; and
5. Relate back to personal outcomes on the POC.
Provider Staff Interviews
Provider agency staff is interviewed as part of the on-site review to ensure that staff meets the
following qualifications:
1. Education;
2. Experience;
3. Skills;
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4. Knowledge;
5. Employment status;
6. Hours worked;
7. Staff coverage;
8. Supervisor to staff ratio;
9. Caseload/beneficiary assignments;
10. Supervision documentation; and
11. Other applicable requirements.
Monitoring Report
Upon completion of the on-site review, the HSS staff discusses the preliminary findings of the
review in an exit interview with appropriate provider staff. The HSS staff compiles and analyzes
all data collected in the review, and a written report summarizing the monitoring findings and
recommended corrective action is sent to the provider agency.
The monitoring report includes the following:
1. Identifying information; and
2. A statement of compliance with all applicable regulations; or
3. Deficiencies requiring corrective action by the provider.
The HSS program managers will review the reports and assess any sanctions as appropriate.
Corrective Action Report
The provider is required to submit a plan of correction to HSS within 10 working days of receipt
of the report.
The plan must address how each cited deficiency has been corrected and how recurrences will be
prevented. The provider is afforded an opportunity to discuss or challenge the HSS monitoring
findings.
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Upon receipt of the written plan of correction, HSS program managers review the provider’s plan
to assure that all findings of deficiency have been adequately addressed. If all deficiencies have
not been addressed, the HSS program manager responds to the provider requesting immediate
resolution of those deficiencies in question.
A follow-up monitoring survey will be conducted, when deficiencies have been found, to ensure
that the provider has fully implemented the Plan of Correction. Follow-up surveys may be
conducted on-site or via evidence review.
Informal Dispute Resolution (Optional)
In the course of monitoring duties, an informal hearing process may be requested. The provider
is notified of the right to an informal hearing in correspondence that details the cited deficiencies.
The informal hearing is optional on the part of the provider and in no way limits the right of the
provider to a formal appeal hearing. In order to request the informal hearing, the provider should
contact the program manager at HSS. (See Appendix C for contact information).
This request must be made within the time limit given for the corrective action recommended by
the HSS.
The provider is notified of the time and place of the informal hearing. The provider should bring
all supporting documentation that is to be submitted for consideration. Every effort will be made
to schedule a hearing at the convenience of the provider.
The HSS program manager convenes the informal hearing and providers are given the opportunity
to present their case and to explain their disagreement with the monitoring findings. The provider
representatives are advised of the date to expect a written response and are reminded of their right
to a formal appeal.
There is no appeal of the informal hearing decision; however, the provider may appeal the original
findings to the Louisiana Department of Health (LDH) Bureau of Appeals.
Fraud and Abuse
When HSS staff detects patterns of abusive or fraudulent Medicaid billing, the provider will be
referred to the Program Integrity Section of the Medicaid program for investigation and sanctions,
if necessary. Investigations and sanctions may also be initiated from reviews conducted by the
Surveillance and Utilization Review System (SURS) of the Medicaid Program. LDH has an
agreement with the Office of the Attorney General to investigate Medicaid fraud. The Office of
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the Inspector General, Federal Bureau of Investigation (FBI), and postal inspectors also conduct
investigations of Medicaid fraud.
Quality Management
Direct service providers and support coordination agencies must have a quality enhancement
process that involves the following:
1. Learning;
2. Responding;
3. Implementing; and
4. Evaluating.
Agency quality enhancement activities must be reviewed and approved by the Local Governing
Entity (LGE), as described in the Quality Enhancement Provider Handbook. (See Appendix D for
information on this handbook).
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INCIDENTS, ACCIDENTS AND COMPLAINTS
The support coordination agency and direct service provider are responsible for ensuring the health
and safety of the beneficiary. Support coordination and direct service staff must report all
incidents, accidents, or suspected cases of abuse, neglect, exploitation or extortion to the on-duty
supervisor immediately and as mandated by law to the appropriate agency. Reporting an incident
only to a supervisor does not satisfy the legal requirement to report. The supervisor is responsible
for ensuring that a report or referral is made to the appropriate agency.
All suspected cases of abuse (physical, mental, and/or sexual), neglect, exploitation or extortion
must be reported to the appropriate authorities. (See Appendix C for contact information).
If the beneficiary needs emergency assistance, the worker must call 911 or the local law
enforcement agency.
Any other circumstances that place the beneficiary’s health and well-being at risk should also be
reported.
Support coordination agencies and direct service providers are responsible for documenting and
maintaining records of all incidents and accidents involving the beneficiary. The Office for
Citizens with Developmental Disabilities (OCDD)’ Critical Incident Reporting, Tracking and
Follow-up Activities for Waiver Services procedures must be followed for all reporting, tracking
and follow-up activities of all critical incidents. Non-compliance shall result in administrative
actions as indicated in this document. (See Appendix D for information on where to obtain a copy
of this document).
Internal Complaint Policy
Beneficiaries must be able to file a complaint regarding their services without fear of reprisal. The
provider must have a written policy to handle beneficiary complaints. In order to ensure that the
complaints are efficiently handled, the provider must comply with the following procedures:
1. Each provider must designate an employee to act as a complaint coordinator to investigate
complaints. The complaint coordinator must maintain a log of all complaints received. The
complaint log must include:
a. The date the complaint was made;
b. Name and telephone number of the complainant; and
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c. Nature of the complaint and resolution of the complaint;
2. If the complaint is verbal, the provider staff member receiving the complaint must obtain
and send all pertinent information in writing to the provider complaint coordinator. If the
beneficiary completes the complaint form, they will be responsible for sending the form to
the provider complaint coordinator;
3. The complaint coordinator must send a letter to the complainant acknowledging receipt of
the complaint within five working days;
4. The complaint coordinator must thoroughly investigate each complaint. The investigation
includes, but is not limited to, gathering pertinent facts from the beneficiary, the personal
representative, the worker, and other interested parties. These contacts may be either in
person or by telephone. The provider is encouraged to use all available resources to resolve
the complaint at this level and must include the on-site program manager. For issues
involving medical or quality of care issues, the on-site program manager must sign the
resolution;
5. The provider’s administrator or designee must inform the beneficiary and/or the authorized
representative in writing within 10 working days of receipt of the complaint, the results
of the internal investigation; and
6. If the beneficiary is dissatisfied with the results of the internal investigation regarding the
complaint, they may continue the complaint resolution process by contacting the
appropriate local governing entity (LGE) in writing, or by telephone.
If the complainant’s name and address are known, the OCDD will notify the complainant within
two working days that the complaint has been received and action on the complaint is being taken.
Complaint Disclosure Statement
La. R.S. 40:2009.13 - .21 sets standards for identifying complainants during investigations in
nursing homes. The Bureau is mandated to use these standards for use within the Home and
Community-Based Services waiver programs. When the substance of the complaint is furnished
to the service provider, it must not identify the complainant or the beneficiary unless they consent
in writing to the disclosure. If the disclosure is considered essential to the investigation or if the
investigation results in judicial proceeding, the complainant must be given the opportunity to
withdraw the complaint.
The OCDD may determine when the complaint is initiated that a disclosure statement is necessary.
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If a Complainant Disclosure Statement is necessary, the complainant must be contacted and given
an opportunity to withdraw the complaint.
If the complainant still elects to file the complaint, the OCDD will mail or fax the disclosure form
to the complainant with instructions to return it to Central Office.
Definition of Related Terms Regarding Incidents and Complaints
The following definitions are used in the incident and complaint process:
1. Complaint - an allegation that an event has occurred or is occurring and has the
potential for causing more than minimal harm to a consumer or consumers. (La.
R.S. 40:2009.14);
2. Minimal harm - is an incident that causes no serious temporary or permanent
physical or emotional damage and does not materially interfere with the consumer’s
activities of daily living. (La. R.S. 40:2009.14);
3. Trivial report - is an account of an allegation that an incident has occurred to a
beneficiary or beneficiaries that causes no physical or emotional harm and has no
potential for causing harm to the beneficiary or beneficiaries. (La. R.S.
40:2009.14);
4. Allegation of noncompliance - is an accusation that an event has occurred or is
occurring that has the potential for causing no more than minimal harm to a
consumer or consumers. (La. R.S. 40:2009.14);
5. Abuse - is the infliction of physical or mental injury on an adult by other parties,
including, but not limited to, such means as sexual abuse, abandonment, isolation,
exploitation, or extortion of funds, or other things of value, to such an extent that
his health, self-determination, or emotional wellbeing is endangered. (La. R.S.
15:1503);
6. Exploitation - is the illegal or improper use or management of an aged person’s or
disabled adult’s funds, assets or property, or the use of an aged persons or disabled
adult’s power of attorney or guardianship for one’s own profit or advantage. (La.
R.S. 14:403.2);
7. Extortion - is the acquisition of a thing of value from an unwilling or reluctant
adult by physical force, intimidation, or abuse of legal or official authority. (La.
