202 Program Guidelines and Requirements

Georgia State Seal

Georgia Division of Aging Services
Home and Community-Based Services Manual

Chapter:

200

Effective Date:

Section Title:

Program Guidelines and Requirements

Reviewed or Updated in:

MT 2021-09

Section Number:

202

Previous Update:

202.1 Purpose

The guidelines and requirements contained in this section are to be used by Area Agencies on Aging (AAA) and their subcontract service providers along with any rules or requirements associated with specific fund sources.

202.2 Scope

These rules apply to all services provided under contract and funded in part or in whole with funds provided by the Department/Division under the Older Americans Act (OAA), as amended, or by State general revenue appropriations, or other funding source granted or contracted to the Division of Aging Services (DAS) for use in providing services, or other funds pooled with such funds to meet the costs for services under the Older Americans Act. These rules provide suggested guidelines for services paid for by local funds or through fee-for-service models.

The Title V program, Senior Community Service Employment Program (SCSEP) has specific program criteria and supersedes guidance provided in this chapter. AAAs will use these guidelines for issues not addressed in SCSEP guidelines. Refer to MAN 5300, Section 400 for SCSEP guidelines.

Unless otherwise noted, the policies contained in this chapter apply to all services included in MAN 5300. Specific services or programs may include additional guidelines or requirements as described in the corresponding chapters.

AAAs may add additional requirements for programs provided that such requirements do not conflict with OAA or DAS requirements and are described in the Area Plan.

202.3 Definitions

Moved to MAN 5600, Appendix E.

202.4A Client Eligibility

Except for fund-source specific eligibility criteria, and for specific eligibility criteria for OAA congregate meals, home delivered meals, and caregiver services, AAAs should use the following eligibility criteria for services:

  1. any person, age 60 or over, for all services authorized under the Older Americans Act and any such services supported by any other source of State funding; and

  2. any person, regardless of age, who is identified as having Alzheimer’s disease or a related disorder, and the families and caregivers of those persons, for state-funded Alzheimer’s respite and day care services.

If funding is not sufficient to serve all eligible individuals requesting services, the Older Americans Act provides for giving preference to specific persons:

  1. Persons in greatest economic need,

  2. Persons in greatest social need,

  3. Persons who are frail, and

  4. Persons who are at risk of institutionalization.

Additionally, AAAs should give particular attention to serving low-income minority individuals within these categories. See MAN 5300, 218 Transportation Services for additional information on Older Americans Act target criteria.

The Older Americans Act defines a “comprehensive and coordinated system” as a system for providing all necessary support services…using available resources efficiently and with a minimum of duplication. All services provided or authorized under the auspices of the Division should reflect no duplication in service delivery across funds sources, providers, and types of service without documented explanation in the client record. Examples of this duplication include, but are not limited to, services provided via waiver programs, the Veterans Administration, and community and faith-based organizations.

An AAA may designate up to 10% of non-Older Americans Act funds to serve persons with disabilities who are under the age of 60 and/or to serve caregivers not eligible under the National Family Caregiver Support Program requirements. The AAA must indicate in its Area Plan how it will allocate funding for services to these populations.

AAAs may develop fee-for-service programs for persons who may not otherwise meet these target criteria. See MAN 5600 2051 Eligibility, MAN 5600 3016 Targeting Service Delivery, and MAN 5300 118 Prioritizing Clients for additional guidance.

202.4B Client Status

DAS recognizes two categories of client status for purposes of service delivery and reporting of home and community-based services (HCBS):

  1. Active – the client is enrolled in and is currently receiving any HCBS service or has received a unit of any HCBS service within 60 calendar days. For clients receiving multiple services, he/she is considered “active” if at least one service meets the definition above.

  2. Closed – the client does not currently receive an HCBS service or has not received any service within 60 days. Clients receiving multiple services are considered closed when an end date is entered for the last service received. Staff must enter the correct disposition code each time a service is ended.

