Stabilization Home Manual

Stabilization Home (SH) Manual

Mission Statement

It is our goal to provide people with I/DD who are experiencing acute behavioral health conditions, the supports necessary to achieve behavioral stabilization and develop the skills necessary to successfully live in community-based environments.

Introduction
Overview of Services
Eligibility and Referrals for Support at a Stabilization Home
Stabilization Home Provider Requirements
Home Expectations
Programmatic Requirements
1. Client Rights
2. Staffing
3. Meetings
4. Weekly Schedule
Medical, Mental Health, and Behavioral Health Requirements
1. Medical Care
2. Behavioral Health Care
Administrative Requirements
1. Record Keeping
2. New Admission Process
3. Transition to Originating Provider and Discharge from Stabilization Home
4. Billing and Payments
Originating Provider Requirements

1. Introduction

The 24- hour Stabilization Home (SH) is a program within the Illinois Department of Human Services, Division of Developmental Disabilities (IDHS,DDD) Adult Medicaid waiver designed to meet the needs of individuals with intellectual and developmental disabilities (I/DD) ages 18+ who are experiencing acute behavioral health conditions. They may be living in community-based settings, searching for community placement, transitioning from hospital settings, or child group home settings and require temporary services outside of their existing settings. This is a manual that outlines service provisions for short-term and long-term stabilization homes.

2. Overview of Services

The SH will provide comprehensive clinical supports to individuals who are experiencing behavioral health challenges in their current living situation. SH providers are not able to decline any referrals from the DDD. Services may include, but are not limited to, the development of a sustainable behavior plan and interventions, implementation of positive and necessary behavior interventions, monitoring and tracking of individuals' behaviors and medications, access to psychiatric supports, remediation of negative peer-to-peer interactions, resolution of other issues that are jeopardizing the individual's current community placement, and technical assistance to habilitation service providers serving the individual or potential habilitation service providers that may serve the individual.

During the individual's stay in the SH, the SH will work closely with the Support Services Team (SST), Independent Service Coordinator (ISC), guardian, provider agency, and IDHS, DDD. The SH will host Interdisciplinary meetings to review progress as they work towards stabilization; as the individual moves forward through the stabilization and/or transition process, the SH will work collaboratively with SST to provide training and support to prepare both the individual, and the provider agency/family, for a successful transition.

The SH program maintains 2 types of 24-Hour Stabilization Services: Short Term Stabilization Homes (90 days); and Long-Term Stabilization Homes (1-2 years).

3. Eligibility and Referrals for Support at a Stabilization Home (SH)

SHs are available for individuals with ID/DD who are receiving waiver services or are on the PUNS list. Appropriate referrals include individuals who are experiencing acute behavioral health conditions. They may be living in a community-based setting, searching for community placement, a hospital setting, or a residential facility and require temporary stabilization services.

The individual must be referred to the SH program by the SST or directly from the Division of Developmental Disabilities with the approval of the Director. SST, or the Director of the Division of Developmental Disabilities will add the individual to the SH Consideration Review list. The Consideration Review list is reviewed and maintained bi-weekly by SST and the DDD. The DDD will then identify candidates for admission into the SH program based on priority of need, acuity, and vacancy.

The SH provider will be given a 24-hour notice, prior to intake of a new admission and cannot decline referrals.

The SH program does not have the ability to support a polypharmacy washout (also known as a "med wash").

Individuals who receive services at a short-term stabilization home must have a viable home to return to after their time in the SH program. An exception to this can be made with approval from the Director of the Division of Developmental Disabilities.

4. SH Provider Requirements

An SH provider must be an established 24-hour CILA provider in good standing with the Division of Developmental Disabilities for at least 5 years. Prior to receiving approval to be an SH provider, the DDD must review the last 2 years' worth of surveys from the Bureau of Clinical Services (BCS), the Bureau of Quality Management (BQM), and the Bureau of Accreditation, Licensure and Certification (BALC). The SH provider must be in compliance with all CILA rules and regulations, including but not limited to, Rule 116, Rule 120, Rule 119 (if applicable), Rule 115, and the Federal Settings Rule

The SH provider must demonstrate they have an effective method for managing and maintaining individual records. The SH provider must be able to produce records for audit purposes with a reasonable amount of notification.

The SH provider must also be able to demonstrate competency in supporting individuals with behavioral health needs.

5. Home Expectations

Stabilization Homes must have no more than 4 people per address. Each bedroom must be single occupancy.

