1943.1Remote Supports Services is the provision of supports by staff of a certified provider at a remote location and/or through an electronic method of service delivery who are engaged with individual(s) through equipment with the capability for live two-way communication. Equipment rental/purchase shall be through assistive technology services. Equipment used to meet this requirement shall include one (1) or more of the following components:
(a) Motion sensing system;(b) Radio frequency identification;(e) Web-based monitoring system;(f) Sensor detection monitoring system;(g) A device that facilitates live two-way communication; or(h) A device that facilitates therapy service(s) covered under the IDD Waiver.1943.2Remote supports services shall be provided in real time, not via a recording, by staff who are at a Monitoring Base using the appropriate connection. While remote support is being provided, the remote supports staff shall not have duties other than remote supports.
1943.3Remote supports services are available through the following HCBS waiver services:
(a) Behavioral Support Services;(b) Creative Arts Therapies Services;(c) Day Habilitation Services;(d) Employment Readiness Services;(e) Family Training Services;(f) Occupational Therapy Services;(g) Parenting Support Services;(h) Speech, Hearing, and Language Services;(i) Supported Employment Services;(j) Supported Living Services; and(k) Wellness Services, to include bereavement counseling, fitness training, nutrition evaluation/consultation, and sexuality education.1943.4Remote supports services are intended to address a person's assessed needs and promote autonomy, maintain or improve functional abilities, enhance interactions, support meaningful relationships, and promote independent living and meaningful participation in the community.
1943.5The remote supports services caregiver shall utilize equipment capable of live two-way communication to interact, coordinate supports, monitor, and/or respond to the person's needs.
1943.6Remote supports services shall be delivered in the following four (4) different delivery models:
(a) Active Support: Real-time observation of the monitoring system during scheduled times. The remote caregiver monitors the system in real-time and responds immediately as needed.(b) On-Demand Active Support: Real-time observation of the monitoring system only when needed. This type of "as needed" real-time support starts when a triggering event occurs (from a sensor of some type) indicating the need for support.(c) Scheduled Check-in: A remote caregiver checks-in with the person at scheduled times. These are typically centered around activities of daily living or can be a simple wellness check.(d) Drop-in: a remote caregiver checks-in at random times to ensure the wellness of the person supported to determine if they need any assistance.1943.7The Service Coordinator, in consultation with the person and their team, shall assess whether remote supports are sufficient to ensure services are delivered in a person-centered manner that ensures their health and welfare. If it is determined that in-person assistance is required, remote supports shall not be provided.
1943.8If at any time a person requires in-person assistance during the provision of a service, the person shall receive that service in-person and not through remote supports.
1943.9The person's support team shall complete the Person-Centered Support Tool to identify support needs, preferences, outcomes, and technology solutions and determine whether:
(a) The person is equipped to receive remote supports services; and(b) The extent to which remote services should be received.1943.10Informed consent shall be given by the person who receives remote supports services or their authorized representative.
1943.11Remote supports involving the use of audio or video equipment that permits remote supports staff to view activities or listen to conversations in the residence shall not be provided until the person who receives the service, or their authorized representative, and each person who lives with the individual:
(a) Is fully informed of what remote supports entails including, but not limited to, that the remote supports staff will observe their activities and/or listen to their conversations in the residence, where in the residence the remote supports will take place, and whether or not recordings shall be made; and(b) Has given written consent to the provision of remote support services, as described in paragraph (a), in their residence. The service coordinator and provider shall keep copies of the signed consent forms with the person's ISP.1943.12Remote supports services staff shall have written protocols for responding to a person's needs as specified in the ISP, including contact information for the on-call support person to provide assistance when necessary and times when remote supports shall be provided. The ISP shall set forth the protocol to be followed should the individual request that the equipment used for delivery of remote supports be turned off. The ISP shall include required remote supports content.