202.4C Homebound Clients

DAS targets some services within the delivery system to serve persons who are homebound.

Homebound (as defined by Centers for Medicare and Medicaid Services): An individual is considered homebound only if the following two criteria are met:

  1. Criteria One:

    1. Because of illness/disability or injury, the individual needs the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence OR

    2. The individual has a condition such that leaving his or her home is medically contraindicated,

      AND.

  2. Criteria Two:

    1. There must exist a normal inability to leave home AND leaving home must require a considerable and taxing effort.

Individuals who meet the criteria for homebound will have scored at least a 2 on the DON-R for Level of Impairment in the domain of Outside Home. AAAs should give priority to those individuals who have highest Unmet Need scores in the domain of Outside Home. Homebound individuals will have also scored positively on the NSI in regard to the statement “I am not always physically able to shop, cook, and/or feed myself” regardless of the diagnosis resulting in the inability to perform these tasks.

202.4D Risk Factors

AAAs should consider the following Risk Factors when referring older adults or persons with disabilities for community-based services in order to maximize the effectiveness and efficiency of services and to target services to individuals at greatest risk. Whenever possible, AAAs should prioritize services based on the individual’s risk level, and should recommend services based on specific domains of risk.

  1. Functional Status

    • Persons having significant ADL impairments and/or IADL impairments (a score of 2 or 3 on a domain of the DON-R) based on physical, cognitive, or emotional factors that place them at risk of institutionalization

  2. Unmet Need for Care

    • Persons who have unmet needs that can be met through the Aging network, other community resources, or through their support system

  3. Health and Medical Status

    • Persons identified as having acute and/or complex health conditions (including behavioral health conditions)

    • The degree to which the client uses emergency and primary care appropriately

    • The degree to which chronic conditions are managed or impact daily routine

    • Frequent or inappropriate hospital use or re-hospitalizations

    • The presence of medical conditions that demonstrate a trajectory of decline over time

    • The presence of significantly compromised nutritional health status

  4. Prior Unplanned Hospital Use

    • The number of unplanned hospital visits, including emergency room visits, within the last 180 days

    • The number of re-hospitalizations within 30 days for the same condition

  5. Risk of Falls

    • Risk identified from impairments on the DON-R in domains of Bathing, Transferring, and Outside Home

    • The degree to which the individual is at risk for falls as determined by diagnoses, medications, and environmental factors

    • A prior history of falls

  6. Cognitive Impairment

    • Risk identified in any DON-R domain based on the need for reminding, cueing, or prompting

    • Risk identified during interview involving attention, recall, or processing information

    • Diagnosis of cognitive impairment, or treatment or medication for a cognitive impairment by a medical professional

  7. Depression/Anxiety

    • Risk identified based on the PHQ-2 and GAD-2 screening

    • Diagnosis of a behavioral health condition, or treatment or medication for a behavioral health condition by a medical professional

  8. Caregiver Burden

    • Risk identified based on the Zarit Burden Interview, screening version

    • Risk identified from comparing DON-R Levels of Impairment with Unmet Need for Care with attention to the number of caregivers available

    • Caregiver’s intention to place the care receiver in an institutional setting

  9. Substance Abuse

    • Risk identified from NSI question, “I have 3 or more drinks of beer, liquor or wine almost every day.”

    • Risk identified from the AUDIT-C questionnaire

  10. Risk of Abuse, Neglect, or Exploitation

    • The history of prior or current involvement with Adult Protective Services

    • The frequency of APS involvement

    • Whether there is an ongoing investigation at the time of the assessment

    • Identification of factors that place the person at risk of abuse, neglect, or exploitation

  11. Social Supports

    • Risk identified by response to the NSI question, “I eat alone most of the time.”

