Technology Dependent Medicaid Waiver 525-05-25-12

(Revised 2/1/17 ML #3490)

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In order for services to be payable under the provisions of the Medicaid Waiver for Home and Community Based Services, the person receiving the service must meet all of the following:

1. Recipient of Medicaid Program under the State Plan for Medical Assistance as set forth in Service Chapter 510-05, Medical Assistance Eligibility Factors;  
2. Age 18 or older and physically disabled as determined by the Social Security Administration, or be at least 65 years of age;
3. Eligible to receive care in a skilled nursing facility;
4. Ventilator dependent minimum of 20 hours per day;
5. Medically stable - documented by primary physician at a minimum on annual basis;
6. Has an informal caregiver system for contingency planning;
7. Is competent to participate in development of care plan as documented by physician annually;
8. Have Person Centered Plan of Care SFN 404, developed and approved by the applicant/client or legal representative and HCBS case manager that adequately meets the health, safety, and personal care needs of the recipient
9. Voluntarily choose to participate in the Technology Dependent Waiver after discussion of available options. This is documented by the completion of Explanation of Client Choice, SFN 1597;
10. Receive services on a monthly basis (does not include Case Management); and
11. Not eligible or receiving services through other waivers.

Waiver Service Setting Requirements: effective 12/31/2016

All waiver service settings and the delivery of services in those settings must:

1. Be integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
2. Be selected by the individual from among setting options including non-disability specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the individual's needs, preferences, and, for residential settings, resources available for room and board.
3. Ensure an individual’s right of privacy, dignity, and respect. Coercion, and or seclusion, of waiver recipients is expressly prohibit in all service settings. Restraint of waiver recipients is also expressly prohibited.
4. Optimize but not regiment, individual initiative, autonomy, and independence in making life choices, including, but not limited to, daily activities, physical environment, and with whom to interact.
5. Facilitate individual choice regarding services and supports, and who provides them.

Provider owned or controlled residential settings must also:

1. Be a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity.
2. Offer privacy in their sleeping or living unit. The unit must have entrance doors lockable by the individual with only appropriate staff having keys to the doors.
3. Offer a choice of roommates within the setting.
4. Allow the recipient the freedom to furnish and decorate their sleeping unit or living units within the lease or other agreement.
5. Allow the recipient freedom and support to control their schedule and activities and have access to food at any time.
6. Allow the recipient to have visitors of their choosing at any time.
7. Be physically accessible to the individual.

Any modification of the additional conditions must be supported by a specific assessed need and justified in the person-centered service plan. The following requirements must be documented in the person-centered service plan: Specific individualized assessed need; Prior interventions and supports including less intrusive methods; description of condition proportionate to assessed need; ongoing data measuring effectiveness of modification, established time lines for periodic review of modifications; individual’s informed consent; and assurance that interventions and supports will not cause harm.

Waiver services cannot be provided in the following settings:

• A nursing facility; (Institutional Respite care is excluded from this requirement)
• An institution for mental diseases;
• An intermediate care facility for individuals with intellectual disabilities;
• A hospital;
• Any other locations that have qualities of an institutional setting as determined by the Secretary or:
• Any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS

Prohibited Activities effective 12/31/2016

The provision of services funder under the technology dependent waiver must ensure an individual’s right of privacy, dignity, and respect. Coercion, and or seclusion, of waiver recipients is expressly prohibited in all settings where technology dependent waiver services are provided.

Critical Incident Reporting

Unauthorized restraints are required to be reported as suspected abuse, neglect, or exploitation per NDCC 50-25.2.