(DD) Waiver Service Standards - New Mexico Department of Health

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B. On-Site Inspections. All Provider Agencies shall submit to and cooperate with announced and unannounced inspection or survey and complaint investigations conducted by the DOH in order to receive or maintain a DDSD Waiver agreement and/or a contract with the DOH. The Provider Agency shall give the DOH immediate or reasonable access to all records required by these standards. The Provider Agency shall permit the DOH to have private interviews with individuals and staff. (1) Frequency and Type of Inspections: An inspection or survey may occur at the discretion of the DOH and may be triggered by an event including but not limited to any one of the following: (a) Prior to the issuance of an agreement and/or contract; (b) Prior to the annual renewal of an agreement and/or contract; (c) Upon complaint or allegation of violation of these standards; (d) When there has been a change in ownership of the Provider Agency; (e) When necessary to determine correction of cited deficiencies, compliance with a directed Plan of Correction or a Provider Agency generated Plan of Correction, or satisfaction of conditions placed on agreement and/or contract; (f) Through routine monitoring of the Provider Agency’s quarterly reports assessing the effectiveness of service delivery based on the selected performance indicators established from the requirements within these standards; and (g) Anytime the DOH has probable cause to believe a Provider Agency has violated a regulation or provision of these standards. (2) Retaliation Prohibition: The DOH will accept complaints from any party regarding suspected violation of these standards. The Provider Agency shall not retaliate against any staff, individual or his or her representative for filing a complaint or allegation. All complainants have immunity from civil or criminal liability when the complaint is made in good faith. Any violations noted during a complaint investigation will be reported to the Provider Agency in writing. (3) Enforcement Procedures: (a) After inspection, a report of findings will be sent to the Provider Agency if the inspection or survey identifies any failure to comply with these standards. A report of findings may be accompanied by a directed Plan of Correction. (b) The Provider Agency shall complete a Plan of Correction to correct each deficiency, sign and date the plan certifying that the plan will be 14
implemented, and return the plan to the DOH within ten (10) working days of receipt of any statement of deficiency. The plan will include detailed action steps and timelines for improvement. DDSD will verify implementation of the plan within the stated timelines. C. Sanctions. Failure to correct any deficiency(s) or to file a Plan of Correction with the DOH may lead to the immediate imposition of sanctions or penalties as described in paragraph (2) below: (1) The DOH will make the final determination regarding whether a Plan of Correction is acceptable and when it has been adequately implemented. (2) Grounds for Sanctions: The DOH is authorized to immediately impose one or more sanctions when any one of the circumstances listed below are present: (a) Operating without appropriate licensure; (b) Impeding or interfering with the enforcement of standards governing the agreement and/or contract of a Provider Agency, or giving false information in connection with the enforcement of these standards; (c) Failure to cooperate with DOH surveyors or inspectors; (d) Failure to submit a Plan of Correction within ten (10) working days after receipt of a report of findings; (e) Failure to take timely corrective action in accordance with a Plan of Correction or a directed plan of correction; (f) Failure to comply with applicable laws or standards; and (g) Failure to comply with DDSD performance expectations based on the requirements established with in these standards. (3) Interventions and Sanctions: The DOH is authorized to immediately impose one or more of the following sanctions when any one of the circumstances listed above are present and the DOH determines that a sanction is necessary and appropriate to ensure compliance with these standards and to protect the individuals receiving services: (a) The Provider Agency may be directed to immediately stop all new admissions regardless of payment source or to admit only those individuals the DOH approves of until such time as it determines that corrective action has been taken; (b) The DOH may issue a directed Plan of Correction; and (c) The DOH may impose a financial penalty upon a Provider Agency. (4) Financial Penalties: Financial penalties may be imposed when: 15
Page 1 and 2: Developmental Disabilities (DD) Wai
Page 3 and 4: Developmental Disabilities (DD) Wai
Page 5 and 6: TABLE OF CONTENTS C. Adult Habilita
Page 7 and 8: TABLE OF CONTENTS V. REQUIREMENTS U
Page 9 and 10: TABLE OF CONTENTS A. Provider Agenc
Page 11 and 12: TABLE OF CONTENTS D. Consultation w
Page 13 and 14: TABLE OF CONTENTS D. Non-Medical Tr
Page 15 and 16: DOH/DDSD (Appendix A) Individual Tr
Page 17 and 18: (b) Emotional, psychological, and p
Page 19 and 20: AD. AE. IDEA. means Individuals wit
Page 21 and 22: includes a functional assessment of
Page 23 and 24: CHAPTER 1 INTRODUCTION These standa
Page 25 and 26: (2) On the day a Provider Agency is
Page 27 and 28: provided to the receiving agency wh
Page 29 and 30: G. Transportation. Provider agencie
Page 31 and 32: equires delivery by licensed or cer
Page 33 and 34: F. Sanitation. When services are pr
Page 35: (6) Report required personnel train
Page 39 and 40: (g) Reduction in term of the agency
Page 41 and 42: (10) Non-Medical Transportation; (1
Page 43 and 44: (4) Physical Therapy (limited and w