The interior of the home must be well maintained and person-centered. Individuals who receive services at an SH site must be able and supported to personalize their room to meet their needs and interests, pursuant to the Federal Setting Rule 42 CFR §441.301(c)(4)(i-v)

The landscaping must be maintained and in a condition such that individuals may use all aspects of the grounds as they would if it were their permanent home. It is expected that the SH provider has a reliable system in place for addressing home maintenance needs, including, but not limited to, structural damage to the home, furniture repair, landscaping, and ensuring the home is accessible based on the needs of the individuals who live there.

6. Programmatic Expectations

Client Rights

SH providers must follow all Federal Settings Rules pursuant to the Federal Setting Rule 42 CFR §441.301(c)(4)(i-v)

The Centers for Medicare and Medicaid Services (CMS) has specific rights that must be afforded to individuals receiving services funded by the HCBS waiver, regardless of the setting type. SHs must comply with the HCBS Settings Rule requirements outlined at 42 CFR §441.301(c)(4)(i-v)

Staffing

All SH sites must staff the home based on the clinical needs of the individuals. This may mean a 1:1 ratio of individual to direct support professionals (DSP). The DSPs or Authorized Direct Support Professionals (ADSPs) must meet all DDD requirements necessary to work as a DSP or ADSP. Within 90 days of employment at an SH site, the DSP or ADSP must successfully complete the Registered Behavior Technician (RBT) training course.

Providers are required to provide Qualified Intellectual Disabilities Professional (QIDP) services, Board Certified Behavior Analyst (BCBA) services, psychiatric services, access to mental health supports (licensed clinical psychologist, Licensed Clinical Social Worker or Licensed Clinical Professional Counselor), and other staff (nurses and management) as needed to ensure treatment goals are met.

Meetings

Providers are responsible for scheduling and facilitating meetings to ensure all necessary information is communicated in a timely manner. All meetings must be scheduled with enough notice to ensure required participants are able to attend. SH providers are also responsible for taking minutes, maintaining this documentation, and sharing it with the other entities. The following meetings are required:

Pre-intake meetings
- All referrals to the SH provider must be accepted and placed within 24 hours of receipt of the referral from DDD.
- The purpose of these meetings is for the SH clinical team to meet with all necessary parties of the interdisciplinary team (IDT) to gain and share relevant background information prior to the individuals' admission into the program.
- Separate meetings will be held with the following entities: ISC, SST, provider agency, and guardian, if applicable.
72- hour intake meetings
- The purpose of this meeting is for SH staff to provide a brief overview of the program, and for the IDT to discuss challenges the individual is currently struggling with, consequently impacting their ability to successfully reside in the community. The team will establish a definition of stabilization for the individual and create goals to work towards achieving that definition, during their stay in the program. The team will also use this time to establish the bi-weekly interdisciplinary meeting time.
- The following people should be in attendance: the ISC, provider agency, guardian (if applicable), SST, DDD, and individual served.
- The following paperwork must be completed at this meeting: 72-hour staffing summary.
Weekly or Bi-weekly interdisciplinary meetings
- The purpose of these meetings is to discuss current progress made towards stabilization, behavioral trends, treatment modalities being utilized and their corresponding response rates, all pertinent medical information, emergent events, changes in activity, or treatment provided. The team will also utilize this time to explore the need for additional resources as necessary - one-to-one staffing funding, adaptive equipment or home modifications for the individual, changes to the originating home environment, etc. The following people should be in attendance: ISC, provider agency, guardian (if applicable), SST, SSH staff.
- The following paperwork must be completed at this meeting: Weekly Update Form
- The frequency of these meetings (weekly or every 2 weeks) is determined by the needs by the needs of the individual.
Meetings to identify prospective providers for SH residents, as applicable.
Pre -Transition Planning Meeting
- This occurs 60 days prior to discharge from the SH.
- The purpose of these meetings is to discuss and establish the necessary preparations for the individual's transition to a community setting, including:
Anticipated date and time of transition,
Person responsible for providing transport,
Mode of transportation,
Review of behavior plan to ensure that interventions are appropriate for the permanent placement.
Scheduling planned visits from SST to aid the individual in reintegration and transition to their permanent resident.
- The following people should be in attendance: SST caseworker and SH staff.
- The following paperwork must be completed at this meeting: Transition Plan form.
Transition Meeting
- This occurs 1-2 weeks prior to discharge from SH.
- The purpose of this meeting is to provide training to the originating provider/ permanent placement, answer any questions they might have, and confirm the planned details of the transition i.e., time, date, location, etc.
- The following people should be in attendance: ISC, provider agency, particularly staff that will be directly working with the individual, guardian (if applicable), SST, SH staff.