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R.S. 15:1503);
8. Neglect - is the failure, by a caregiver responsible for an adult’s care or by other
parties, to provide the proper or necessary support or medical, surgical, or any other
care necessary for his well-being. No adult who is being provided treatment in
accordance with a recognized religious method of healing in lieu of medical
treatment shall for that reason alone be considered to be neglected or abused. (La.
R.S. 15:1503);
9. Self-neglect - is the failure, either by the adult’s action or inaction, to provide the
proper or necessary support or medical, surgical, or any other care necessary for his
own well-being. No adult who is being provided treatment in accordance with a
recognized religious method of healing in lieu of medical treatment shall for that
reason alone be considered to be self-neglected. (La. R.S. 15:1503);
10. Sexual abuse - is any sexual activity between a beneficiary and staff without regard
to consent or injury; any non-consensual sexual activity between a beneficiary and
another person; or any sexual activity between a beneficiary and another
beneficiary or any other person when the beneficiary is not competent to give
consent. Sexual activity includes, but is not limited to kissing, hugging, stroking,
or fondling with sexual intent; oral sex or sexual intercourse; insertion of objects
with sexual intent; request, suggestion, or encouragement by another person for the
beneficiary to perform sex with any other person when beneficiary is not competent
to refuse;
11. Disabled person - is a person with a mental, physical, or developmental disability
that substantially impairs the person’s ability to provide adequately for their own
care or protection; and
12. Incident - any situation involving a beneficiary that is classified in one of the
categories listed in this section, or any category of event or occurrence defined by
OCDD as a critical event, and has the potential to impact the beneficiary or affect
delivery of waiver services.
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PROVIDER REQUIREMENTS
All home and community-based services (HCBS) delivered through a 1915(c) waiver must be
provided in accordance with the following qualities:
1. Integrated in and supports access to the greater community;
2. Provide opportunities to seek employment and work in competitive and integrated
settings, engage in community life and control personal resources;
3. Ensures that the individual receives services in the community to the same degree
of access as individuals not receiving Medicaid HCBS services;
4. Allow for a setting selected by the individual from among setting options, including
non-disability specific settings and an option for a private unit in a residential
setting;
5. Ensure an individual’s rights of privacy, dignity, respect, and freedom from
coercion and restraint;
6. Optimize individual initiative, autonomy and independence in making life choices;
and
7. Facilitate individual choice regarding services and supports and who may provide
said services and supports.
In addition to the above qualities, residential provider-owned/controlled settings must have the
following qualities:
1. The specific unit/dwelling must be owned, rented, or occupied under a legally
enforceable agreement/lease;
2. Same responsibilities/protections from eviction as all tenants under landlord tenant
law of state, parish, city or other designated entity;
3. If tenant laws do not apply, state ensures lease, residency agreement or other written
agreement is in place providing protections to address eviction processes and
appeals comparable to those provided under the jurisdiction’s landlord tenant law;
4. Each individual has privacy in their sleeping or living unit;
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5. Units have lockable entrance doors, with the individual and appropriate staff
members having keys to doors as needed;
6. Individuals who are sharing units have a choice of roommates;
7. Individuals have the freedom to furnish and decorate their sleeping or living units
within the limits imposed by the lease or other agreement;
8. Individuals have the freedom and support to control their schedules and activities
and have access to food at any time;
9. Individuals may have visitors at any time; and
10. The setting is physically accessible to the individual.
Provider participation in the Louisiana Medicaid program is voluntary. In order to participate in
the Medicaid program, a provider must:
1. Meet all of the requirements for licensure as established by applicable state laws
and rules promulgated by the Louisiana Department of Health (LDH);
2. Agree to abide by all applicable rules and regulations established by the Centers for
Medicare and Medicaid Services (CMS), LDH, and other state agencies; and
3. Comply with all the terms and conditions for Medicaid enrollment.
Providers must attend all mandated meetings and training sessions as directed by the Office for
Citizens with Developmental Disabilities (OCDD) or the local governing entity (LGE) as a
condition of enrollment and continued participation as a waiver provider. A provider enrollment
packet must be completed for each LDH administrative region in which the agency will provide
services. Providers will not be added to the Freedom of Choice (FOC) list of available providers
until they have completed the home and community-based services (HCBS) training related to
compliance with Louisiana Administrative Code (LAC) Title XXI Chapter 9. Provider
Requirements for participation in the waiver programs mandate that the provider has been issued
a Medicaid provider number.
Providers must participate in the initial trainings for prior authorization and data collection, as well
as any training provided on changes in the system. Initial training is provided at no cost to the
agency. Any repeat training must be paid for by the requesting agency.
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Providers must have available computer equipment, software, and internet connectivity necessary
to participate in trainings, prior authorization (PA), data collection, and electronic visit verification
(EVV).
It is the provider’s responsibility to ensure that the use of contractors, including the use of
independent contractors, complies with all state and federal laws, rules and/or regulations,
including those regarding LAC Title XXI Chapter 9. Provider Requirements and those enforced
by the United States Department of Labor.
All residential providers must maintain a toll-free telephone line with 24-hour accessibility
manned by either a staff member or an answering service. This toll-free number must be given to
beneficiaries at either intake or the first meeting.
Brochures providing information on the agency’s experience must include the agency’s toll-free
number along with the OCDD’s toll-free information number. OCDD must approve all brochures
prior to use.
Providers must develop a Quality Improvement and Self-Assessment Plan. This is a document
completed by the provider describing the procedures that are used, and the evidence that is
presented, to demonstrate compliance with program requirements. The first self-assessment is due
six (6) months after approval of the Quality Improvement Plan (QIP), and annually thereafter.
The QIP must be submitted for approval within sixty (60) days after the training is provided by
LDH.
Providers must be certified for a period of one (1) year. Re-certification must be completed no
less than sixty (60) days prior to the expiration of the certification period.
The agency must not be excluded from participation in Louisiana Medicaid as an entity as
evidenced by an open exclusion on the Louisiana State Adverse Actions database, the Office of
Inspector General’s (OIG) national exclusions database, or the federal System for Award
Management (SAM) database. The agency also must not have an outstanding Medicaid program
audit exception or other unresolved financial liability owed to the state.
Changes in the following areas are to be reported in writing to the LDH, Health Standards Section
(HSS), to OCDD, and to the fiscal intermediary’s Provider Enrollment Section in at least ten (10)
days prior to any change:
1. Ownership;
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2. Physical location;
3. Mailing address;
4. Telephone number; and/or
5. Account information affecting electronic funds transfer (EFT).
The provider must complete a new provider enrollment packet when a change in ownership of five
percent (5%) to fifty percent (50%) of the controlling interest occurs, but the provider may continue
serving beneficiaries. When fifty-one percent (51%) or more of the controlling interest is
transferred, a complete re-certification process must occur, and the agency shall not continue
serving beneficiaries until the re-certification process is complete. Beneficiaries should be offered
a new freedom of choice when this occurs.
Waiver services are to be provided only to persons who are waiver beneficiaries and in strict
accordance with the provisions of the approved plan of care (POC) and home and community
based services (HCBS) guidance.
Providers may not refuse to serve any waiver beneficiary that chooses their agency unless there is
documentation to support an inability to meet the individual’s health, safety, and welfare needs, or
all previous efforts to provide services and supports have failed and there remains no option but to
refuse services. Such refusal to serve an individual must be made in writing by the provider and
include a detailed explanation as to why the provider is unable to serve the individual. Written
notification must be submitted to the LGE. Providers who contract with other entities to provide
waiver services must maintain copies of such contracts signed by both agencies. Such contracts
must state that the subcontractor may not refuse to serve any waiver beneficiary referred to it by
the enrolled direct service provider agency.
The beneficiary’s provider and support coordination agency (SCA) must have a written working
agreement that includes the following:
1. Written notification of the time frames for POC planning meetings;
2. Timely notification of meeting dates and times to allow for provider participation,
which includes all providers who are providing a service on the POC;
3. Information on how the agency is notified when there is a POC or service delivery
change; and
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4. Assurance that the appropriate provider representative is present at planning
meetings as invited by the beneficiary.
The Supports Waiver (SW) services outlined below may be provided by the provider or by an
agreement with other contracted agents. The actual provider of the service, whether it is the
provider or a subcontracted agent, must meet the following licensure or other qualifications:
Waiver Service Requirements Service Provided by
Support Coordination
Case Management License
Providers of support coordination for the SW program
must have a signed performance agreement with OCDD
to provide services to waiver beneficiaries.
SCAs must meet all of the performance agreement
requirements in addition to any additional criteria
outlined in the Case Management Services manual
chapter, LAC Title XXI, and the SW Provider Manual.
Provider Type 45
Case Management
Center-Based Respite
HCBS Provider License
Respite Care Module for a facility
Provider Type 83:
Respite
In-Home Respite N/A
Provider Type 82:
Attendant Care Services
Personal Emergency
Response Systems
Must meet all applicable vendor requirements, federal,
state, parish and local laws for installation.