1943.13Required remote supports content in the ISP must include the following:
(a) Justification statement that:(1) Explains how remote supports benefits the person, promotes independence, assists in outcome achievement, and assures health and safety; and(2) Justifies the need for any other service such as the need for Assistive Technology services for the purposes to acquire Equipment rental/purchase; and(3) Supports the need for remote services and identifies a percentage of services to be delivered through remote supports, not to exceed service caps under the approved IDD Waiver.(b) A description of the person's preferences and how the delivery of remote supports will reflect them. This should reflect the utilization of person-centered tools and exhibit how support strategies have been developed to meet the person's preferences;(c) Verification that a risk assessment was completed and reviewed through the utilization of a person's person-centered tools and other assessment results by the support team to ensure the appropriate technology solutions and/or support strategies have been identified to address any risk areas;(d) A description of the required remote supports equipment function, purpose, features, general location in home, person and family knowledge of and how to use equipment (e.g., turn on and off, how to request assistance remotely);(e) A description of initial and ongoing training strategies for person supported, support staff, and family members, if applicable;(f) A description of a defined thirty (30) day trial period where the person supported will still receive direct supports while receiving remote supports services to ensure the established support strategies are effective, and meet their support needs and preferences;(g) A schedule of when remote supports services shall be provided and the delivery model for provision of remote supports (e.g., Active Support, Active On-Demand, Check-in Scheduled, Check-in Random) provided;(h) A description of a back-up plan in the event of system failure (e.g., equipment malfunction, power outage), including a detailed emergency/on-call responder plan in the event the person needs a paid in-person response to their residence. The emergency response plan can include natural supports or paid supports. The detailed plan for response at the person's residence or location covered by remote supports shall include, at minimum, descriptions of: (1) Response times, that are defined by the person's support team. In situations requiring a person to respond to a person's residence, the response time should not exceed thirty (30) minutes;(2) Response type that includes face-to-face and/or telephone, depending on how to optimally respond to the person's particular need at that time to ensure health and safety;(3) The remote supports vendor and/or caregiver's effective procedure for notifying emergency personnel such as police, fire, emergency medical services, and psychiatric crisis response entities in emergency situations; and(4) Documentation of the event as outlined by Incident Reporting policy.1943.14Remote supports services shall be provided by a certified provider that has a Medicaid provider agreement with the Department of Health Care Finance ("DHCF") and DDS/DDA and that meets the following requirements:
(a) Shift training to include ETC and/or ETIS;(b) Operation of the Remote Support Monitoring Base systems;(c) Phase I, II, and III Trainings with the exemption of CPR and TME; and(d) Compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), as amended by the Health Information Technology for Economic and Clinical Health ("HITECH") Act, and their applicable regulations to protect the privacy and security of the participant's protected health information.1943.15The remote supports provider/vendor shall provide initial and ongoing training to its staff to ensure they know how to use the monitoring base system.
1943.16The remote supports provider/vendor shall provide an individual who receives remote supports services with initial and ongoing training on how to use the remote supports system as specified in the ISP.
1943.17A monitoring base shall not be located at the residence of an individual who receives remote supports services.
1943.18Participant privacy rights and obligations shall be assured and monitored on an ongoing basis.
1943.19Video or remote supports devices shall not be used or placed in participant bedrooms or bathrooms.
1943.20The supported living periodic remote supports provider/vendor shall have a backup power system (e.g., battery power and/or generator) in place at the monitoring base in the event of electrical outages. The supported living periodic remote supports provider/vendor shall have other backup systems and additional safeguards in place which shall include, but are not limited to, contacting the on-call support person in the event the Monitoring Base system stops working for any reason. If services are unable to be delivered remotely, the on-call support person shall arrive at the individual's location within thirty (30) minutes when a request for in-person assistance is made.
1943.21A monitoring base shall not be located at the residence of a person who receives remote supports services.
1943.22A secure network system requiring authentication, authorization, and encryption of data that complies with 45 CFR §§ 164.102 to §§ 164.534 as in effect on the effective date of this rule shall be in place to ensure that access to computer, video, audio, sensor, and written information is limited to authorized persons.
