Rule 24-2-30.3 - Medical Supervised LivingA. Medical Supervised Living is not a separate service from Supervised Living Services but allows an increased reimbursement rate for persons enrolled in ID/DD Waiver with significant medical needs. Additional eligibility requirements for persons who receive this level of support and requirements for Supervised Living settings to receive the increased reimbursement rate are outlined in this section. Rule 30.1 - Supervised Living Services for Intellectual/Developmental Disabilities Service Components and Chapter 13 for Health, Environment, and Safety for Supervised Living Services for People with Intellectual/Developmental Disabilities, applies to Medical Supervised Living.B. Medical Supervised Living provides additional support for people with chronic physical or medical condition(s) requiring prolonged dependency on medical treatment for which skilled nursing intervention is necessary. Medical Supervised Living cannot be received unless the person requires frequent nursing oversight to include a minimum of monthly nursing assessments by a RN.C. To provide Medical Supervised Living, a provider must first be approved to do so by DMH. The following must be submitted through the Division of Certification: 1. Documentation and procedures to ensure a RN will conduct all Nursing Assessments and develop all Nursing Care Plans.2. Documentation and procedures describing how nursing staff will provide coverage 24 hours per day, seven (7) days per week in order to respond to the person's medical needs and requests for assistance/information from staff in the home. Documentation must include a copy of the nurse's current license to provide nursing care.D. Documentation supporting that the person requires the level of support offered in Medical Supervised Living is gathered by the Supervised Living Services provider and Support Coordinator or Transition Coordinator and submitted to DMH for eligibility determination.E. Criteria to support Medical Supervised Living include the following: 1. The person's physical or medical condition may be characterized by one (1) of the following: (a) A condition that requires medical supervision and physician treatment consultation.(b) The need for administration of specialized treatments that are medically necessary such as, injections, wound care for decubitus ulcers, etc.(c) Dependency on medical technology requiring nursing oversight such as, enteral (feeding tube) or parenteral (intravenous tube) nutrition support (bolus feedings only) or continuous oxygen.(d) The administration of specialized treatments that are ordered by a physician or nurse practitioner.(e) Other medical support needs that are approved by DMH.2. Medical Supervised Living will not be approved unless the person requesting this service requires frequent nursing oversight to include a minimum of monthly nursing assessments.F. People living in the home with someone considered medically fragile must be compatible and not pose a threat to the person who has higher medical support needs.G. Pre-Admission Requirements for Medical Supervised Living1. For people moving from home or already receiving Supervised Living Services, the agency provider must arrange for a nursing assessment to be conducted by a RN before or the same day the person is admitted to the home. At a minimum, the following systems must be addressed:(h) Thorax, Lungs, and Abdomen;(k) Special Diet Requirements. The nursing assessment by the RN must result in a Nursing Care Plan and must be updated every 60 days or as needed.
2. For people moving from an institution, the agency provider's RN must review the nursing assessment from the institution and develop the Nursing Care Plan. The nurse may choose to conduct an on-site nursing assessment.H. Employee Training 1. If a person is already receiving Supervised Living Services and is approved for Medical Supervised Living, employees must be trained by the provider's RN or LPN regarding that person's individual support needs as there must have been a change that necessitated the transition to Medical Supervised Living.2. If a person is moving into a Medical Supervised Living arrangement from home or an institution, employees must be trained about the person's support needs before admission to the home. This can be accomplished by a nurse (RN or LPN), nurse practitioner, or a physician. Others who know the person's support needs well (e.g., family member[s], other caregivers the person has, etc.) may also provide information.3. Documentation of employee training, regardless of if a person is moving into the home or already lives in the home, must be in their record. The documentation must be signed and dated by the person receiving the training, as well as the person providing the training.I. Additional Documentation Requirements for Medical Supervised Living 1. The RN must provide the level of oversight and monitoring necessary to determine the implementation and efficacy of the strategies in the nursing assessment/Nursing Care Plan.2. There must be at least monthly nursing notes and monthly assessments from a RN that include: (a) A summary of all visits/contacts related to the person's physical or medical condition(s).(b) A description of the person's current physical medical status.(c) The status of any physician's orders (new orders, discontinued orders, etc.), status of laboratory or diagnostic tests, specialist evaluations, medical appointments, medications, treatment, and/or equipment.3. The skilled nursing services provided and the person's response to the interventions.J. Additional Requirements 1. Agency providers of Medical Supervised Living must have a nurse (RN or LPN) on-call 24 hours a day, seven (7) days a week to respond to requests for assistance/information from employees in the home. If an LPN is on call, a RN must be available for consultation or assistance, as needed.2. LPNs can provide daily nursing care.K. Ongoing Review of Need for Medical Supervised Living1. DMH will review the need for ongoing Medical Supervised Living at least annually before recertification.2. All required documentation must be sent in a complete manner to the Support Coordinator within 90 days of the person's recertification date; partial submissions will not be accepted. The Support Coordinator will submit the information to DMH. The following information is required:(a) Nurse's notes from the previous two (2) months;(b) Nursing assessments from the previous two (2) months;(c) Current Nursing Care Plan;(d) Relevant information from other agency providers (home health, day service, etc.); and(e) Rationale for the need for continued Medical Supervised Living.L. Short-Term Medical Supervised Living 1. A person can receive Medical Supervised Living on a short-term basis (60 days) in order to recover from an illness or procedure because of the need for more intensive medical care than can be provided in traditional Supervised Living/Shared Supported Living/Supported Living Services.2. The need for short-term Medical Supervised Living will be evaluated by DMH. The following must be submitted to the Support Coordinator for submission to DMH before short-term Medical Supervised Living can be authorized. (a) Physician/Specialty evaluation notes (agency provider/family responsibility).(b) Discharge Plan (agency provider/family responsibility).(c) Other information deemed relevant to support the continued need for the service.3. Short-Term Medical Supervised Living beyond the initial 60 days can be requested. The need will be re-evaluated by DMH. The following must be submitted to the Support Coordinator for submission to DMH within two (2) weeks before the end of the first 60 day stay:(a) Estimated number of additional days needed;(b) Justification for the additional days;(c) Nurse's notes since the beginning of the stay;(e) Nursing Care Plan; and(f) Any information from home health, therapists, or other agency providers who may have delivered services to the person.