Provider Type 16:
Personal Emergency
Response Systems
Habilitation HCBS Provider License
Provider Type 82, 98, 14
or 13:
Dental
Current and valid Louisiana license to practice in the
field of expertise/specialty
Provider 27:
Dental-Individual or
Group
Individual Supported
Employment
Employment Specialist has a certification from an
approved vendor in a 40 hour supported employment
program with 20 hours of employment related training
every two years
Provider Type 98:
Individual Supported
Employment
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Waiver Service Requirements Service Provided by
Group Supported
Employment
Employment specialist has a certification from an
approved vendor in a 40 hour supported employment
program with 20 hours of employment related training
every two years
OR
HCBS Provider license with Adult Day Care (ADC)
Module and Employment specialist has a certification
from an approved vendor in a 40 hour supported
employment program with 20 hours of employment
related training every two years
Provider Type 98:
Group Supported
Employment
Onsite Prevocational
Services/Community
Career Planning
HCBS Provider License
(ADC Module)
Provider Type 13:
Prevocational
Habilitation
Onsite Day
Habilitation/Community
Life Engagement
HCBS Provider License
(ADC Module)
Provider Type 14:
Adult Day Habilitation
When required by state law, the person performing the service, must meet all applicable
requirements for professional licensure.
Provider Responsibilities for All Providers
All providers of SW services are responsible for the following:
1. Ensuring an appropriate representative from the agency attends the POC planning
meeting and is an active participant in the team meeting;
NOTE: An appropriate representative is considered to be someone who has
knowledge and authority to make decisions about the beneficiary’s service
delivery. This person may be a program manager, a direct services professional,
case supervisor, or the executive director or designee. An unlicensed direct service
worker who works with or will work with the beneficiary is not considered an
appropriate representative for the POC planning meeting.
2. Communicating and working with support coordinators and other support team
members to achieve the beneficiary’s personal outcomes;
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3. Ensuring the provider plan of care documents/attachments are updated and kept
current as changes occur, including the beneficiary’s emergency contact
information and list of current medications;
4. Informing the support coordinator by telephone or e-mail as soon as the agency
recognizes that any goals, objectives or timelines in the POC will not meet the
beneficiary’s needs, and such information must be provided no later than ten (10)
days prior to the expiration of any timelines in the service plan that cannot be met;
5. An update to the provider’s document should only occur as a result of a documented
meeting with the beneficiary or authorized representative where the reason for
change is indicated and all parties sign the meeting attendance record;
6. Ensuring the provider agency support team member(s) sign and date any revisions
to the service plan indicating agreement with the changes to the goals, objectives,
or timelines;
7. Providing the support coordination agency or LDH representatives with requested
written documentation, including, but not limited to:
a. Completed, signed, and dated POC attachment;
b. Service logs, progress notes, and progress summaries;
c. Direct service worker (DSW) attendance and payroll records;
d. Written grievances or complaints filed by beneficiaries/family;
e. Critical or other incident reports involving the beneficiary; and
f. Entrance and exit interview documentation.
8. Explaining to the beneficiary/beneficiary’s family in their native language, the
beneficiary rights and responsibilities within the agency; and
9. Ensuring that beneficiaries are free to make a choice of providers without undue
influence.
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Note: It is the policy of the Louisiana Department of Health (LDH), Office for Citizens with
Developmental Disabilities (OCDD) that all critical incidents for HCBS be reported, investigated
and tracked. The statewide incident management system MUST be used for ALL critical
incident reporting.
Support Coordination
Support coordination is a service that will assist beneficiaries in gaining access to all of their
needed support services, including medical, social, educational, and other services, regardless of
the funding source for the services.
Support Coordination Providers
Providers of support coordination for the SW program must have a signed performance agreement
with OCDD to provide services to waiver beneficiaries. SCAs must meet all of the performance
agreement requirements in addition to any additional criteria outlined by OCDD.
Support Coordination activities include, but are not limited to, the following:
1. Assisting the beneficiary in coordinating and convening the person-centered
planning team for the annual POC and/or as needed. Supporting the beneficiary to
lead the meeting, which should include those who the beneficiary chooses to
participate in the meeting. Those might include, but are not limited to, the
beneficiary’s family, friends, direct service provider(s), including the day and/or
employment provider, employer (if applicable), medical and social work
professionals, as necessary, and advocates, who assist in determining the
appropriate supports and strategies needed in order to meet the beneficiary’s needs
and preferences;
2. Support coordinator (SC) should participate in training regarding employment and
assisting the beneficiary with obtaining employment;
3. Complete a quarterly discussion around employment and the career path with each
beneficiary who wants to work;
4. Offer freedom of choice of providers and settings, to include non-disability specific
settings to each beneficiary;
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5. On-going coordination and monitoring of supports and services included in the
beneficiary’s approved POC;
6. Building and implementing the supports and services as described in the POC;
7. Assisting the beneficiary to use the findings of formal and informal assessments to
develop and implement support strategies to achieve the personal outcomes defined
and prioritized by the beneficiary in the POC;
8. Providing information to the beneficiary on potential community resources,
including formal resources and informal/natural resources, which may be useful in
developing strategies to support the beneficiary in attaining their desired personal
outcomes;
9. Assisting with coordinating transportation so that the beneficiary may have access
to medical services, community resources and their job;
10. Assisting the beneficiary, families, services providers, and/or the LGE with the
problem solving;
11. Assisting the beneficiary to initiate, develop, and maintain informal and natural
support networks and to obtain the services identified in the POC, assuring that they
meet their individual needs;
12. Advocating on behalf of the beneficiary to assist them in obtaining benefits,
supports or services (i.e., to help establish, expand, maintain, and strengthen the
beneficiary’s information and natural support networks). This may involve calling
and/or visiting beneficiaries, community groups, organizations, or agencies with or
on behalf of the beneficiary;
13. Training and supporting the beneficiary in self-advocacy (i.e., the selection of
providers and utilization of community resources to achieve and maintain their
desired outcomes);
14. Oversight of the service providers to ensure that the beneficiary receives
appropriate services and outcomes as designated in the POC;
15. Assisting the beneficiary to overcome obstacles, recognize potential opportunities,
and develop creative opportunities;
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16. Meeting with the beneficiary in face-to-face meetings, as well as via telephone
contact, as specified. This includes meeting the beneficiary where the services take
place. The initial and annual POC meetings are to be done in a face-to-face meeting,
preferably in the home, and at least one other meeting during the POC year must
be done in a face-to-face manner;
17. Make the determination, using the guidelines provided, to determine if the
beneficiary meets the criteria for virtual visits. If the criteria is met, the additional
two meetings may be completed virtually, using an allowed source. The meeting
may not be conducted telephonically and must be done where the individual and
the home may be observed;
18. Reporting and documenting any incidents, complaints, abuse, and/or neglect
according to the OCDD policy and in accordance with licensure, state laws, rules,
and regulations, as applicable;
19. Arranging any necessary professional/clinical evaluations needed and ensuring
beneficiary choice;
20. Identifying, gathering, and reviewing the array of formal assessments and other
documents that are relevant to the beneficiary’s needs, interests, strengths,
preferences, and desired personal outcomes;
21. Developing an action plan in conjunction with the beneficiary to monitor and
evaluate strategies to ensure continued progress toward the beneficiary’s personal
outcomes; and
22. On-going discussions with the beneficiary, if they are of working age, about
employment including:
a. Identifying barriers to employment and working to overcome those
barriers, connecting the beneficiary to certified work incentive
coordinators (CWIC) to do benefits planning;
b. Assisting the beneficiary in the reporting of income to social security;
c. Assisting the beneficiary in setting up an Achieving a Better Life
Experience (ABLE) account;
d. Referring the beneficiary to Louisiana Rehabilitation Services (LRS);
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e. Following the case through closure with LRS; and
f. Other activities in the employment process may be identified, including
the quarterly completion of data input using the Path to Employment form.
NOTE: Advocacy is defined as assuring that the beneficiary receives appropriate supports and
services of high quality and locating additional services not readily available in the community.
Support Coordination Providers Qualifications
Support coordination providers must meet the following requirements:
1. Must be licensed as a support coordination provider; and
2. Meet all requirements as outlined in the Support Coordination Performance
Agreement.
NOTE: Please refer to the Guidelines for Support Planning, Operational Instruction for Critical
Incident Review, and OCDD Support Coordination Reference Guide for additional information.
