La. Admin. Code tit. 50 § XXI-13901

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXI-13901 - Individual and Family Support Services

A. Individual family support (IFS) services are direct support and assistance services, provided in the beneficiary's home or in the community, that allow the beneficiary to achieve and/or maintain increased independence, productivity, enhanced family functioning and inclusion in the community to the same degree as individuals without disabilities. IFS services are also used to provide relief to the primary caregiver. Transportation is included in the reimbursement for these services. Reimbursement for these services includes the development of a service plan for the provision of these services, based on the approved COPC.

1. Individual and family support day (IFS-D) services will be authorized during waking hours for up to 16 hours when natural supports are unavailable in order to provide continuity of services to the beneficiary. Waking hours are the period of time when the beneficiary is awake and not limited to traditional daytime hours as outlined in the CPOC.

a. Additional hours of IFS-D services beyond the 16 hours can be approved based on documented need, which can include medical or behavioral need, and specified in the approved CPOC.

2. Individual family support-night (IFS-N) service is direct support and assistance provided during the beneficiary's sleeping "night" hours. Night hours are considered to be the period of time when the beneficiary is asleep and there is a reduced frequency and intensity of required assistance. IFS-N services are not limited to traditional nighttime hours and are outlined in the CPOC. The IFS-N worker must be immediately available and in the same residence as the beneficiary to be able to respond to the beneficiary's immediate needs. Documentation of the level of support needed, based on the frequency and intensity of needs, shall be included in the CPOC with supporting documentation in the provider's services plan. Supporting documentation shall outline the beneficiary's safety, communication, and response methodology planned for and agreed to by the beneficiary and/or his/her authorized representative identified in his/her circle of support. The IFS-N worker is expected to remain awake and alert unless otherwise authorized under the procedures noted below.

a. Beneficiaries who are able during sleeping hours to notify direct support workers of his/her need for assistance may choose the option of IFS-N services where staff is not required to remain awake.

b. The beneficiary's support team shall assess the beneficiary's ability to awaken staff. If it is determined that the beneficiary is able to awaken staff and requests that the IFS-N worker be allowed to sleep, the CPOC shall reflect the beneficiary's request.

c. Support teams should consider the use of technological devices that would enable the beneficiary to notify/awaken IFS-N staff. (Examples of devices include wireless pagers, alerting devices such as a buzzer, a bell or a monitoring system.) If the method of awakening the IFS-N worker utilizes technological device(s), the service provider will document competency in use of devices by both the beneficiary and IFS-N staff prior to implementation. The support coordinator will require a demonstration of effectiveness of this service no less than quarterly.

d. A review shall include review of log notes indicating instances when IFS-N staff was awakened to attend to the beneficiary. Also included in the review is acknowledgement by the beneficiary that IFS-N staff responded to his/her need for assistance timely and appropriately. Instances when staff did not respond appropriately will immediately be brought to the support team for discontinuation of allowance of the staff to sleep. The service will continue to be provided by awake and alert staff.

e. Any allegation of abuse/neglect during sleeping hours will result in the discontinuation of allowance of the staff to sleep until investigation is complete. Valid findings of abuse/neglect during night hours will require immediate revision to the CPOC.

B. IFS services may be shared by up to three waiver beneficiaries who may or may not live together and who have a common direct service provider agency. Waiver beneficiaries may share IFS services staff when agreed to by the beneficiaries and health and welfare can be assured for each beneficiary. The decision to share staff must be reflected on the CPOC and based on an individual-by individual determination and choice. Reimbursement rates are adjusted accordingly. Shared IFS services, hereafter referred to as shared support services, may be either day or night services. In addition, IFS direct support may be shared across the Children's Choice Waiver or the Residential Options Waiver at the same time.

C. IFS (day or night) services include:

1. assisting and prompting with the following activities of daily living (ADL):

a. personal hygiene;

b. dressing;

c. bathing;

d. grooming;

e. eating;

f. toileting;

g. ambulation or transfers;

h. other personal care and behavioral support needs; and

i. any medical task which can be delegated;

2. assisting and/or training in the performance of tasks related to maintaining a safe, healthy and stable home, such as:

a. housekeeping;

b. laundry;

c. cooking;

d. evacuating the home in emergency situations;

e. shopping; and

f. money management;

3. personal support and assistance in participating in community, employment, health and leisure activities;

4. support and assistance in developing relationships with neighbors and others in the community and in strengthening existing informal social networks and natural supports;

5. enabling and promoting individualized community supports targeted toward inclusion into meaningful integrated experiences; and

6. accompanying the beneficiary to the hospital and remaining until admission or a responsible representative arrives, whichever occurs first. IFS services may resume at the time of discharge.

D. Exclusions. The following exclusions apply to IFS services.

1. IFS-D services and IFS-N services will not be authorized or provided to the beneficiary while the beneficiary is in a center-based respite facility.

2. IFS-D and IFS-N services will not be authorized or provided to the beneficiary while the beneficiary is receiving monitored in-home caregiving services.

3. Beneficiaries receiving adult companion care services are not eligible to receive individual family support services.

E. Staffing Criteria and Limitations

1. Family members who provide IFS services must meet the same standards as providers or direct care staff who are unrelated to the beneficiary. Service hours shall be capped at 40 hours per week, Sunday to Saturday, for services delivered by family members living in the home.

2. Legally responsible individuals (such as a parent or spouse) and legal guardians may provide individual and family support services for a beneficiary provided that the care is extraordinary in comparison to that of a beneficiary of the same age without a disability and the care is in the best interest of the beneficiary.

F. Place of Service

1. IFS services shall be provided in the state of Louisiana. IFS services may be performed outside the state for a time-limited period or for emergencies. The provision of services outside of the state must be prior-approved by the department.

2. Provision of IFS services shall not be authorized outside of the United States or the Territories of the United States.

3. The provision of IFS services in licensed congregated settings shall be excluded from coverage.

G. Provider Requirements. Providers must be licensed by the Department of Health as a home and community-based services provider and must meet the module-specific requirements for the service being provided.

La. Admin. Code tit. 50, § XXI-13901

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Community Supports and Services, LR 30:1202 (June 2004), amended by the Department of Health and Hospitals, Office of the Secretary, Office for Citizens with Developmental Disabilities, LR 32:2063 (November 2006), LR 33:1647 (August 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 40:71 (January 2014), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 4451 (1/1/2018), Amended LR 481547 (6/1/2022).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.