Post-transition meeting
- This occurs 1 week after being discharged from SH.
- This is a virtual meeting between the permanent placement, SST, guardian/family if applicable, and the SH provider to answer any outstanding questions.

Weekly Schedule

The SH provider is responsible for ensuring the individual attends a day program or receives Enhanced Residential Services during their stay at the SH site. In addition to day programming activities, the SH provider is responsible for ensuring the individual accesses the community. The SH provider can put parameters around visitation at the SH site that are in compliance with the Federal Settings rule.

7. Medical and Behavioral Care

The SH provider must be equipped to support individuals with mental health needs, behavioral needs, and provide trauma informed care. SH should have ready access to a professional medication review provided by a psychiatrist.

The SH BCBA and mental health professionals should work collaboratively with the interdisciplinary team to develop stabilization outcomes for the focus of the time in the SH program, as well as create a Human Rights Committee (HRC) approved behavior plan, which will be provided to the community service provider, guardian, DDD, SST, and ISC. The BCBA will track behavioral data and provide trainings for community service providers, guardians, ISC, SST and other support services working with the individual, prior to the individual's return to a community setting. Upon transition from the program, the SH clinical team will complete and submit the DHS approved closure form.

Medical Care

The SH provider will maintain adequate medical supports and coordinate medical care as required, ensuring access to medical and psychiatric supports as necessary. The SH provider must comply with Rule 116 and is subject to regulations within Rule 116. The SH provider must have a consistent RN trainer on-call at all times who has access to the records of the SH residents. Prior to admission into an SH site, the RN Trainer must have a conversation with the originating provider's RN Trainer to gain a full understanding of the individual's medical and nursing needs. During this phone conversation, the nurses should discuss medical complexities, allergies, and medications.

Upon admission to an SH home, the SH provider must secure paper prescriptions for general pain and cold medications for the individual. The SH provider is responsible for ensuring that prescriptions are filled so that individuals have access to their medications.

The SH provider must have established a relationship with the individual and a primary care physician. If the annual physical falls during the time the individual is living at the SH site, the SH provider is responsible for ensuring that this requirement is met. This may mean that the SH provider will have to transport to the individual's primary care provider near their originating provider.

All ADSPs must be trained in accordance with Rule 116. There must be a nursing assessment on file. This may mean that a new nursing assessment must be completed by the SH provider if the individual does not have a nursing assessment.

Medications

Upon receipt of the intake packet from DDD, the SH provider registered nurse (RN) will review and account for all medical and psychiatric intake materials, including but not limited to psychiatric and psychological evaluations, physicals, SAMAs, HRST, Physician's Orders, MAR's, pharmacy information, prescriptions, and medications. The SH provider RN will connect with the originating provider's RN prior to arrival to conduct a nurse-to-nurse review of all of the individual's medical needs, and transfer all prescriptions to the SH provider's pharmacy, for the duration of the individual's stay, to allow for prescriptions to be refilled, as necessary. Upon arrival, the SH's RN will account for all medications received upon admission.

Behavioral Health Care

The expectation is that the SH provider will evaluate the individual's behavioral and mental health from a wholistic perspective; this includes evaluating how external factors, such as family, are impacting the individual's ability to be stable in their placement. The SH provider must work in conjunction with SST to address external factors that are impacting the individual's ability to be stable in their home. If clinically indicated, SH will provide modeling supports and therapeutic interventions to caretakers to assist in fostering therapeutic relationships between the caretaker and individual.

The SH provider must have access to consistent and reliable behavioral health services. This includes access to a BCBA, therapist (LCSW or LCPC) and psychiatric care. The SH provider must work in conjunction with the originating provider's behavioral healthcare team to ensure an effective transition home. The originating provider's behavioral health care team should be involved in the individual's care while at the SH site, as appropriate. The level of involvement of the originating provider's behavioral health care team should be discussed in the 72-hour meeting.