Provider Responsibilities for All Residential Care Service Providers
Direct service provider agencies must have written policy and procedure manuals that include, but
are not limited to, provisions that govern the following:
1. Training policy that includes orientation and staff training requirements according
to the HCBS Providers Licensing Standards, the DSW Registry, and the Class A
Child Placing Licensing Standards (as applicable to specific residential service
being provided);
2. Direct care abilities, skills, and knowledge requirements that employees must
possess in order to adequately perform care and assistance as required by waiver
beneficiaries;
3. Employment and personnel job descriptions, hiring practices that include a policy
against discrimination, employee evaluation, promotion, disciplinary action,
termination, and hearing of employee grievances, staffing, and staff coverage plan;
4. Record maintenance, security, supervision, confidentiality, organization, transfer,
and disposal;
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5. Identification, notification, and protection of beneficiary’s rights, both verbally and
in writing, in a language that the beneficiary/beneficiary’s family is able to
understand;
6. Written grievance procedures;
7. Information about abuse and neglect as defined by LDH regulations and state and
federal laws;
8. Electronic visit verification (EVV): requirement for proper use of check in/out;
acceptable editing of electronically captured services; reporting services when in
“no service zones” or failure to clock in/out (Electronic Connectivity form and
manual entry); confidentiality of log in information; monitoring of EVV system for
proper use;
9. DSW Registry: requirement for accessing the Department’s Adverse Action
database for findings placed against the direct service workers prohibiting
employment;
10. Criminal history checks: requirement for compliance with state statutes for non-
licensed direct care personnel; and
11. DSW Wage floor: requirement for provider agencies to follow the DSW Wage floor
established by Louisiana Medicaid and pay the DSWs as directed. The current
wage floor can be found in the LAC and OCDD will post a memo on their website
(https://ldh.la.gov/subhome/11) and providers will be responsible for following this
directive.
POC Provider Documents
The direct service provider must complete the provider attachments that are a part of the POC, to
include all waiver services that the agency provides to the beneficiary based on the beneficiary’s
identified POC goals and other supports required.
The provider documents in the POC must be person-centered, focused on the beneficiary’s desired
outcomes, and include the following elements:
1. Specific goals matching the goals outlined in the beneficiary’s approved POC;
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2. Measurable objectives and timelines to meet the specified goals, and strategies to
meet the objectives;
3. Identification of the direct service provider staff and any other support team
members who will be involved in implementing the strategies; and
4. The method that will be used to document and measure the implementation of
specified goals and objectives.
The POC provider documents must be reviewed and updated, as necessary, to comply with the
specified goals, objectives, and timelines stated in the beneficiary’s approved POC or when
changes are necessary based on beneficiary needs.
Back-up Planning
Direct service providers are responsible for providing all necessary staff to fulfill the health and
welfare needs of the beneficiary when paid supports are scheduled to be provided. This includes
during times when the scheduled direct service worker is absent or is unavailable or unable to work
for any reason.
All direct service providers are required to develop an individualized back-up plan for each
beneficiary that includes detailed strategies and person-specific information that addresses the
specialized care and supports needed by the beneficiary.
Direct service providers are required to:
1. Have policies in place which outline the protocols that the agency has established
to ensure that back-up direct service workers are readily available;
2. Ensure that lines of communication and chain of command procedures have been
established; and
3. Have procedures for dissemination of the back-up plan information to beneficiaries,
their authorized representatives, and their support coordinators.
Protocols must also describe how and when the direct support staff will be trained in the care
needed by the beneficiary. This training must occur prior to any direct support staff member being
solely responsible for a beneficiary.
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Back-up plans must be updated as changes occur and, at a minimum, on an annual basis to ensure
that the information is kept current and applicable to the beneficiary’s needs. The back-up plan
must be submitted to the beneficiary’s support coordinator in a timely manner to be included as a
component of the beneficiary’s initial and annual POC.
Direct service providers may not use the beneficiary’s informal support system as a means of
meeting the agency’s individualized back-up plan and/or emergency evacuation response plan
requirements without documented consent of the informal support system. The beneficiary’s
family members and others identified in the beneficiary’s circle of support may elect to provide
back-up, but this does not exempt the provider from the requirement of providing the necessary
staff for back-up purposes when paid supports are scheduled.
Emergency Evacuation Planning
Emergency evacuation plans must be developed in addition to the beneficiary’s individualized
back-up plan. Providers must have an emergency evacuation plan that specifies in detail how the
direct service provider will respond to potential emergency situations such as fires, hurricanes,
tropical storms, hazardous material release, flash flooding, ice storms, and terrorist attacks.
The emergency evacuation plan must be person-specific and include at a minimum the following
components:
1. Individualized risk assessment of potential health emergencies;
2. A detailed plan to address the beneficiary’s individualized evacuation needs,
including a review of the beneficiary’s individualized back-up plan, during
geographical and natural disaster emergencies and all other potential emergency
conditions;
3. Policies and procedures outlining the agency’s implementation of emergency
evacuation plans and the coordination of these plans with the local Office of
Emergency Preparedness and Homeland Security;
4. Establishment of effective lines of communication and chain of command
procedures;
5. Establishment of procedures for the dissemination of the emergency evacuation
plan to beneficiaries and support coordinators; and
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6. Protocols outlining how and when direct service workers and beneficiaries will be
trained in the implementation of the emergency evacuation plan and post-
emergency procedures.
Training for direct service workers and surety of competency must occur prior to the worker being
solely responsible for the support of the beneficiary.
The beneficiary must be provided with regular, planned opportunities to practice the emergency
evacuation response plan.
OCDD, support coordination agencies, and direct service provider agencies are responsible for
following the established emergency protocol before, during, and after hurricanes or other natural
disasters or events as outlined in the “Emergency Protocol for Tracking Location Before, During,
and After Hurricanes” document found in the OCDD Guidelines for Support Planning manual.
(Refer to Appendix D of this manual chapter for website information).
Day Habilitation Provider Responsibilities
The providers who provide Day Habilitation services must possess a current, valid HCBS Provider
ADC License to provide day habilitation/community life engagement services and must adhere to
the following requirements in order to provide transportation to beneficiaries:
1. Vehicles used in transporting beneficiaries must adhere to the requirements of the
HCBS licensing rule;
2. Drivers must have a valid, current Louisiana driver’s license that is applicable to
the vehicle being used;
3. The provider must document this service in the beneficiary’s record, and the trip
must be documented in the provider’s transportation log, which can be either
electronic with GPS tracking or a paper log; and
NOTE: The log is not required to be filed in the beneficiary’s record file, but must
contain information that identifies the beneficiary, the time of pick up, and the time
of drop off. It shall also be available upon request for review by any Louisiana state
agency, including LGE and Support Coordination.
4. Vehicles used in transporting beneficiaries must:
a. Be in good condition and repair;
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b. Have a current Louisiana inspection sticker; and
c. Have a first aid kit on board.
Supported Employment Provider Responsibilities
Supported Employment providers must maintain documentation in the file of each individual
beneficiary that the services are not available to the beneficiary in programs funded under Section
110 of the Rehabilitation Act of 1973 or Section 602 (16) and (17) of the Individuals with
Disabilities Education Act [20 U.S.C. 1401 (26) and (29.)], if available. LRS does not fund group
employment, only individual employment. Therefore, if an individual is seeking group
employment, this does not apply.
The employment specialist must possess a current certification from an accepted Supported
Employment training program and the continuing education hours required (20 every two years).
The provider may also have a valid HCBS Provider ADC license, but this is not a requirement to
provide supported employment services in the community.
Supported Employment providers who have an ADC license must adhere to the following
requirements in order to provide transportation to beneficiaries:
1. Vehicles used in transporting beneficiaries must adhere to the requirements of the
HCBS licensing rule;
2. Drivers must have a valid, current Louisiana driver’s license applicable to the
vehicle being used;
3. The provider must document this service in the beneficiary’s record, and the trip
must be documented in the provider’s transportation log, which can be either
electronic with GPS tracking or a paper log; and
NOTE: The log is not required to be filed in the beneficiary’s record file, but must
contain information that identifies the beneficiary, the time of pick up, and the time
of drop off. It shall also be available upon request for review by any Louisiana state
agency, including LGE and Support Coordination.
4. Vehicles used in transporting beneficiaries must:
a. Be in good condition and repair;
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b. Have a current Louisiana inspection sticker; and
c. Have a first aid kit on board.
Providers must have a documented quarterly discussion with individuals who are working in
group employment or individual employment.
The discussion should include the following:
1. Is the individual happy with the current job?
2. Is the individual interested in additional hours or advancement on the job?
In addition to these questions, if the individual is working in group employment:
1. Is the individual interested in finding individual employment in the community?
2. Is the individual interested in career planning services?
3. Is the individual interested in additional hours or advancement?
Prevocational Provider Responsibilities
The provider must maintain documentation in the file of each individual beneficiary receiving
Prevocational services that the services are not available to eligible beneficiaries in programs
funded under Section 110 of the Rehabilitation Act of 1973 or Section 602 (16) and (17) of the
Individuals with Disabilities Education Act [20 U.S.C. 1401 (26) and (29)], if available.
The service provider must adhere to the following requirements in order to provide transportation
to beneficiaries:
1. Vehicles used in transporting beneficiaries must adhere to the requirements of the
HCBS licensing rule;
2. Drivers must have a valid, current Louisiana driver’s license that is applicable to
the vehicle being used;
3. The provider must document this service in the beneficiary’s record, and the trip
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must be documented in the provider’s transportation log; and
4. The vehicles used in transporting beneficiaries must:
a. Be in good condition and repair;
b. Have a current Louisiana inspection sticker; and
c. Have a first aid kit on board.