    • The status of formal and/or informal support system

    • The degree to which the support system is deteriorating and placing the individual at risk of premature or avoidable placement outside the home

    • The identity of persons whom the individual would contact in the event of an emergency

    • Risk identified by the Lubben Assessment or the UCLA 3-item Loneliness Scale

  12. Environmental Risk

    • The presence or absence of significant structural or safety concerns in the individual’s environment

    • Inappropriate or unhealthy living conditions

    • The absence of utilities

    • The lack of access to working appliances

  13. Access to Services

    • The individual’s degree of difficulty accessing services due to rural location

    • Absence of transportation services

    • Lack of income or resources to afford services

    • Safety of individual’s neighborhood

See MAN 5300, 118 Prioritizing Clients for details about prioritizing clients.

202.4E Complex Cases

The level of potential risk and complexity of the presenting problem(s) will in part determine whether an individual should benefit from Community Options Counseling, Care Consultation, Care Transitions, Case Management, or other community-based interventions.

The following situations, though not inclusive, provide indicators in determining whether a case is complex:

  1. The presenting problem or situation is vague or ill-defined, or could jeopardize the health or safety of the individual

  2. The individual/family has multiple or complex problems

  3. The individual has multiple diagnoses or a new diagnosis with complex follow-up requirements

  4. The individual/family may need multiple services or coordination of services across multiple programs or agencies

  5. Informal supports are missing, inadequate, overwhelmed, neglectful, or abusive

  6. The individual’s judgment about his/her needs is questionable

  7. The individual/family indicates multiple competing needs, or

  8. The individual is at high risk of institutionalization or has multiple risk factors

202.4F Conflict-Free Service Delivery

Person-centered approaches and outcomes that are cost-effective for both individuals and the community characterize an efficient service delivery system. Therefore, DAS supports the implementation of a conflict-free service delivery system.

The key elements included in the design of such as system include:

  1. The separation of eligibility determination/assessment and care planning from service provision

  2. The evaluator of the individual’s needs has no relationship to the individual and has no financial interest in any service provider

  3. The agency responsible for determining eligibility has firewalls in place to mitigate the risk of potential conflict if eligibility determination/assessment and service provision overlap, and

  4. DAS and the AAA have robust monitoring and oversight to reduce potential conflicts

DAS and the AAAs will pursue systematic and deliberate progress toward a conflict-free delivery system.

202.5 Client Records and Activities

AAAs will ensure through contractual requirements that subcontractors maintain complete client information records.

The AAA will establish and implement written policies and procedures for the maintenance and security of client records, including:

  1. The person responsible for supervising the maintenance of records

  2. The person(s) having custody of record, and

  3. The persons/entities to whom records may be released and for what purposes

DAS, or a particular program area, may establish specific criteria for content of client records. In lieu of specific criteria, client records should include all applicable fields in the electronic client database. To the extent possible, the AAA should maximize the use of electronic records and minimize duplication between electronic and paper records. The holder of the client record is required to keep a paper record only of documents that are not available or that cannot be converted to electronic format.

All client records will be maintained pursuant to MAN 5600 1060 Technology and Data Management, MAN 5600 1061 Record Retention, and MAN 5600 3012 Area Agency on Aging Records.

202.5A Documentation

Documentation ensures accountability, the coordination of services among providers, and high-quality service delivery. The AAA should ensure that all documentation is concise, current, meaningful, and accurate. This can be achieved through orientation, on-going staff development and monitoring. Staff must complete documentation no later than 2 business days after the event, though the AAA may adopt more stringent requirements for timeliness of documentation.

Staff should write documentation with two specific instances in mind:

  1. That another staff person or supervisor would be able to read documentation about a consumer and be able to understand the consumer’s situation and provide appropriate services or interventions in the absence of the primary case manager; and

  2. That the consumer’s record, if received by subpoena or Open Records Request, would adequately, accurately, and professionally reflect the services provided by the AAA.

