Application for a §1915 (c) hcbs waiver Submitted by


Attachment #1 to Appendix F-1

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Attachment #1 to Appendix F-1

Provide a copy of the notice or notices that are used to inform individuals of the opportunity to request a Fair Hearing.



Please see attachment F-1 #1






Appendix G: Participant Safeguards

Appendix G-1: Response to Critical Events or Incidents

a. State Critical Event or Incident Reporting Requirements. Specify the types of critical events or incidents (including alleged abuse, neglect and exploitation) that the State requires to be reported for review and follow-up action by an appropriate authority, the individuals and/or entities that are required to report such events and incidents and the timelines for reporting. State laws, regulations, and policies referenced in this specification are available through the Medicaid agency or the operating agency (if applicable).

The provider shall document major and minor incidents and make the incident reports and related documentation available to the department upon request. The provider shall ensure cooperation in providing pertinent information regarding incidents as requested by the department. Major incident means an occurrence involving a consumer of services that results in physical injury to or by the consumer that requires a physician’s treatments or admission, results in someone’s death, requires emergency mental health treatment for the consumer, requires the intervention of law enforcements; requires a report of child abuse pursuant to Iowa Code or a report of dependent abuse pursuant to Iowa Code, or constitutes a prescriptions medication error or a pattern of medication result in hospitalization or death. A minor incident means occurrence involving a consumer of services that is not a major incident and that results in the application of basic first aid; results in bruins, results in seizure activity, results injury to self or others or property, or constitutes a prescription medication error. When a major incident occurs, provider staff shall notify the consumer or the consumer’s legal guardian within 72 hours of the incident and shall distribute a complete incident report reform as follows:


  • Forward a copy to the supervisor with 24 hours of the incident

  • Send a copy of the report to the consumers Medicaid targeted case manager (when applicable) and the department’s Bureau of Long Term Care within 72 hours of the incident

  • File a copy of the report in a centralized location and make a notation in the consumer’s file

As part of the quality assurance policies and procedures for Home and Community Based Waivers all incidents will be a monitored by the HCBS specialists. On quarterly basis a QA committee will review data collected on incidents and will analyze data to determine trends, problems and issues in service delivery and make recommendations of any policy changes.




b. Participant Training and Education. Describe how training and/or information is provided to participants (and/or families or legal representatives, as appropriate) concerning protections from abuse, neglect, and exploitation and how participants (and/or families or legal representatives, as appropriate) can notify appropriate authorities or entities when the participant may have experienced abuse, neglect or exploitation.

Information concerning participants’ protections is provided to consumers at the time of their application. The case manager also shares information at the time of service plan development. In addition this information is shared with consumers during the HCBS consumer Quality assurance interview process. Information is also on the Iowa Department of Human Services website. The Department of Human service recognizes the need to provide this training on a more formal process to participants. The state will develop a process by July 2006 to ensure that service workers and case managers provide this information to consumers at a minimum on a yearly basis. Service workers will be provided with information concerning protections from abuse and neglect to discuss with consumers and their families. This will also be a milestone developed on the Individualized Services Information System (ISIS) to monitor that is this completed with consumers



c. Responsibility for Review of and Response to Critical Events or Incidents. Specify the entity (or entities) that receives reports of critical events or incidents specified in item G-1-a, the methods that are employed to evaluate such reports, and the processes and time-frames for responding to critical events or incidents, including conducting investigations.

For both Child and Adult Abuse, the Department of Human Services, protective service agency, receives the reports and if immediate threat of physical safety is believed to exist, the Department will make every effort to examine that child or adult with in one hour of receipt and/or take any lawful action necessary. If the adult or child is not in danger, the Department will make every effort to examine the adult or child within 24 hours. The Department will provide an evaluation report within 20 days of receipt of the report, which will include necessary actions, and/or an assessment of services needed. The Central Registry of Abuse shall receive the reports as well as the county attorney office. In addition, the Iowa Department of Human Services’ HCBS specialist also receives incident reports. If the incident is a situation that has caused or is likely to cause a serious injury, impairment or abuse to the consumer and if the Iowa Department protective services agency has completed or is in the process of conducting an investigation, the HCBS specialist will coordinate with the other agency, if the protective services agency is not investigating, the HCBS specialist will begin an on site review within two working days of receipt of the report, if it is determined that immediate jeopardy has been removed or not present, the review will be initiated with in twenty working days of receipt of report. For other non-jeopardy incidents, a review will be initiated within twenty days. For both child and adult abuse cases, the consumer and/or the family are notified the results in writing by the department as soon as the investigation has concluded



d. Responsibility for Oversight of Critical Incidents and Events. Identify the State agency (or agencies) responsible for overseeing the reporting of and response to critical incidents or events that affect waiver participants.