Providers should review the progress made on the Individual Career Planning (ICP) Profile on a
quarterly basis. The provider must have a documented quarterly discussion with individuals who
are in this service to include the following:
1. Review of the ICP Profile and the progress made thus far;
2. Is the individual still interested in finding employment;
3. Potential employment opportunities in the community; and
4. Ensure the individual is still interested in career planning services.
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SUPPORT COORDINATION
Support coordination, which is also referred to as case management, is a waiver service that is
provided to all Supports Waiver (SW) beneficiaries. Support coordination is an organized system
by which a support coordinator (SC) assists a beneficiary to prioritize and define their personal
outcomes and to identify, access, coordinate and monitor appropriate supports and services within
a community service network. Beneficiaries may have multiple service needs and require a variety
of community resources.
Core Elements
Support coordination agencies (SCAs) are required to perform the following:
1. Intake;
2. Assessment;
3. Plan of care (POC) development and implementation;
4. Follow-up/monitoring;
5. Reassessment; and
6. Transition/closure.
Intake
Intake serves as an entry point into the Waiver and is used to gather baseline information to
determine the beneficiary’s medical eligibility for waiver services, service needs, appropriateness
for services, including support coordination.
Intake Procedures
Referrals for support coordination services are only made from the Office for Citizens with
Developmental Disabilities (OCDD) through the Medicaid data management contractor. The
applicant must be interviewed to obtain the required information regarding their demographics,
preferably through a face-to-face interview in the applicant’s home, within three working days of
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receipt of the Freedom of Choice (FOC) form.
The POC process begins with an initial face-to-face meeting in the beneficiary’s home.
The SC requests and gathers medical, social, educational and psychological documentation
necessary to complete the POC.
The local governing entity (LGE) will transfer the eligibility documents along with the
transfer of records to the SCA. Prior authorization to cover services from the beginning
date of the POC will be issued upon approval of the POC.
The SC must determine whether the applicant:
1. Has a need for immediate support coordination intervention; and
2. Is receiving support coordination service or other services from another
provider or community resource.
NOTE: If the applicant is receiving support coordination from another OCDD
provider, the OCDD State Office Support Coordination Program Manager must be
contacted to correct the linkage. (See Appendix C for contact information).
Applicants who are receiving support coordination from another provider must remain with their
current provider until approved for the waiver. Requests to change to a different SCA may be made
following waiver certification. Refer to the “Changing Support Coordination Agencies” subsection
at the end of this section.
The SC must obtain signed release forms and have the applicant/authorized representative sign a
standardized intake form that documents the applicant/authorized representative:
1. Was informed of procedural safeguards;
2. Was informed of their rights along with grievance procedures;
3. Was advised of their responsibilities;
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4. Accepted support coordination service;
5. Was advised of the right to change support coordination providers,
SCs, and/or service providers; and
6. Was advised that waiver services and support coordination service
are an alternative to institutionalization.
If SW services are not appropriate to meet the applicant’s needs, or if the applicant does not meet
the eligibility requirements for waiver services, the applicant should be notified immediately, given
appeal rights and directed to other service options or to the source of the initial referral, or begin
the process for moving to the Residential Options Waiver (ROW) using the tiered waiver process.
Assessment
Assessment is the process of gathering and integrating informal and formal/professional
information relevant to the development of an individualized POC. The information should be
based on, and responsive to, the beneficiary’s current service needs, desired personal outcomes
and functional status. The assessment provides the foundation for support coordination service by
defining the beneficiary’s needs and assisting in the development of the POC.
Assessment Process
The SC must conduct the person-centered support assessment which consists of the following:
1. Face-to-face home interviews with the beneficiary/beneficiary’s family or
guardian/authorized representative;
2. Direct observation of the beneficiary;
3. Direct contact with family, other natural supports, professionals and
support/service providers as indicated by the situation and the desires of
the beneficiary; and
4. Freedom of choice of all services, support coordination and alternative to
institutionalization.
Characteristics and components of the assessment include:
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1. Identifying information (demographics);
2. Use of a standardized instrument for certain targeted populations;
3. Personal outcomes identified, defined and prioritized by the beneficiary;
4. Medical/physical information;
5. Psycho social/behavioral information;
6. Developmental/intellectual information;
7. Socialization/recreational information including the social environment
and relationships that are important to the beneficiary;
8. Patterns of the beneficiary’s everyday life;
9. Financial resources;
10. Educational information;
11. Employment discussion that includes past and present employment, or if the
person has never worked a discussion about looking for employment,
including benefits planning and how employment can improve their life;
12. Daily activities, including how they spend their time and in what hobbies they
participate (e.g., church, clubs, volunteering, ect.);
13. Housing/physical environment of the beneficiary;
14. Information about previously successful and unsuccessful strategies to
achieve the desired personal outcomes;
15. Information relevant to understanding the supports and services needed by
the beneficiary to achieve the desired personal outcomes, (e.g., input from
formal and informal service providers and caregivers as relevant to the
personal outcomes); and
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16. Identification of areas where a professional evaluation is necessary to
determine appropriate services or interventions.
It is the responsibility of the SC to assist the beneficiary to arrange any professional/clinical
evaluations that are needed to develop strategies for obtaining the services, resources, and supports
necessary to achieve their desired personal outcomes while ensuring beneficiary choice. The SC
must identify, gather, and review the array of formal assessments and other documents that are
relevant to the beneficiary’s needs, interests, strengths, preferences, and desired personal
outcomes. A signed authorization must be obtained from the beneficiary or authorized
representative to secure appropriate services. A signed authorization for release of information
must be obtained and filed in the case record.
NOTE: Evaluations, tests, and/or reports are not covered support coordination activities. The
necessary medical, psychological, psycho social, and/or other clinical evaluations, tests, etc., may
be covered by Medicaid or other funding sources.
Time Frame for Initial Assessment
The initial assessment must begin within seven calendar days and be completed within 30
calendar days following the referral/linkage.
Ongoing Assessment Procedures
The assessment must be ongoing to reflect changes in the beneficiary’s life and the changing of
prioritized personal outcomes over time. These changes include strengths, needs, preferences,
abilities, and the resources of the beneficiary. If there are significant changes in the beneficiary’s
status or needs, the SC must revise the POC.
Plan of Care Development and Implementation
The POC is the analysis of information from the formal evaluations and the person-centered
supports assessment, and is based on the unique personal outcomes identified, defined and
prioritized by the beneficiary.
The POC is developed through a collaborative process involving the beneficiary and the persons
who the beneficiary chooses to participate in the process. This may include family, friends or other
support systems, the SC, appropriate professionals/service providers, and others who best know
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the beneficiary.
The purpose of the POC is to:
1. Establish direction for all persons involved in providing supports and
services for the beneficiary by describing how the needed supports and
services interact to form overall strategies that assist the beneficiary to
maintain or achieve the desired personal outcomes of their choice;
2. Provide a process for ensuring that the paid medical services and other
resources are deemed medically necessary and meet the needs and desires
of the beneficiary, including health and welfare, as determined by the
assessment and that these services and supports are provided in a cost-
effective manner; and
3. Represent a strategy for ensuring that services received are the choice of
the beneficiary, are appropriate and available, and are responsive to the
beneficiary’s changing outcomes, desires, and needs as updated in the
assessment.
The POC should not be considered a treatment plan of specific clinical interventions that service
providers would use to achieve treatment or rehabilitation goals. Instead, the POC should be
considered a “master plan” consisting of a comprehensive summary of information to aid the
beneficiary to obtain assistance from formal and informal service providers, as it relates to
obtaining and maintaining the desired personal outcomes of the beneficiary.
Required Procedures
The initial and annual POC must be completed in a face-to-face home visit at a time that is
convenient for the beneficiary. The initial and annual POC must include the beneficiary and the
service provider, and may include members of the support network; the support network, may
include family members, appropriate professionals, persons, who are well acquainted with the
beneficiary, and who the beneficiary chooses to invite.
The POC must:
1. Be outcome-oriented, individualized and updated on at least an annual
basis. The planning process should include tailoring the POC to the
beneficiary’s needs and desires based on the on-going personal outcomes
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assessment. It must develop mutually agreed upon strategies to achieve or
maintain the desired personal outcomes, which rely on informal, natural
community supports, and appropriate formal paid services. The
beneficiary, SC, members of the support system, direct service providers,
and appropriate professional personnel must be directly involved in the
development of the POC;
2. Assist the beneficiary in making informed choices, including the choice to
receive services in a non-disability specific setting, and regarding all
aspects of supports and services needed to achieve their desired personal
outcomes. This involves assisting the beneficiary to identify specific,
realistic needs, and choices for the POC. It must also assist the beneficiary
in developing an action plan which will lead to the implementation of
strategies to achieve the desired personal outcomes, including action steps,
review dates, and individuals who will be responsible for specific steps;
3. Incorporate steps that empower and help the beneficiary to develop
independence, growth, and self-management; and
4. Be written in a language that is understandable to all parties involved.
Specific problems due to a diagnosis or situation that causes a problem for
the beneficiary must be clearly explained. The POC must be approved prior
to issuance of any prior authorization.