DAS does not prescribe a specific format for documentation. The AAA may choose a format to be used at its discretion. However, the following general criteria must be used in all documentation:

  1. Notes should include:

    1. the specific date of the activity (month, day, and year)

    2. the case manager’s name

    3. the type of activity (face-to-face, telephone call, etc.)

    4. the identify of person(s) involved in the interaction, if any

    5. the purpose of the contact; and

    6. significant information or observations.

  2. Notes should reflect objective and factual language and should avoid subjective or vague language, including direct quotes when necessary.

  3. Notes should avoid opinions and perceptions, unless these are specifically labeled as such and are necessary for the documentation.

  4. Notes not prepared in electronic format must be legible.

Staff should use acronyms standard to the Division of Aging Services. See Man 5600, Appendix E “Glossary of Terms, Abbreviations and Acronyms.”

Monitoring of Documentation – the AAA or supervisory staff should review records periodically to ensure quality by reviewing whether:

  1. Assessments and Service Plans are thorough, accurate, timely, and internally consistent.

  2. Clients and their caregivers/families were actively involved in making informed choices regarding service delivery.

  3. Services provided were appropriate to achieve client outcomes.

See Appendix B for additional information about documentation.

202.5B Confidentiality of and Access to Client Records

AAAs will ensure maintenance of client records according to the following minimum requirements:

  1. Staff may not disclose information about a client or obtained from a client in a form that identifies the person without the informed consent of the person or of his legal representative, unless the disclosure is required by court order, by specific law, or for program monitoring. For more detailed information on informed consent and release of information forms, see MAN 5600 2053 Confidentiality.

  2. Staff will use client information only for the specific purpose outlined in the written consent authorization or for purposes of performing program evaluation by authorized Federal or State personnel, or the AAA as the local monitoring agency.

Staff must include all signed consent for release of information forms in the client record. See MAN 5600, Appendix D for the Authorization for Release of Information form.

Additional guidance regarding confidentiality and access to records can be found in MAN 5600 1060 Technology and Data Management, MAN 5600 2053 Confidentiality, and MAN 5600 2054 Health Insurance Portability and Accountability Act of 1996 (HIPAA). Also see 45 C.F.R. § 1321.51.

202.5C Client Rights and Responsibilities

AAAs and provider organizations will assure that all individuals, or their caregivers/representatives, receive written notification of their rights and responsibilities as program/service participants upon their admission to services. See MAN 5300, Appendix E for the Client Rights and Responsibilities form.

202.5D Client Complaint and Incident Procedures

AAAs will ensure that each provider establishes written client complaint procedures that provide all clients and their advocates with the opportunity for communicating those aspects of the service which have negative impact on them.

The provider must document in each client record that the client was given information about his/her right to make such complaints and of the procedures for filing such complaints prior to the beginning of service delivery.

Procedures should include, at a minimum:

  1. A description of the manner in which the provider will handle and resolve complaints, including options for submitting complaints either orally or in writing

  2. An explanation of how the provider will address and resolve complaints in a timely manner

  3. A description of how the specific provider will ensure client access to contact information related to questions or complaints about services

AAAs will maintain the following information related to complaints and incidents:

  1. Documentation of any complaints regarding services provided, including documentation of action taken by the provider/AAA to resolve the complaints

  2. Documentation of all incident reports or reports of unusual occurrences or critical incidents (such as falls, accidents, etc.) that affect the health, safety and welfare of staff or clients, including documentation of action taken by the provider/AAA to address the incidents or occurrences following guidelines outlined in MAN 5600 9006 Serious Incident Review Team (SIRT) Process, and

  3. Documentation of disclosure to the appropriate contract authority (AAA and/or DAS) upon receipt of any complaints or allegations of employee misconduct

202.5E Client Notification

AAAs will ensure that each provider notifies individuals when services begin (including the type and cost of service), when there are any changes in service delivery (including type, frequency, or cost of service), and when the provider intends to terminate services.

