Supervision 525-05-30-63

(Revised 06/01/2025 ML #3921)

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Purpose

Supervision may be provided to assist eligible individuals remain in their home and community.

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).

• 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. Be at least age 18;
3. The care needs of the individual must fall within the scope of supervision as described in this service chapter.
4. If an individual requires supervision 24 hours per day, the case manager must justify in the individual narrative/case note why the individual needs the support of awake staff to assure health and safety needs are met at night. Providers, who provide supervision at night while the individual is sleeping must stay awake while providing supervision.

Service Location

Services will be administered in the most integrated setting consistent with the Person Centered Plan of Care, including (checked if allowable):

ü The individual's home

□ Workplace

□ Other community service settings

Service Tasks/Activities

Allowable supervision tasks include: Having the knowledge of, and account for, the activity and whereabouts of the individual 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 individual and is not actively providing personal care or homemaker tasks etc., they may play games, visit, read, and participate in activities with the individual. If the individual is physically able, they may also participate in activities on or around the individual'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 SPED personal care, Medicaid State Plan personal care, waiver 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. Medication assistance is not an allowable task under this service.

Supervision outside of the individual's home

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

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

Cognitively Impaired Individuals, Services to

For cognitively impaired individuals who are receiving less than 24 hours of care, 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 supervision or other services are not being provided, cooperative and coordinated efforts of meeting the needs of the individual by the family, other informal providers, must be identified.

Service Activities, Authorized and Limits

1. Supervision does not include taking/transporting recipients out of the home to community/social events etc.

   • Under Supervision, Community Integration, Social Appropriateness, and Transportation are tasks which cannot be authorized under this chapter. If an individual needs these tasks they must be authorized under Transitional Living, Residential Habilitation, or Community Support Services.

2. Supervision can be authorized with the following services, but payment for supervision cannot be claimed, during the time these services are being provided: Homemaker, Respite Care, Extended Personal Care, Chore, Non-Medical Transportation, Medicaid State Plan Personal Care, Transitional Living, Supported Employment, Adult Day Care, Community Transition Services and Companionship Services. Supervision cannot duplicate the services provided under Transitional Living.

3. To avoid duplication of services, Supervision cannot be combined with: Adult Foster Care, Residential Services, Residential Habilitation, Community Support and Family Personal Care as supervision is already an allowable task under these services.

4. Supervision cannot be combined with an Emergency Response System as this service is not meant to replace the need for human intervention. For unusual or unique circumstances, approval from the HCBS Program Administrator must be obtained.

5. In circumstances where live-in providers are seeking to provide personal care under a unit rate, combined with supervision, the case managers must seek prior-approval for this service combination.

6. For unusual or unique circumstances, contact the HCBS Program Administrator in writing for consideration as a potential reasonable modification based on the totality of the circumstances.

Authorizing Service

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

Example: If an individual requiring 24/7 supports 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.

Providers

Supervision may be provided by the following individual QSP's or employees of a QSP agency (checked if allowable):

□ Guardian

□ Legally Responsible Person - Legal spouse or parent of a minor child.

üRelative within the definition of Family Home Care under subsection 4 of N.D.C.C. 50-06.2-02.

When an individual is requesting supervision by a live-in relative meeting the definition of a “family member” or a live-in provider who has a close personal relationship with the individual to be authorized, consult with program administration for consideration. This includes individuals who may be hired to provide care under a QSP agency.