Required Components
The POC must incorporate the following required components and shall be prepared by the SC with
the chosen service provider, beneficiary, parent/family and others, at the request of the beneficiary:
1. Beneficiary’s prioritized personal outcomes and specific strategies to
achieve or maintain the desired personal outcomes, focusing foremost on
informal natural/community supports and if needed, paid formal services;
2. Budget payment mechanism, as applicable;
3. Target/resolution dates for the achievement/maintenance of personal outcomes;
4. Assigned responsibilities;
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5. Identified preferred formal and informal support/service providers and the
specific service arrangements;
6. Identified individuals who will assist the SC in planning,
building/implementing supports, or direct services;
7. Ensured flexibility of frequency, intensity, location, time, and method of
each service or intervention, and is consistent with the POC and
beneficiary’s desired outcomes;
8. Change in a waiver service provider(s) can only be requested by the
beneficiary at the end of a six-month linkage unless there is “good cause.”
Any request for a change requires a completion of a FOC form. A change
in support coordination providers is to be made through the Medicaid data
management contractor. A change in direct service providers is to be made
through the SC;
9. All participants present at the POC meeting must sign the POC;
10. The POC must be completed and approved as per POC instructions; and
11. The beneficiary must be informed of their right to refuse a POC after
carefully reviewing it.
Building and Implementing Supports
The implementation of the POC involves arranging for, building, and implementing a continuum
of both informal supports and formal/professional services that will contribute to the achievement
of the beneficiary’s desired personal outcomes.
Responsibilities of the SC include:
1. Building and implementing the supports and services as described in the POC;
2. Assisting the beneficiary/beneficiary’s family to use the findings of formal
and informal assessments to develop and implement support strategies to
achieve the personal outcomes defined and prioritized by the beneficiary
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in the POC;
3. Being aware of and providing information to the beneficiary/beneficiary’s
family on potential community resources, including formal resources
(Supplemental Nutrition Assistance Program (SNAP), Supplemental
Security Income (SSI), housing, Medicaid, benefits planning, Louisiana
Rehabilitation Services (LRS), etc.) and informal/natural resources, which
may be useful in developing strategies to support the beneficiary in
attaining their desired personal outcomes;
4. Assisting with problem solving with the beneficiary, supports, and service
providers;
5. Assisting the beneficiary to initiate, develop, and maintain informal and
natural support networks, and to obtain the services identified in the POC,
assuring that they meet the beneficiary’s individual needs and desires;
6. Advocating on behalf of the beneficiary to assist in obtaining benefits,
supports, or services, e.g., to help establish, expand, maintain, and
strengthen the beneficiary’s informal and natural support networks by
calling and/or visiting beneficiaries, community groups, organizations, or
agencies with or on behalf of the beneficiary;
7. Training, supporting and/or connecting the beneficiary in self-advocacy
groups, e.g., selection of providers and utilization of community resources
to achieve and maintain the desired outcomes;
8. Overseeing the service providers to ensure that the beneficiary receives
appropriate services and outcomes as designed in the POC;
9. Assisting the beneficiary to overcome obstacles, recognize potential
opportunities, and develop creative opportunities;
10. Monthly phone calls with the beneficiary; and
11. Meeting with the beneficiary face-to-face in the beneficiary’s home, for
each initial and/or annual POC development, and for at least one other
quarterly meeting. These quarterly meetings may happen on a more
frequent basis if so requested by the beneficiary/beneficiary’s family and
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that such meetings can be completed in the day program. If the beneficiary
meets the criteria for virtual visits and requests a virtual visit, the remaining
two quarterly meetings may be completed using a virtual delivery format.
NOTE: Advocacy is defined as assuring that the beneficiary receives appropriate
supports and services of high quality and locating additional services not readily
available in the community.
Required Time Frames
1. Linkage:
The initial POC must be completed and received by the LGE within 35
calendar days following the date of the notification of linkage by the data
management contractor. All incomplete packages will be returned.
2. Revisions to the POC:
Revisions must be submitted ten working days prior to the change.
3. Emergencies:
Emergency changes must be submitted within 24 hours or the next working
day following the change.
4. Reviews:
a. At a minimum, the POC should be reviewed on a quarterly basis
to ensure that the personal outcomes and support strategies are
consistent with the needs and desires of the beneficiary; and
b. At a minimum, the POC must be revised on an annual basis or as
otherwise needed, but in no case shall it be revised later than thirty-
five (35) days prior to expiration. The POC may be submitted as
early as sixty (60) days prior to expiration, provided the form 90-L
does not expire prior to the POC expiration date.
Changes in the Plan of Care
If there are significant changes to the POC (i.e., adding or deleting services) in the way that the
beneficiary prioritizes their personal outcomes, and/or if there are significant changes to the
support strategies or service providers, the SC must revise the POC to reflect these changes. A
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revision request must be submitted to the LGE for approval on all beneficiaries. Whenever possible,
additional service needs should be anticipated and planned for in the initial/annual POC during the
POC meeting. When an unidentified need is identified 10 or more business days prior to the change,
a POC Revision request should be submitted and will be processed within ten (10) business days.
The revision should be marked as “routine”. If an unanticipated need is identified less than ten (10)
business days prior to the needed change, the POC revision request must be identified as “urgent”
and the additional responsibilities for the Provider and SC must be assumed. For “urgent” requests,
the box must be checked. An urgent need exists when there is an unplanned/unpredictable event
which requires urgent changes to waiver services and/or changes in the service provider. Urgent
changes are defined as changes that must begin in fewer than ten (10) business days off receipt by
the LGE.
Initiating a Change in the Plan of Care
The beneficiary/beneficiary’s family will contact the SC when a change is required. The SC will call
a meeting with the service provider(s) to complete the POC revision form. All participants
attending the meeting will sign the POC revision, and it will be submitted to the LGE for approval.
The SC will notify the service provider and beneficiary of the approval/disapproval.
NOTE: The annual expiration date of the POC should never change.
Documentation
A copy of the approved POC must be kept at the beneficiary’s home, in the beneficiary’s case
record at the SCA, and in the service provider’s files. The SC is responsible for providing the
copies.
A copy of the POC must be made available to all staff directly involved with the beneficiary.
Follow-up/monitoring
POC monitoring should be completed monthly, quarterly and annually using the Support
Coordination Documentation form.
All visits and contacts should be documented in the case record using monthly progress notes.
Progress notes may be brief as long as all components are addressed. Information documented in
the progress notes do not need to be duplicated in the case record.
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Monthly progress notes must address personal outcomes separately and reflect the beneficiary’s
interpretation of the outcomes. Monthly progress notes shall include:
1. Desired personal outcomes;
2. Strategies to achieve the outcomes;
3. Effectiveness of the strategies;
4. Obstacles to achieving the desired outcomes;
5. New opportunities; and
6. Developing a new action plan.
Reassessment/Working Plan of Care
Assessment must be ongoing to reflect changes in the beneficiary’s life and the changing
prioritized personal outcomes over time, such as strengths, needs, preferences, abilities, and the
beneficiary’s resources. Reassessment is the process by which the baseline assessment is reviewed
and information is gathered for evaluating and revising the ‘working’ POC.
A reassessment is required when a major change occurs in the status of the beneficiary, the
beneficiary’s family, or the beneficiary’s prioritized needs. A reassessment must be completed
within seven (7) calendar days of notice of a change in the beneficiary’s status.
NOTE: The beneficiary/family may request a complete POC review by the LGE at any time
during the POC year if it is felt that the POC is unsatisfactory or is inadequate in meeting the
beneficiary’s service needs.
Annual Reassessment
A completed annual reassessment package must be received by the LGE no later than thirty-five
(35) calendar days, but as early as sixty (60) calendar days prior to expiration of the POC,
provided the form 90-L does not expire prior to the POC expiration date. Incomplete packages will
not be accepted. SCs will be responsible for retrieving incomplete packages from the LGE.
Sanctions will be applied.
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SCA Approval Authority of SW Annual Plan of Care
SCs have limited POC approval authority as authorized by OCDD. Approval of a POC for an
annual reassessment shall be limited to those cases where:
1. The beneficiary’s health and welfare can be assured;
2. There are no changes in waiver services; and
3. The current waiver services are meeting the needs of the beneficiary.
NOTE: All necessary documentation must be submitted to the LGE with a copy of the approved
POC.
Transition/Closure
The transition or closure of support coordination services must occur in response to the request of
the beneficiary or when it is determined that the beneficiary is no longer eligible for services. The
closure process must ease the transition to other services or care systems outside of waiver.