The provider will include in each client record a Client Notification Form for each change in service. See MAN 5300, Appendix D for the Client Notification Form.

202.5F Client Appeals and Grievances

AAAs will ensure that each service provider has established written appeals procedures that are consistent with MAN 5300 CH 110 “Grievance Procedures for Participants in Non-Medicaid Home and Community Based Services”. These procedures will provide all clients or their advocates with the opportunity to appeal provider decisions concerning the provision of services, including, but not limited to, the initiation or termination of services, and increases or decreases in service levels. The intent of these procedures is to assure client satisfaction with the services provided. It is the responsibility of the service provider to give specific consideration to the client’s concerns.

The AAA will ensure that all providers establish and implement policies and procedures through which individuals and providers may file a written grievance that specify:

  1. The process by which all parties receive notification of their right to appeal

  2. The rights and responsibilities of all parties

  3. The time frames under which each party must take action, and

  4. The process by which notifications of appeals decisions occur

202.6 Services to Private Membership Prohibited

AAAs will ensure that those subcontractors with contracts to operate facilities such as nutrition sites, senior centers, day care centers or provide other supportive services under the Older Americans Act or other federal or state funding will not limit such facilities and services to membership in a specific private organization, group, association, or fraternal organization, nor show discriminating preference for such membership. However, this does not preclude AAAs from establishing membership-based senior centers.

202.7 Agency Records

AAAs will maintain proper records related to client activities, personnel, criminal records investigations, reports of complaints, and incidents at both the agency level and the provider level.

AAAs are responsible for ensuring that each service provider maintains agency records according to MAN 5600 3012 Area Agency on Aging Records.

202.7A Personnel Records

The AAA will ensure that providers maintain separate written records for each employee including the following:

  1. Identifying information including name, address, telephone number, emergency contact(s)

  2. Employment history

  3. Documentation of qualifications such as transcripts, diplomas, licenses, or certificates

  4. Dates of employment

  5. Documentation of results of criminal records investigation, including documentation that the employee has not been convicted of any charge of abuse, neglect, or exploitation or convicted of any crime (excluding misdemeanors or traffic violations) that would pose a safety or health risk to clients or their families

  6. Individual job description or statement of the employee’s duties and responsibilities, preferably signed by the employee

  7. Documentation of completion of orientation and training requirements, and ongoing staff development activities (see Appendix 202-A Training Requirements for HCBS Staff for list of basic training requirements)

  8. Documentation of a performance evaluation conducted at least annually

The Division recognizes that many Aging network staff routinely are in contact with the public. Therefore, each AAA will document that staff have received appropriate preventive measures to protect against the spread of communicable disease. Each AAA may determine local policy, but DAS encourages that employees be current on the required immunization schedule and that they receive annual flu vaccines and tuberculosis screening.

202.7B Criminal Records Investigations

All AAAs will document completion of criminal history investigations in accordance with MAN 5600 3036 Criminal History Investigations on behalf of all employees and volunteers.

202.7C Administrative Appeals

AAAs will ensure that each service provider establishes written appeals procedures that are consistent with MAN 5600 3020 Administrative Appeals.

202.8 Data Collection and Reporting

All AAAs will comply with all requirements of MAN 5600 1060 Technology and Data Management.

AAAs will make accessible to staff all information needed to initiate and carry out HCBS services, including the DAS data system, as well as any associated hardware and software required to access and operate the system. Whenever possible, the AAA will provide enhanced technology (i.e. laptop computers) to improve program efficiency. The AAA may require additional information systems at its discretion but may not fail to meet the minimal standards required by DAS.

Unless DAS approves a waiver to the AAA, staff must maintain all information gathered on behalf of clients in the DAS data system.

The AAA will use data from the DAS data system, at a minimum, to facilitate quality improvement and data analysis functions in conjunction with other programmatic, client, and cost data.