8. Administrative

The SH provider will coordinate admission into the SH program, on a no-decline basis, within 24 hours of receipt of the referral/intake packet from DDD. The SH provider will host an intake meeting within 72 hours of admission. The SH home will typically admit new referrals Monday-Thursday from 11am-3pm. Having a designated admission window ensures that necessary staff are able to attend the admission meeting and be properly trained. SH provider is not able to deny admission outside of this window if DDD determines that the individual is in danger to themselves or others, is in imminent risk, or it is not feasible to schedule admission within the preferred admission timeframe.

They will work collaboratively with all agencies throughout the individual's stay including, but not limited to, the originating provider agency, guardian (if applicable), DDD, SST, ISC, and other community -based entities (psychiatrist, medical professionals, community based BCBAs, etc.). The SH provider is required to facilitate and provide transportation to potential placement opportunities, visits, and medical appointments.

SH provider will provide timely notification of all OIG allegations, unusual incidents and CIRAS reports to DHS. This may include, but is not limited to, serious injury and/or emergent medical treatment, and police involvement. SH administration will also participate in bi-weekly meetings with DHS administration and submit monthly attendance records.

Record Keeping

The SH provider is required to comply with all record keeping regulations stipulated in Rule 115, Rule 116, and Rule 120. The SH provider is subject to all the same BALC, BQM and Rule 116 surveys that a traditional CILA must undergo. The SH provider must maintain, at a minimum, the following records: weekly/biweekly team meeting notes (that are sufficient to meet the requirement for monthly QIDP notes), DSP shift notes, staff training records, Medication Administration Records (MARs), and medication errors.

New Admission Process

When a potential candidate has been identified for SH services, DDD will reach out to the originating provider (OP) or caretaker to provide an overview of the program, answer any preliminary questions they may have, review the intake and transition process, as well as the obligations and expectations of the OP, upon the individuals' acceptance into the program. DDD will then provide the OP a listing of all required supporting documents, consents for services, and commitment to serve.

The following documents are required for services at an SH:

Completed SH Application form
Signed consents for services with the SH provider
Copy of ID, Social Security card, medical cards, Medicaid eligibility
Current signed Physician's Order
Personal Plan
ICAP
Incident reports
Behavior Support Plan
3-months' worth of summarized behavioral data
Most recent psychiatric evaluation
Psychological
Social History, if available
Nursing Assessment
- HRST
- MAR
- Self-Administration of Medication Assessment
- Medication and active prescriptions

Transition to Originating Provider and Discharge from SH

The SH is required to facilitate transition meetings within 30 days of the anticipated discharge date. If the SH provider anticipates there will be a delay in transitioning to the originating provider, the SH provider must notify the DDD as soon as possible to request an extension in services. The DDD then determines if an extension is necessary.

Prior to discharge, the SH provider's nurse is required to have a conversation with the originating provider's nurse, or guardian if returning to family home, regarding medications management.

Billing and Payment

The SH provider will receive a monthly rate, determined by the annual contractual amount, upon acceptance of all required ROCS data entry for SH referrals This rate is calculated based on the annual cost required to have these services be available to individuals with varying needs who are referred by the Division of Developmental Disabilities (DDD). Included in this rate are wages and benefits for direct service staff, administrative/executive/supervisory staff, medical and behavioral clinical staff, day programming costs, consultants, housing, equipment and housing repair/maintenance, housekeeping, utilities, non-food supplies, food supplies, administrative expenses, insurance, and indirect costs from the provider. The rates may be adjusted through contractual amendments subject to cost-of-living increases appropriated by the Illinois General Assembly, through negotiations during contract renewals, or through subsequent calls for request for applications. 24-hour service billing is submitted by the respective SH providers through ROCs. During the individual's stay in SH, the occupancy factor as enacted by IDHS, DDD will apply to the OP in relation to the individual's waiver rate.

Upon discharge from the SH site, the DDD will confirm that that there hasn't been any inappropriate billing during the individual's time at the SH site (for example, 60D).

9. Originating Provider Requirements

The originating provider/placement (OP) must provide all required documentation prior to admission into the SH program. The representative payee should contact the Social Security Administration and follow all reporting requirements for the individual's supplemental security income.

While the individual is enrolled in the program, the OP must work in conjunction with SSH and SST. They will be expected to participate in all interdisciplinary meetings and trainings held by both SSH and SST. Once the individual has completed their stay or SH resources have been exhausted, the OP must accept the individual's return. Failure to follow these requirements will result in sanctions from DDD. For more information on OP responsibilities, please see the OP Manual.