Closure Criteria
Criteria for closure of waiver and support coordination services include, but are not limited to, the
following:
1. The beneficiary requests termination of services;
2. Death;
3. Permanent relocation of the beneficiary out of the service area (transfer to
another region) or out of state;
4. Long-term admission to an institution or nursing facility;
5. The beneficiary requires a level of care beyond that which can safely be
provided through waiver services; or
6. Beneficiary refuses to comply with support coordination.
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Procedures for Transition/Closure
The SC must provide assistance to the beneficiary and to the receiving agency during a transition
to assure the smoothest possible transition. Transition/closure decisions should be reached with the
full participation of the beneficiary/family. As part of the transition/closure procedure, SCs must:
1. Notify the beneficiary/beneficiary’s family immediately if the beneficiary
becomes ineligible for services;
2. Complete a final written reassessment identifying any unresolved problems
or needs and discuss methods of negotiating their own service needs with
the beneficiary;
3. Notify the service provider(s) immediately if services are being transitioned
or closed; and
4. Assure the receiving agency, program or SC receives copies of the most
current POC and related documents. (The form 148-W must be completed
to reflect the date on the transfer of records and submitted to the LGE).
As part of the transition/closure procedure, the SCA must:
1. Notify the LGE of the transition/closure four weeks prior to the closure to
allow the LGE to establish a transition plan;
2. Follow their own policies and procedures regarding intake and closure; and
3. Serve as a resource to beneficiaries who choose to assume responsibility
for coordinating some or all of their own services and supports, or who
choose to ask a member of their network of support to assume some or all of
these responsibilities. All closures must be entered into the database
immediately.
NOTE: An agency shall not close a beneficiary’s case when there is a pending appeal. The case
may be closed only upon receipt of the appeal decisions. If an appeal is requested within ten days,
the case remains open. If an appeal is not requested within ten days, the case will be closed.
The agency shall not retaliate in any way against the beneficiary for terminating services or
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transferring to another agency for support coordination services.
Changing Support Coordination Agencies
When a beneficiary selects a new support coordination provider, the data management contractor
will link the beneficiary to the new provider. The new support coordination provider must:
1. Complete the FOC file transfer;
2. Obtain the case record and authorized signature; and
3. Inform the transferring SCA.
Upon receipt of the completed form, the transferring provider must provide copies of the following
information:
1. Most current POC;
2. Current assessments on which the POC is based;
3. Number of services used in the calendar year;
4. Most recent six months of progress notes; and
5. Form 90-L.
The transferring support coordination provider shall continue to provide services until the records
are transferred to the receiving provider and the transferring provider is eligible to bill for support
coordination services after the dated notification is received (transfer of records) by the receiving
agency. In the month the transfer occurs, the receiving agency shall begin providing services within
three days after the transfer of records and is eligible to bill for services the first full month after
the transfer of records. The receiving agency must submit the required documentation to the LGE
and Medicaid data management contractor to begin prior authorization immediately after the
transfer of records.
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Other Support Coordination Responsibilities
Reporting of Incidents, Accidents and Complaints
The SC must report and document any complaint, incident, accident, suspected case of abuse,
neglect, exploitation or extortion to the OCDD, Health Standards Section (HSS), and other
appropriate agency as mandated by law. All suspected cases of abuse (physical, mental, and/or
sexual), neglect, exploitation or extortion must be reported to the appropriate authorities. Refer to
Section 43.6 – Incidents, Accidents and Complaints of this manual chapter for additional
instructions.
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CHAPTER 43: SUPPORTS WAIVER
APPENDIX A: DEVELOPMENTAL DISABILITY LAW PAGE(S) 2
Developmental Disability Law Page 1 of 2 Appendix A
DEVELOPMENTAL DISABILITY LAW
A developmental disability is defined by the Developmental Disability Law (Revised Statutes
28.452.1). The law states that a developmental disability means either:
1. A severe chronic disability of a person that:
a. Is attributable to an intellectual or physical impairment or combination of
intellectual and physical impairments;
b. Is manifested before the person reaches age twenty-two;
c. Is likely to continue indefinitely;
d. Results in substantial functional limitations in three or more of the following
areas of major life activity:
i. Self-care;
ii. Receptive and expressive language;
iii. Learning;
iv. Mobility;
v. Self-direction;
vi. Capacity for independent living; or
vii. Economic self-sufficiency.
e. Is not attributed solely to mental illness; and
f. Reflects the person’s need for a combination and sequence of special,
interdisciplinary, generic care, treatment, or other services, which are of
lifelong or extended duration and are individually planned and coordinated.
OR
2. A substantial developmental delay or specific congenital or acquired condition in a
person from birth through age nine which, without services and support, has a high
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APPENDIX A: DEVELOPMENTAL DISABILITY LAW PAGE(S) 2
Developmental Disability Law Page 2 of 2 Appendix A
probability of resulting in criteria that, later in life, may be considered to be a
developmental disability.
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CHAPTER 43: SUPPORTS WAIVER
APPENDIX B: SERVICE PROCEDURE CODES/RATES PAGE(S) 2
Service Procedure Codes Page 1 of 2 Appendix B
The following chart describes the codes and rates that are to be used with the Supports Waiver.
Providers must bill the appropriate procedure code for the service performed.
PROVIDER
TYPE
SERVICE DESCRIPTION
PROCE
DURE
CODE
MODIFIER
2
nd
MODIFIER
RATE
STANDARD
UNIT OF
SERVICE
HOURS
PER
UNIT
ANNUAL
SERVICE
LIMITS
98
Individual Job Self-
Employment or
Microenterprise Job
Assessment, Discovery, and
Development
1:1 Beneficiary Ratio
H2023
UK
$4.96
15 minutes
2880
98
Group Employment Job
Assessment, Discovery, and
Development
H2023
NO MOD
$3.78
15 minutes 480
98
Individual Job, Self-
Employment or
Microenterprise Initial Job
Support, and Retention
H2023
TS
-$13.63
15 minutes
960
98
Virtual Delivery of Individual
Job, Self-Employment or
Microenterprise Initial Job
Support, and Retention
1:1 Beneficiary Ratio
H2023
TS
GT
$13.63 15 minutes
960
98
Group Employment Initial
Job Support and Retention
1:1-2 Beneficiary Ratio
H2026 TT
$83.25 1 Day 1 plus 240
98
Group Employment Initial
Job Support and Retention
1:3-4 Beneficiary Ratio
H2026 UQ
$69.97
1 Day 1 plus 240
98
Group Employment Initial
Job Support and Retention
1:5-8 Beneficiary Ratio
H2026 NO MOD
$49.40
1 Day 1 plus 240
14
Community Life
Engagement Day
Habilitation
1:1 Beneficiary Ratio
T2021
TT
$4.75
15 minutes
4800
14
Community Life
Engagement Day
Habilitation
1:2-4 Beneficiary Ratio
T2021
UQ
$3.56
15 minutes
4800
14
Day Habilitation
Onsite 1:5-8 Beneficiary
Ratio
T2021
NO MOD
$2.48
15 minutes
4800
14
Virtual Delivery of Day
Habilitation
1:5-8 Beneficiary Ratio
T2021
GT
$2.98
15 minutes
4800
13
Community Career Planning
1:1 Beneficiary Ratio
T2025
TT
$4.75
15 minutes
4800
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APPENDIX B: SERVICE PROCEDURE CODES/RATES PAGE(S) 2
Service Procedure Codes Page 2 of 2 Appendix B
PROVIDER
TYPE
SERVICE DESCRIPTION
PROCE
DURE
CODE
MODIFIER
2
nd
MODIFIER
RATE
STANDARD
UNIT OF
SERVICE
HOURS
PER
UNIT
ANNUAL
SERVICE
LIMITS
13
Community Career Planning
1:2-4 Beneficiary Ratio
T2025
UQ
$3.06
15 minutes
4800
13
Prevocational Services
Onsite 1:5-8 Beneficiary
Ratio
T2025
NO MOD
$1.98
15 minutes 4800
13
Virtual Delivery of
Prevocational Services
1:5-8 Beneficiary Ratio
T2025
GT
$2.98 15 minutes 4800
83 Center-Based Respite T1005 HQ
$4.63
15 minutes
428
82 In-Home Respite S5125 NO MOD
$4.63
13, 14, 82, 98
Habilitation
1:1 Beneficiary Ratio
T2019 NO MOD
-$4.63 15 minutes
285
16
Personal Emergency
Response System (PERS)
Installation
S5160
NO MOD
$30.00 One Time
1 in
current
residence
and 1
each time
participant
moves to
new
residence
16
Personal Emergency
Response System (PERS)
Monthly Maintenance
S5161
NO MOD
$28.00 Monthly 12
45 Support Coordination T2023 NO MOD
$ 201.50
Monthly
12
AW
Permanent Supportive
Housing Stabilization
G9012 NO MOD
$15.11 15 minutes 93
AW
Permanent Supportive
Housing Stabilization
Transition
G9012 U8
$15.11 15 minutes 72
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CHAPTER 43: SUPPORTS WAIVER
APPENDIX C: CONTACT INFORMATION PAGE(S) 2
Contact Information Page 1 of 2 Appendix C
CONTACT INFORMATION
Office for Citizens with Developmental Disabilities and Local Governing Entities
Contact information for the central office and the regional local governing entities (LGEs) is
found on the Office for Citizens with Developmental Disabilities (OCDD) website at:
http://dhh.louisiana.gov/index.cfm/page/134/n/137.