Page 45 and 46: (l) Non-Medical Transportation; (m)
Page 47 and 48: (3) Service Options in Addition to
Page 49 and 50: age 22 or older who are receiving D
Page 51 and 52: CHAPTER 3 BEHAVIORAL SUPPORT CONSUL
Page 53 and 54: (2) Guide the IDT members in assess
Page 55 and 56: B. Behavioral Support Consultation
Page 57 and 58: (4) All Behavioral Support Consulta
Page 59 and 60: (d) Functional evaluations/assessme
Page 61 and 62: the training is not offered by DDSD
Page 63 and 64: K. Inform the individual of his or
Page 65 and 66: (2) A new history and physical; (3)
Page 67 and 68: of the Case Manager and all IDT mem
Page 69 and 70: (b) A change from a less restrictiv
Page 71 and 72: (b) Case Management Provider Agenci
Page 73 and 74: for at least 30 hours per week of p
Page 75 and 76: (c) Bachelor’s or Master’s degr
Page 77 and 78: its designee and will include the n
Page 79 and 80: (2) Services furnished to an indivi
Page 81 and 82: (6) Identification of barriers to i
Page 83 and 84: (4) Volunteer time in the community
Page 85 and 86: conservator, physician’s name(s)
Page 87 and 88:
(2) Whenever possible, direct suppo
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(9) Job coaching; (10) Situational
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(6) Individuals are not excluded fr
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Individual Supported Employment, a
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E. Reimbursement. (g) Assess barrie
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service are determined by the indiv
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(6) Community Access Coaching is al
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(10) The individual is provided opp
Page 103 and 104:
(p) Implement recommendations from
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The Adult Habilitation Service Prov
Page 107 and 108:
(25) Development of increased indep
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XV. PROVIDER AGENCY STAFF QUALIFICA
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CHAPTER 6 COMMUNITY LIVING SERVICES
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(4) Internal service coordination.
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(a) Documentation of determination
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(b) That each individual with a sco
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individual’s home and an updated
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G. IDT Coordination. (1) Appropriat
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J. Qualification for Agency Supervi
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(a) At a maximum of two (2) individ
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(2) Up to 1000 hours of substitute
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(15) Handrails, grab-bars, door han
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(5) Written verification that the c
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Funding for adaptations is availabl
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of a work uniform for an employed i
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CHAPTER 9 OUTLIER SERVICES I. OUTLI
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Necessity Outlier services, the ind
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(b) The billable unit for Outlier A
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III. PERSONAL PLAN FACILITATION REQ
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CHAPTER 11 PERSONAL SUPPORT SERVICE
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(4) Personal Support Services may n
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CHAPTER 12 RESPITE SERVICES I. RESP
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(c) Direct Support Staff are requir
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B. Eligibility for Medicaid DD Waiv
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(b) Therapy Provider Agencies shall
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D. Integrating Therapy Strategies i
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(f) An Occupational Therapy Aide/Te
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(3) Designing, building or preparin
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(12) Providing other non-administra
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(2) Collaborative therapy services
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F. Training Family/Support Staff. (
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(b) Relevant background information
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listed in the ISP. The therapy inte
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L. Discontinuation of Services Repo
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(c) Caregiver training and consulta
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(3) In the first year of service or
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G. Attend IDT meetings. H. The Tier
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E. Reimbursement. (e) Required DDSD
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R. Skin care; S. Weight management;
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CHAPTER 16 NUTRITIONAL COUNSELING S
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CHAPTER 17 NON-MEDICAL TRANSPORTATI
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support the planning process. This
Page 191 and 192:
CHAPTER 18 SUPPLEMENTAL DENTAL CARE
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(DD) Waiver Service Standards - New Mexico Department of Health

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