The Department of Human Services has oversight for monitoring incidents that affect waiver participants. There is a HCBS quality assurance team that reviews all critical incident reports as soon as they are reported to the Department. All critical incidents are tracked in a critical incident database. This database tracks the date of the event, the waiver the consumer participates in, the provider if applicable, and the nature of the event and follow up that was provided. If the incident is a situation that has caused or is likely to cause a serious injury, impairment or abuse to the consumer and if the Iowa Department protective services agency has completed or is in the process of conducting an investigation, the HCBS specialist will coordinate with the other agency, if the protective services agency is not investigating, the HCBS specialist will begin an on site review within two working days of receipt of the report, if it is determined that immediate jeopardy has been removed or not present, the review will be initiated with in twenty working days of receipt of report. For other non-jeopardy incidents, a review will be initiated within twenty days. The HCBS quality assurance team meet monthly to review the data tracked in the critical incident data base and decide if policy changes are needed or if additional training needs to be provided.





Appendix G-2: Safeguards Concerning Restraints and Restrictive Interventions


This Appendix must be completed when state policy permits the use of restraints and/or restrictive interventions during the course of the provision of waiver services regardless of setting.

a. Applicability. Select one:




This Appendix is not applicable. The State does not permit the use of restraints or restrictive interventions (do not complete the remaining items)

X

This Appendix applies. Check each that applies:




X

The use of personal restraints, drugs used as restraints, mechanical restraints and/or seclusion is permitted subject to State safeguards concerning their use. Complete item G-2-b.

X

Service furnished to waiver participants may include the use of restrictive interventions subject to State safeguards concerning their use. Complete items G-2-c.

b. Safeguards Concerning Use of Restraints or Seclusion

i. Safeguards Concerning the Use of Restraints or Seclusion. Specify the safeguards that the State has established concerning the use of each type of restraint (i.e., personal restraints, drugs used as restraints, mechanical restraints or seclusion). State laws, regulations, and policies that are referenced are available through the Medicaid agency or the operating agency (if applicable).

All restrictive interventions must be identified in the service plan, including the type of restrictions used and the situations in which they may be used and the alternative methods that should be used first. The use of restrictive interventions are reviewed during the quality assurance review process to ensure the health and safety of an individual. The department requires that providers who use restraints, have policy and procedures in place for how and when these are used and the training and education that is required for those who are authorized to use restraints. These policies and procedures are reviewed during the quality assurance review process. The Department of Human Services recognizes the need to develop an oversight process for the use of restraints and the state will develop this process by July 2006




ii. State Oversight Responsibility. Specify the State agency (or agencies) responsible for overseeing the use of restraints or seclusion and ensuring that State safeguards concerning their use are followed and how such oversight is conducted and its frequency:

The Department of Human Services monitors the service plans through the quality assurance process. If restraints are used and are listed on the service plan, the state will request to see providers policy and procedures in regards to restraints. The state will also review the alternative methods that should be used first to determine if that is the case. The department will work with the provider if it is determined that unauthorized restraints are used. If necessary, adult protective services within the department will be asked to investigate if it is determined that abuse or neglect has occurred with the use of restraints. The Department of Human Services recognizes the need to develop a formal oversight process for the use of restraints and the state will develop this process by July 2006




c. Safeguards Concerning the Use of Restrictive Interventions

i. Safeguards Concerning the Use of Restrictive Interventions. Specify the safeguards that the State has in effect concerning the use of interventions that restrict participant movement, participant access to other individuals, locations or activities, restrict participant rights or employ aversive methods (not including restraints or seclusion) to modify behavior. State laws, regulations, and policies referenced in the specification are available through the Medicaid agency or the operating agency.

All restrictive interventions must be identified in the service plan, including the type of restrictions used and the situations in which they may be used, who is authorized to perform restrictions and that the use of non-aversive methods are used first. The use of restrictive interventions are reviewed during the quality assurance review process to ensure the health and safety of an individual. The department requires that providers, who use restrictive interventions, have policy and procedures in place for how and when these are used and the training and education that is required. These policies and procedures are reviewed during the quality assurance review process. The Department of Human Services recognizes the need to develop an oversight process for the use of restrictive interventions and the state will develop this process by July 2006




ii.State Oversight Responsibility. Specify the State agency (or agencies) responsible for monitoring and overseeing the use of restrictive interventions and how this oversight is conducted and its frequency:


The Department of Human Services monitors the service plans through the quality assurance process. If restrictions are used and are listed on the service plan, the state will request to see providers’ policy and procedures in regards to restrictions. The state will also review the alternative methods that should be used first to determine if that is the case. The department will work with the provider if it is determined that unauthorized restraints are used. If necessary, adult protective services within the department will be asked to investigate if it is determined that abuse or neglect has occurred with the use of restraints. The Department of Human Services recognizes the need to develop a formal oversight process for the use of restraints and the state will develop this process by July 2006


Appendix G-3: Medication Management and Administration

This Appendix must be completed when waiver services are furnished to participants who are served in licensed or unlicensed living arrangements where a provider has round-the-clock responsibility for the health and welfare of residents. The Appendix does need not be completed when waiver participants are served exclusively in their own personal residences or in the home of a family member.

a. Applicability. Select one:

X

Yes. This Appendix applies (complete the remaining items).