Appeals
OFFICE NAME TYPE OF ASSISTANCE CONTACT INFORMATION
Louisiana Department of
Health (LDH) Health
Standards Section
Office to contact to report
changes that affect provider
license
Health Standards Section
P.O. Box 3767
Baton Rouge, LA 70821
or (225) 342-0138
Fax: (225) 342-5073
Division of
Administrative Law –
Health Section
Office to contact to file an appeal
request
Division of Administrative Law -
Health Section
P. O. Box 4189
Baton Rouge, LA 70821-4189
(225) 342-5800
Fax: (225) 219-9823
Gainwell Technologies
Provider Enrollment Section
Office to contact to report
changes in agency ownership,
address, telephone number or
account information affecting
electronic funds transfer
Gainwell Technologies Provider
Enrollment Section
P. O. Box 80159
Baton Rouge, LA 70898-0159
(225) 216-6370
Gainwell Technologies
Provider Relations Unit
Office to contact to obtain
assistance with questions
regarding billing information
Gainwell Technologies Provider
Relations Unit
P. O. Box 91024
Baton Rouge, LA 70821
1-800-473-2783 or 225-924-5040
Department of Children and
Family Services – Local Child
Protection Hotline
Office to contact to report
suspected cases of abuse, neglect,
exploitation or extortion of a
beneficiary under the age of 18
Refer to the Department of Children and
Family Services website at:
https://www/dcfs.louisiana.gov
under the “Report Child Abuse/Neglect”
link
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APPENDIX C: CONTACT INFORMATION PAGE(S) 2
Contact Information Page 2 of 2 Appendix C
Adult Protective Services
Office to contact to report
suspected cases of abuse, neglect,
exploitation or extortion of a
beneficiary aged 18-59 or an
emancipated minor
Louisiana Department of Health
Office of Aging and Adult Services
1-800-898-4910
Elderly Protective Services
Office to contact to report
suspected cases of abuse, neglect,
exploitation or extortion of a
beneficiary aged 60 or older
Governor’s Office of Elderly Affairs
http://goea.louisiana.gov
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CHAPTER 43: SUPPORTS WAIVER
APPENDIX D: FORMS AND LINKS PAGE(S) 1
Forms and Links Page 1 of 1 Appendix D
FORMS AND LINKS
This section contains a list of the forms, handbooks and other documents that are used in the Supports
Waiver program and the associated web links where the information can be obtained.
Providers are
required to follow the policy and procedures that are outlined for each of the documents utilized
in the Supports Waiver.
For additional documents and forms that may be utilized in the Supports Waiver use this link:
https://ldh.la.gov/page/4361.
Form/Document Name Web Address
Job Assessment, Job Discovery, and Job
Development Completion Form
https://ldh.la.gov/page/4361
Rights and Responsibilities Form
(Beneficiary)
https://ldh.la.gov/page/4361
Statewide Incident Management System https://ldh.la.gov/page/137
Quality Enhancement Provider Handbook https://ldh.la.gov/page/4361
Universal Plan of Care document and
attachments
https://ldh.la.gov/page/4361
Guidelines for support planning https://ldh.la.gov/page/4361
Bureau of Health Services Financing
(BHSF) Form 90-L
http://www.ldh.la.gov/assets/docs/OCDD/waiver/N
OW/90LForm0318Fillable.pdf
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CHAPTER 43: SUPPORTS WAIVER
APPENDIX E – CLAIMS FILING PAGE(S) 5
Claims Filing Page 1 of 5 Appendix E
CLAIMS FILING
Hard copy billing of waiver services are billed on the paper CMS-1500 (02/12) claim form or
electronically on the 837P Professional transaction. Instructions in this appendix are for
completing the CMS-1500; however, the same information is required when billing claims
electronically. Items to be completed are listed as required, situational or optional.
Required information must be entered in order for the claim to process. Claims submitted with
missing or invalid information in these fields will be returned unprocessed to the provider with a
rejection letter listing the reason(s) the claims are being returned, or will be denied through the
system. These claims cannot be processed until corrected and resubmitted by the provider.
Situational information may be required, but only in certain circumstances as detailed in the
instructions that follow.
Paper claims should be submitted to:
Gainwell Technologies
P.O. Box 91020
Baton Rouge, LA 70821
Services may be billed using:
1. The rendering provider’s individual provider number as the billing provider number
for independently practicing providers; or
2. Group provider number as the billing provider number and the individual rendering
provider number as the attending provider when the individual is working through
a ‘group/clinic’ practice.
NOTE: Electronic claims submission is the preferred method for billing. (See the EDI
Specifications located on the Louisiana Medicaid web site at www.lamedicaid.com, directory link
“HIPAA Information Center, sub-link “5010v of the Electronic Transactions” – 837P Professional
Guide).
LOUISIANA MEDICAID PROGRAM ISSUED: 05/26/23
REPLACED: 12/21/21
CHAPTER 43: SUPPORTS WAIVER
APPENDIX E – CLAIMS FILING PAGE(S) 5
Claims Filing Page 2 of 5 Appendix E
This appendix includes the following:
1. Instructions for completing the CMS-1500 claim form and a sample of a completed
CMS-1500 claim form; and
2. Instructions for adjusting/voiding a claim and a sample of an adjusted CMS-1500
claim form.
CMS 1500 (02/12) Instructions for Waiver Services
In order to access the CMS 1500 (02/12) instructions for waiver services and to view sample
forms, use the following link:
https://www.lamedicaid.com/Provweb1/billing_information/CMS_1500.htm.
NOTE: You must write “WAIVER” at the top center of the claim form.
ADJUSTING/VOIDING CLAIMS
An adjustment or void may be submitted electronically or by using the CMS-1500 (02/12) form.
Only a paid claim can be adjusted or voided. Denied claims must be corrected and resubmitted –
not adjusted or voided.
Only one claim line can be adjusted or voided on each adjustment/void form.
For those claims where multiple services are billed and paid by service line, a separate
adjustment/void form is required for each claim line if more than one claim line on a multiple line
claim form must be adjusted or voided.
The provider should complete the information on the adjustment exactly as it appeared on the
original claim, changing only the item(s) that was in error and noting the reason for the
change in the space provided on the claim.
LOUISIANA MEDICAID PROGRAM ISSUED: 05/26/23
REPLACED: 12/21/21
CHAPTER 43: SUPPORTS WAIVER
APPENDIX E – CLAIMS FILING PAGE(S) 5
Claims Filing Page 3 of 5 Appendix E
If a paid claim is being voided, the provider must enter all the information on the void from the
original claim exactly as it appeared on the original claim. After a voided claim has appeared on
the remittance advice, a corrected claim may be resubmitted (if applicable).
Only the paid claim's most recently approved internal control number (ICN) can be adjusted or
voided; thus:
1. If the claim has been successfully adjusted previously, the most current ICN (the
ICN of the adjustment) must be used to further adjust the claim or to void the claim;
or
2. If the claim has been successfully voided previously, the claim must be resubmitted
as an original claim. The ICN of the voided claim is no longer active in claims
history.
If a paid claim must be adjusted, almost all data can be corrected through an adjustment with the
exception of the Provider Identification Number and the Beneficiary/Patient Identification
Number. Claims paid to an incorrect provider number or for the wrong Medicaid beneficiary
cannot be adjusted. They must be voided and corrected claims submitted.
Adjustments/Voids Appearing on the Remittance Advice
When an Adjustment/Void Form has been processed, it will appear on the Remittance Advice
under Adjustment or Voided Claim. The adjustment or void will appear first. The original claim
line will appear in the section directly beneath the Adjustment/Void section.
The approved adjustment will replace the approved original and will be listed under the
"Adjustment" section on the RA. The original payment will be taken back on the same RA and
appear in the "Previously Paid" column.
When the void claim is approved, it will be listed under the "Void" column of the RA.
An Adjustment/Void will generate Credit and Debit Entries which appear in the Remittance
Summary on the last page of the Remittance Advice.
Sample forms are on the following pages.
LOUISIANA MEDICAID PROGRAM ISSUED: 05/26/23
REPLACED: 12/21/21
CHAPTER 43: SUPPORTS WAIVER
APPENDIX E – CLAIMS FILING PAGE(S) 5
Claims Filing Page 4 of 5 Appendix E
SAMPLE WAIVER CLAIM FORM ADJUSTMENT WITH ICD-10 DIAGNOSIS CODE
(DATES ON OR AFTER 10/01/15)
LOUISIANA MEDICAID PROGRAM ISSUED: 05/26/23
REPLACED: 12/21/21
CHAPTER 43: SUPPORTS WAIVER
APPENDIX E – CLAIMS FILING PAGE(S) 5
Claims Filing Page 5 of 5 Appendix E
