At-Home Day Program (37U) Use Effective 7/1/20

Purpose:

The Division of Developmental Disabilities (DDD) is providing new guidance on the use of At-Home Day Program 37U for individuals with I/DD residing in Community Integrated Living Arrangements (CILA) (60D & 65H) or Community Living Facilities (67D & 67E).

Overarching:

At-Home Day Program (37U) is part of the residential habilitation program for Adult Waiver participants. Through At-Home Day Programs, CILA and CLF providers furnish staff and other supports necessary to enable individuals to engage in a structured individualized program of in-home and community habilitation activities of his or her choosing.

This program is being authorized for all individuals living in CILA and CLFs due to the COVID-19 pandemic and does not require prior approval.

There is a fiscal year maximum of 1,100 hours for any combination of day programs or supported employment. These include: Community Day Services (31U, 31C), Adult Day Services (35U), Supported Employment (39U) and At Home Day Program (37U).

Billing and Documentation Requirements:

1. At-Home Day Program (37U) has a state fiscal year maximum of 1,100 hours for any combination of day programs or supported employment. Monthly maximum is 115 hours for any combination of day programs or supported employment.
2. At-Home Day Program must be coordinated with other day programs or supported employment to ensure that all providers are able to properly bill for services. Providers should take the monthly and annual maximum hours into consideration when planning and billing.
3. At-Home Day Program Providers can only bill up to 5 hours per day, Monday through Friday.
4. Providers can only bill for hours that individuals are present and receiving a structured habilitative program.
5. There should be documentation of the time, activities and support provided to each individual on a daily basis. This documentation should include:
   • Start and end time(s).
   • Activities and support provided.
   • Location(s) of such activities.
   • Any progress towards outcomes identified in the Personal Plan and Implementation Strategy.
   • Staff signature and date.
6. At least monthly, the QIDP shall review the Implementation Strategy and shall document in the individual's record whether:
   • Services are being implemented as identified in the Implementation Strategy.
   • Services identified in the Implementation Strategy continue to meet the individual's needs or require modification to better meet the individual's needs.
   • Outcomes are being supported as specified in the Personal Plan and Implementation Strategy.
   • Progress is being made toward outcomes as identified in the Personal Plan and Implementation Strategy. In situation when there is no progress made, provider agencies must document barriers and/or reasons why progress was not made and actions are recommended when needed.
7. Documentation must be kept in the individual's file and available for review by the individual's Independent Service Coordination (ISC) Agency, Bureau of Accreditation and Licensure and Certification, and the Division for audit trail documentation and quality management review.
8. Examples of time that are not billable include:
   • Holidays and weekends.
   • Time when no structured individualized program of in-home and community habilitation activities is being provided.
   • Time when an individual is sick, home waiting for an appointment, out with family or other natural supports, independent in the community or away from another day programs (31U, 31C, 35U, 39U).
   • Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
   • Lunchtime, unless the individual's plan indicates a need for active programming during lunch and the training is being provided.
   • Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.
9. Hours billed may not also be billed to the Department on Aging or the Division of Rehabilitation Services Home Services Program.
10. Enhanced staffing for Residential/53R can be authorized for those individuals that require 1:1 staffing support during billable 37U hours. This will require prior approval.
11. Sufficient staff must be provided to allow for each individual in At-Home Day program to participate in a structured, individualized program as they choose. For example, if a person in the home does not want to participate in At-Home Day program the provider must still provide sufficient supervision and support and allow the other individuals to participate in At-Home Day programming of their choosing. The Division expects there will be no fewer staff than those provided during second shift, evening shift, and/or weekend staffing models.
12. For Intermittent CILA (including Family CILA) the provider should provide a 1:4, or less, staffing ratio.

Provider Qualifications:

At Home Day Program providers must:

• Hold a CILA or CLF License.
• Be provided by the same agency as the individual's residential services.

At Home Day Programming:

1. At-Home Day should provide a structured, individualized program provided at an individual's home or in the community.
2. For individuals' health and safety during this pandemic, the Division strongly discourages mixing individuals from multiple sites. Individuals should be supported with their roommates to participate in their chosen programming and activities.
3. When possible and appropriate, programming should include activities in the community. All social distancing and face covering guidelines should be followed.
4. Providers should issue information to the individuals they serve and families detailing daily programming and activities.
5. Programming should be person-centered. Providers should consider the following:
   • Creating and implementing a formalized process for discussing an individual's desired day program activities, both at-home and in the community.
   • Providing activities in the community that the individuals enjoy such as going on walks in a local forest preserve, going to a zoo, outdoor pastimes, etc.
   • Creating and presenting a calendar of activities for individuals that incorporates their input.
   • Providing opportunities for discussion about current events.
   • Creating a formalized mechanism for feedback on quality and enjoyment of activity.
   • Connecting virtually with individuals in other homes, family members and members of the community at large and developing a "pen pal" program.
   • Creating a database of activities that can be shared among homes within a provider agency.
   • Reaching out to local libraries, museums, and educational institutions to learn about their virtual programming.
6. Providers should issue information to individuals they serve and families detailing how safety measures will be taken both in the home and in the community.

ISCs and Personal Plans:

1. ISCs must edit the Personal Plan of each person in a CILA (60D & 65H) or Community Living Facility (67D & 67E) by adding At-Home Day Program (37U).
   • The start date for services is July 1, 2020.
   • It is not necessary to review/revise the Discovery Tool at this time, unless this change coincides with the annual Plan update.
   • It is not necessary to submit a Request for At-Home Day Program. All individuals in CILA and CLF are approved.
2. ISCs should add At-Home Day Program as a service to the Service and Support page of the Personal Plan.
   • The "Entity Responsible" will be the person's residential provider.
   • The frequency and duration should be addressed generally (1-5 days/week, up to 5 hours per day) until the ISC has a chance to talk with the individual/guardian. The location will be the person's residence and the community.
3. Although this service may be related to an outcome for some, there is no requirement to have an outcome for each service.
4. As with any edit to the Plan, it is not necessary to obtain new signatures from the individual/guardian; but the individual/guardian should be informed and the ISC must be available to answer any questions or address concerns.
   • This edit does not reset the annual renewal date for the Plan.
5. The ISC will not need to obtain a revised or new Provider Signature Page from the residential provider.

Providers and Implementation Strategies (IS):

1. Residential agencies providing CILA (60D & 65H) or Community Living Facility (67D & 67E) must add an addendum for At-Home Day Program (37U) to each person's Implementation Strategy.
2. The addendum must detail the activities that will occur for each person, and how the staff will support the person. Note: traditionally providers would be required to revise the entire IS.
3. The individual/guardian does not have to sign the addendum, but the provider must share the IS with them and be available to answer questions and address concerns.
4. The addendum must be signed by the provider agency and a copy sent to the ISC agency.
5. The ISC agency will add the addendum to the existing Plan/Provider Signature Page.

Effective Date:

Upon Final Posting