Supervision 525-05-30-63

(NEW 1/1/15 ML #3428)

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Purpose

Supervision may be provided to assist eligible recipients who live alone or with an individual who is not identified as a relative within the definition of family home care under subsection 4 of N.D.C.C. 50-06.2-02.

If the individual who is requesting supervision services lives with their ex­ spouse or one of their following relatives, or the current or former spouse of one of their following relatives, they are not eligible for supervision: Parent, grandparent, adult child, adult sibling, adult grandchild, adult niece or adult nephew.

• If a client lives with a relative but the relative is unable to provide supervision because of a physical or cognitive impairment contact a HCBS Program Administrator to discuss potential eligibility.

Up to 24 hours of supervision may be provided to individuals who because of their disability need monitoring to assure their continued health and safety. Recipients must have a need for supervision as described in this chapter.

Service Description

An individual could be considered to have a need for supervision if because of their impairment they have delusions, hallucinations, severe depression, emotionally labile (severe mood swings) and or other behaviors like screaming, hitting, kicking, biting, wandering, hyperactivity, aggression, inappropriateness, elopement (running away), or frequent falls that may require human intervention to safeguard the individual from harm. (The list of behaviors/needs is not an all-inclusive list).

• If a client requires supervision 24 hours per day, the case manager must justify in the narrative why the client needs the support of staff to assure health and safety needs are met at night. Providers, who provide supervision at night while the client is sleeping, must stay awake while providing supervision.
• Payment for supervision cannot be claimed while ADL & IADL supports or homemaker task are being provided. Those tasks would be billed under personal care or homemaker.

Service Eligibility, Criteria for

The individual receiving supervision will meet the following criteria:

1. Must be eligible for the HCBS Medicaid waiver program;
2. Lives alone or with an individual who does not meet the definition of relative under N.D.C.C. 50-06.2-02(4);
3. Be at least age 18;
4. The care needs of the client must fall within the scope of supervision as described in this service chapter.
5. If a client requires supervision 24 hours per day, the case manager must justify in the client narrative why the client needs the support of awake staff to assure health and safety needs are met at night. Providers, who provide supervision at night while the client is sleeping, must stay awake while providing supervision.
6. Prior approval from a HCBS Program Administrator is required before this service may be authorized.

Service Tasks/Activities

Allowable supervision tasks include: Having the knowledge of, and account for, the activity and whereabouts of the recipient at all times to allow immediate provider intervention as necessary to safeguard the individual from harm. During the time that the provider is supervising the recipient and is not actively providing personal care or homemaker tasks etc., they may play games, visit, read, and participate in activities with the client. If the client is physically able, they may also participate in activities on or around the recipient's home such as gardening, or going for short walks etc.

The following tasks are not considered allowable tasks under this chapter because they would be provided under personal care or homemaker:

Bathing, dress/undress, eye care, feeding/eating, hair/care/shaving, incontinence, mobility, nail (finger) care, skin care, teeth/mouth care, toileting, transferring/turning/ positioning. The global endorsements of exercise, hoyer lift/mechanized bath chair, indwelling catheter, medical gases, prosthetic, orthotics, suppository, bowel program, ted socks, Temp/BP/pulse/respiration rate. The client specific endorsements of apnea monitor, jobst stockings, ostomy care, postural /bronchial drainage, ric bed care. Communication, housework, laundry, meal preparation money management, and shopping are not allowable service tasks under this service. Clients, who live alone, or with a non-relative, are still eligible for home maker services. Medication assistance is not an allowable task under this service.

Supervision outside of the client's home

Payment cannot be made for time performing authorized supervision tasks outside of the client's home/grounds.

1. Exception: When the client is required to seek essential services i.e. medical care etc. outside of North Dakota, contact the HCBS Program Administrator for prior approval.
   • If a supervision client needs transportation to an essential community service non-medical transportation with escort may be authorized.

Cognitively Impaired Clients, Services to

For cognitively impaired clients who are receiving less than 24 hours of personal care with supervision, the care plan must identify how the daily care needs are being met (including supervision) during the time no provider is in the home. During those periods of time when personal care with supervision service is not being provided, cooperative and coordinated efforts of meeting the needs of the client by the family, other informal providers, must be identified.

Service Activities, Authorized and Limits

1. Clients who live alone or with someone who does NOT meet the definition of family member as defined in N.D.C.C. 50-06.2-02(4) may qualify for supervision.
   • If a client lives with a relative but the relative is unable to provide supervision because of a physical or cognitive impairment contact a HCBS Program Administrator to discuss potential eligibility.
2. Under Supervision, Community Integration, Social Appropriateness, and Transportation are tasks which cannot be authorized under this chapter. If a client needs these tasks they must be authorized under transitional care.
3. Supervision can be combined with adult day care, chore, environmental modification; extended personal care, homemaker, home delivered meals, non-medical transportation, non-medical transportation w/escort, personal care, transitional care, specialized equipment and supported employment.
4. Supervision cannot be combined with, respite care, emergency response system, adult family foster care, residential services, and family personal care.
5. For unusual or unique circumstances, prior approval from the HCBS Program Administrator must be obtained.

Authorizing Service

1. The service tasks/activities within the scope of this service chapter must be identified on the Authorization to Provide Service, SFN 404.
2. The amount of units allocated for supervision of the client is determined by subtracting the amount of time the client is receiving informal supports and authorized services i.e. personal care, homemaker etc. from a 24 hour period.

Example: a client receives 4 hours of informal supports and 6 hours per day of personal care they would be eligible for 14 hours of supervision.

3. The supervision provider may also be the personal care, homemaker provider etc. However, there must be more than one QSP identified on the care plan as it is not reasonable to allow one provider to be responsible for 24 hours of care per day.

Standards for Providers

Supervision providers must meet the same standards as respite providers that includes having the global endorsement for cognitive/supervision.