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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsOctober 2013

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Division of Medicaid and Medical Assistance/Division of Developmental Disabilities Services
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the August 2013 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by August 31, 2013 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Social Security Act §1915(c), Provisions Respecting Inapplicability and Waiver of Certain Requirements of this Title
42 CFR §441, Subpart G, Home and Community-Based Services Waiver Requirements
42 CFR §447.205, Public Notice of Changes in Statewide Methods and Standards for Setting Payment Rates
First, the current “supported employment” definition contains an exclusion for transportation: “Transportation is not included in supported employment services.” At page 158. In contrast, the proposed definitions of individual and group supported employment include transportation as an included expense.1 At pages 158-159. GACEC advises that this change merits the endorsement of the Council; and, SCPD strongly endorses this revision.
A. The “Waiver” still contains references to the old standard. See, e.g., attached page 92: “The DDDS Case Manager reviews and monitors the implementation of services at least monthly through a direct, person to person meeting and discussion with the participant.”
C. It’s unclear what documentation would be analyzed by the case manager conducting a monthly “paper” review. Attendance reports may be available on a monthly basis but would not be informative in the context of progress on ELP vocational goals. See attached page 156 from Waiver. The Waiver only contemplates submission of vocational work reports on a quarterly, not a monthly basis. See attached page 91. DHSS could consider either making submission of vocational work reports a monthly requirement or requiring submission of other documentation to allow for meaningful monthly review. For example, Chimes prepares a detailed monthly vocational report. See attached form.
See attached page 154 from Waiver. The Councils could not locate any analog for “rounding” for 15 minute billable units for supported employment, pre-vocational services, and day programming. Clarification would be preferable.
Agency Response: DMMA/DDDS appreciate the Councils’ endorsement of our intention to make transportation available to individuals receiving Supported Employment.
The new language now indicates that the case manager must have a face to face meeting with the participant at least once each calendar quarter. We have also correct page 92 of the application to be consistent with the new standard. We hope this has addressed your concerns.
Please note related changes on DMMA Final Order Regulation #13-36 Attachment indicated by [Bracketed Bold language] for text added at the time the final order was issued and by [Bracketed bold stricken through] for language deleted at the time the final order was issued.
THEREFORE, IT IS ORDERED, that the proposed regulation to publish for public comment a draft of the Division of Developmental Disabilities Services (DDDS) 1915(c) Home and Community-Based Services Waiver (HCBS) waiver to add a new core service, Group Supported Employment, is adopted and shall be final effective October 10, 2013.
[Documentation is maintained that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or IDEA (20 U.S.C. 1401 et seq.) Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: incentive payments made to an employer to encourage or subsidize the employer's participation in supported employment; or payments that are passed through to users of supported employment services.]
The DDDS State Case Manager monitors the contracted agency’s implementation of the participant’s plan of care (the ELP) on a monthly basis[. In addition to the monthly paper monitoring, this includes a direct interview with the participant four times per year, two of which must be in the participant’s home, to review the plan with the participant and his/her family or guardian to assess their satisfaction with the services provided and to review how the participant is progressing with the attainment of his/her state priority outcomes. with the participant and/or appropriate team members. At least once each calendar quarter, the case manager will conduct a face to face interview with the participant. The case manager must conduct at least two of the face to face interviews in the participant’s home, during which the plan is reviewed with the participant, his/her or guardian, if applicable, and/or appropriate team members to assess their satisfaction with the services provided and to review how the participant is progressing with the attainment of his/her stated priority outcomes.] In effect, the participant has a known advocate with the state, which maintains contractual authority over the provider agency.
[The percentage of participants whose State Case Managers have visited with them for the purpose of reviewing the Plan of Care at least four times per year, of which two visits must be in the participant’s home. (The number of participants whose State Case Managers have visited with them for the purpose of reviewing the Plan of Care at least every four months (two of which must be in the home)/the number of participants whose services and supports were reviewed by OQM.) The% of participants whose Case Manager met them to review the Plan of Care at least once each calendar qtr, 2 of which must be in the participant’s home w/i the plan year. (# of participants whose Case Manager met them to review the POC at least once each calendar qtr (2 of which must be in the home within the plan year)/# of participants whose services and supports were reviewed by OQM.)]

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Last Updated: December 31 1969 19:00:00.
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