1943.23Service documentation for remote supports services shall include each of the following to be eligible for Medicaid reimbursement:
(d) The service delivery platform (e.g., Skype, Zoom, Facetime);(e) Start and end time of service;(f) Name of individual receiving the service;(g) Medicaid identification number of individual receiving service;(i) Name of staff person providing service;(j) Provider identifier/contract number;(k) Start and end time of the remote supports services when the on-call support person is needed on site;(l) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider;(m) Number of units of the delivered service per calendar year; and(n) Description and details of the services delivered that directly relate to the services specified in the approved ISP as the services to be provided.1943.24Provider documentation when delivering remote supports services shall include each of the following in order to be eligible for Medicaid reimbursement:
(a) Daily notes to verify service provision;(c) An indication if the period during service delivery was uneventful (e.g., "no response needed");(d) A description of the occurrence that activated the sensor, when it happened, who was involved, response, and outcome, if applicable;(e) A description of any communication between remote caregiver staff and person supported;(f) Staff attendance logs with staff initials for the time segments each staff member was directly involved in providing remote supports during that time frame, if applicable;(g) Provider quarterly report; and(h) Any incident reports, completed as required by DDS Incident Management Policy.1943.25A person approved for remote supports services shall be issued a separate service authorization indicating the frequency of usage.
1943.26Per the approved IDD waiver, no remote supports service shall be provided remotely one hundred percent (100%) of the time.
1943.27A hybrid model shall be used for in-person and remote supports service hours, whereby two (2) separate service authorizations are issued to cover the in-person service hours and the remote supports service hours, respectively.
1943.28When a person receives remote supports services with on-call support, the remote supports provider shall bill for the remote supports and provide the remote supports directly or through a contract with a remote supports vendor that meets the requirements of this rule. If the remote supports staff contacts the remote supports provider to request emergency or in-person assistance, the paid on-call support person's time shall be included in the rate for remote supports services.
1943.29When remote supports services are provided to multiple persons who live in the same residence, the payment rate for remote supports shall be divided equally among the persons concurrently receiving remote supports.
1943.30Remote supported living services staffing ratio for awake (daytime) hours is 1:6 and must have active, continuous engagement and contact with the remote supports platform. Remote Supported Living overnight hours staffing ratio is 1:15. Corresponding on-call remote supports staffing ratio during awake hours is 1:10 and overnight hours is 1:20. Staff shall be available during the service hours and document that they are continuously engaged with the person and/or the remote supports responder platform to bill for hourly services rendered.
1943.31The transportation component of supported living with transportation remote supports services and supported living periodic with transportation remote supports services shall maintain the same reimbursement rates as in-person reimbursement rates.
1943.32Remote day habilitation services staffing ratio is 1:6 and must have active, continuous engagement and contact with the remote supports platform. Staff shall be available during the service hours and document that they are continuously engaged with the person and/or the remote supports responder platform to bill for hourly services rendered.
1943.33Remote employment readiness services staffing ratio is 1:6 and must have active, continuous engagement and contact with the remote supports platform. Staff shall be available during the service hours and document that they are continuously engaged with the person and/or the remote supports responder platform to bill for hourly services rendered.
1943.34The following HCBS waiver services delivered through remote supports services shall maintain the same reimbursement rates as in-person reimbursement rates:
(a) Behavioral Support Services;(b) Creative Arts Therapies Services;(c) Family Training Services;(d) Occupational Therapy Services;(e) Parenting Support Services;(f) Speech, Hearing, and Language Services;(g) Supported Employment Services;(h) Supported Living with transportation and Supported Living Periodic with Transportation Services, transportation component only; and(i) Wellness Services, to include bereavement counseling, fitness training, nutrition evaluation/consultation, and sexuality education.1943.35All individuals providing remote supports services must:
(a) Be at least eighteen (18) years of age;(b) Possess a high school diploma, Certificate of Individual Educational Program ("IEP") Completion, general educational development ("GED") certificate, or, if the person was educated in a foreign country, its equivalent;(c) Complete pre-service and in-service training as described in DDS policy;(d) Have the ability to communicate with the person to whom services are provided;(e) Be able to read, write, and speak the English language, with reasonable accommodation as appropriate, in accordance with the Americans with Disabilities Act;(f) Participate in competency-based training needed to address the unique support needs of the person, as detailed in his or her ISP;(g) Provided that they are not licensed pursuant to any of the provisions of law codified at Chapter 12 of Title 3 of the D.C. Official Code and are not working under the direct supervision of such a person, present proof of compliance with the Health-Care Facility Unlicensed Personnel Criminal Background Check Act of 1998, effective April 20, 1999 (D.C. Law 12238; D.C. Official Code §§ 44-551et seq., as amended; and(h) Be acceptable to the person to whom they are providing supports.D.C. Mun. Regs. tit. 29, r. 29-1943
Final Rulemaking published at 71 DCR 10372 (8/16/2024)