No. This Appendix is not applicable (do not complete the remaining items).


b. Medication Management and Follow-Up

i. Responsibility. Specify the entity (or entities) that have ongoing responsibility for monitoring participant medication regimens, the methods for conducting monitoring, and the frequency of monitoring.

The department of Inspections and Appeals is responsible for consumer’s medication regimes for waiver consumers served in a residential care facility. All medical regimes are included in the consumer’s record. Medications administered by the facility are recorded on a medical record by the individual who administers medication. All Residential care facilities are licensed facilities and must meet all Department of Inspections Rules and Regulations to obtain a license that is renewed on an annual basis medical records are reviewed during the licensure renewal. Persons administrating medication shall be a licensed nurse or physician or have successfully completed a department approved medication aide course.

For respite services, if the provider stores, handles, prescribes, dispenses or administers prescription or over-the-counter medications, the provider shall develop procedures for the storage, handling, prescribing, dispensing or administration of medication. For controlled substances, procedures shall be in accordance with department of inspections and appeals.

If the provider has a physician on staff or under contract, the physician shall review and document the provider’s prescribed medication regime at least annually in accordance with current medical practice.



ii. Methods of State Oversight and Follow-Up. Describe: (a) the method(s) that the State uses to ensure that participant medications are managed appropriately, including: (a) the identification of potentially harmful practices (e.g., the concurrent use of contraindicated medications); (b) the method(s) for following up on potentially harmful practices; and, (c) the State agency (or agencies) that is responsible for follow-up and oversight.

The department of Inspections and Appeals is responsible for the oversight. The department of Inspections and Appeals communicate all findings with the Department of Human Services department and any issues they find with Residential Care Facilities during their licensures process or if any issues or critical incidents arise. Monitoring is done at a minimum on an annual basis or as issues or critical incidents arise. The Department of Inspections and Appeals tracks information and provides training as necessary to improve quality. This information is also shared with the Department of Human Services.
To be enrolled as a respite provider, the agency must supply to provider enrollment their policy and procedures for Medication Management. Providers also must submit any major incidents of medication errors to the HCBS Specialists for the Iowa Department of Human Services. The Quality Assurance Sub committee reviews any trends of medication errors. In addition the provider must track and trend any minor incidents. Department of Inspections and Appeals is responsible for oversight of Home Health Agencies.



c. Medication Administration by Waiver Providers

i. Provider Administration of Medications. Select one:

X


Waiver providers are responsible for the administration of medications to waiver participants who cannot self-administer and/or have responsibility to oversee participant self-administration of medications. (complete the remaining items)



Not applicable. (do not complete the remaining items)

ii. State Policy. Summarize the State policies that apply to the administration of medications by waiver providers or waiver provider responsibilities when participants self-administer medications, including (if applicable) policies concerning medication administration by non-medical waiver provider personnel. State laws, regulations, and policies referenced in the specification are available through the Medicaid agency or the operating agency (if applicable).

Providers of respite must have polices and procedures developed for dispensing, storage and recording all prescription and nonprescription medication administered during respite provisions. Home Health agencies must follow Medicare regulations for medication dispensing. All medications shall be stored in their original containers, with the accompanying physician’s or pharmacist’s directions and label intact. Medications shall be stored so they are inaccessible to consumers and the public. Nonprescription medications shall be labeled with the consumer’s name. In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription.

All providers of respite must develop policies that assure that personnel that administer medications have the appropriate skills and that there is oversight by medical personnel.






iii. Medication Error Reporting. Select one of the following:

X

Providers that are responsible for the administration of medications to waiver participants are required to both record and report medication errors to a State agency (or agencies). Complete the following three items:




(a) Specify State agency (or agencies) to which errors are reported:

The HCBS Specialists through the Iowa Department of Human Services


(b) Specify the types of medication errors that providers are required to record:

Only for major incidents of medication errors in which the health and safety of a consumer has been jeopardized are the providers required to report




(c) Specify the types of medication errors that providers must report to the State:

The providers must track and trend all minor incident reports




Providers responsible for the administration of medications to waiver participants are required to record medication errors but make information about medication errors available only when requested by the State. Specify the types of medication errors that providers are required to record:

Only for major incidents of medication errors in which the health and safety of a consumer has been jeopardized are the providers required to report




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