202.9 Client Contributions, Cost Sharing, and Fee-For-Service

The AAAs will ensure that each service provider establishes written procedures for voluntary contributions, cost sharing, and private pay options. Procedures will correspond to MAN 5600 2025 Fee for Service System Overview, 2026 Cost Share, 2027 Voluntary Contributions, and 2028 Private Pay Services.

Each AAA/provider is encouraged to offer in-home services as a fee-for-service enterprise to enhance the sustainability of the Aging network. In so doing, the AAA must follow all requirements of the Older Americans Act and MAN 5600, Sections 2025-2028, “Fee for Service System”.

Services provided to consumers as a fee-for-service should not differ in quality from service provided to consumers funded through public funds.

202.10 Insurance

AAAs are responsible for ensuring that each service provider maintains appropriate types and levels of insurance coverage that protects the health and safety of clients and employees, and that complies with all applicable state and federal statutes.

202.11 Facilities

AAAs will ensure that contractors which operate congregate facilities (such as nutrition sites, senior centers, adult day care facilities or other such facilities) funded by any grant from DAS locate the facility as close as possible to the majority of eligible persons in the specified target group for the service and service area.

AAAs will ensure that such facilities operate in compliance with all federal, state, and local laws and codes that govern facility operations, including but not limited to space, heating, ventilation and air conditioning (HVAC), plumbing, lighting systems, fire safety, sanitation, and insurance coverage. Specific program guidelines may contain more specific criteria for operation of facilities.

202.11A Emergency Plan

AAAs will ensure that all contractors that operate congregate facilities (such as nutrition sites, senior centers, adult day care facilities or other such facilities funded by any grant from DAS) have a written emergency plan, to include evacuation in the event of fire, inclement weather, public health emergency, or other emergency, including missing participants. Such plans must be consistent with MAN 5600 3017 Emergency Planning and Management.

Specific program guidelines may include more stringent requirements in addition to those listed in this section.

202.11B No Smoking Policy

The Surgeon General of the United States has determined that the smoking of tobacco constitutes a health hazard. DAS prohibits smoking of tobacco during the hours of operation of senior programs and in facilities / physical plants designated for senior activities funded by DAS.

AAAs will ensure that all service providers establish, implement, and review with personnel no less than annually procedures that address the ethical and legal framework for the provision of services, and that all providers comply with Division policies on these and related topics.

Certain services may have specific ethical and/or legal guidelines that refine the general scope outlined in this policy and it is the AAA’s responsibility to ensure appropriate staff is adequately trained in them.

General ethical guidelines for all programs should include, at a minimum:

  1. Advocacy for individuals’ needs and preferences whenever possible and feasible

  2. Professional relationships with individuals and their families

  3. Resolution of conflicts of interest between among staff, the individual, the service provider, or other entities

  4. Business and financial practices and marketing

  5. Resolution of potential or perceived lapses in documented quality of care resulting from actions by individuals or their families, staff, service providers, or other entities that affect service delivery;

  6. Process by which clients and providers may file grievances or appeals

  7. Provision of staff that are adequately screened, trained, and have credentials appropriate to the service provided, and

  8. Prohibition of discrimination against a client or a group of clients

General legal guidelines for all programs should include, at a minimum:

  1. Scope of practice for staff

  2. Laws and procedures affecting client confidentiality and release of information

  3. Federal, state, and local laws that impact service delivery, such as Americans with Disabilities Act, Worker’s Compensation laws, and other laws protecting individuals and staff

  4. Laws regarding reporting of abuse, neglect, and exploitation, and

  5. Laws and practice regarding advanced directives

202.13 Prohibited Activities

The AAA will establish a list of prohibited activities when provider staff is in the client’s home. These prohibited activities will include, at a minimum:

  1. Consumption of clients’ food or drink, except for water

  2. Use of clients’ telephones for personal calls

  3. Discussion of one’s own or others’ personal problems and religious or political beliefs with the client

  4. Bringing other persons, including children, not involved in providing care, to the clients’ homes

  5. Solicitation or acceptance of tips, gifts, or loans in the form of money or goods for personal gain for clients/caregivers

  6. Consumption of alcoholic beverages, or use of medicines or drugs for any purpose, other than as ordered or prescribed for medical treatment, in the clients’ homes or prior to being present in the home to provide services

  7. Smoking in clients’ homes

  8. Breach of the clients’/caregivers’ privacy or confidentiality of information and records

  9. Purchase of any item from the client/caregiver, even at fair market value

  10. Assuming control of the financial or personal affairs, or both, of the client or his/her estate, including accepting power of attorney or guardianship

  11. Taking anything from the clients’ home

  12. Committing any act of abuse, neglect, or exploitation

202.14 Program Evaluation and Monitoring

Using tools specified by DAS at a minimum, the AAA and its providers will periodically monitor performance to determine the degree to which defined program outcomes and objectives are being achieved (see MAN 5600 3015 Area Agency on Aging Monitoring and Evaluation of Service Providers and MAN 5600, 3050 Compliance with Contractor Responsibilities and Sanctions.

The AAA will monitor for compliance with program requirements and evaluate performance on at least an annual basis and provide written feedback to the provider about its findings and will provide technical assistance for continuous quality improvement. If the AAA is the service provider, it will develop and implement a protocol for self-evaluation and objective review of services.

The AAA will monitor each provider annually, including ensuring appropriate time for notification to and response from each provider prior to June 30. The AAA will forward all monitoring reports completed during a calendar quarter to DAS by the 15th working day of the following month.

The evaluation process will include at a minimum:

  1. Review of the existing program

  2. Satisfaction survey results from participants, volunteers, families, and referral sources,

  3. Program modifications made that responded to satisfaction survey results and/or changes in needs or interests of individuals, and

  4. Proposed program and administrative improvements

202.15 Non-Discrimination in Services

All services are to be provided to eligible recipients without regard to race, color, national origin, gender, mental or physical disability, political or religious affiliation, or sexual orientation. Providers may consider age only with regard to eligibility requirements.

202.16 Changes in Service Levels

It is the explicit intent of DAS to serve clients in greatest need and to maximize the efficiency and effectiveness of the Aging Network.

DAS anticipates that during the span of service delivery to an individual, the individual’s needs, supports, and resources will change. Based upon the ongoing process of assessment and reassessment, the AAA may determine based on recommendations from its service provider network, that an individual’s type of service or quantity of service may be reduced or terminated (see MAN 5300 §114 “Guidelines for Client Assessment” and MAN 5300 §118 “Prioritizing Clients”).

Each AAA will develop written guidelines pursuant to MAN 5600 3020 Administrative Appeals ensuring, at a minimum:

  1. That individuals are informed prior to beginning services that the type or quantity of service may be changed

  2. That individuals will be informed of any changes in a timely manner

  3. That individuals are informed of their rights to appeal a decision, and

  4. That all information pertinent to the decision, including changes in assessment data, is thoroughly documented

The provider shall provide written notice of reduction or discontinuation of services, including the reason for the action, at least 30 calendar days prior to the effective date of the change to both the individual and the service agencies involved. The written notice will include information about how to appeal the decision if reduction/termination was not a mutual decision between the family and service provider or not initiated by the individual/family.

The individual will continue to receive services during the 30-day period unless continuation of services would place staff at risk of harm. If other supportive services are also being discontinued, the respective service providers will continue services during the 30-day period.

During the 30-day period, the provider will coordinate with the ADRC as needed to arrange for the provision of information and referral to other services, or to assist with transition to other levels of care as appropriate. If the individual is relocating to another part of the state or country, the provider will refer to appropriate services to assist with coordinating the transition.

For some individuals, a provider may recommend an increase in service levels. In such cases, the increase must be clearly documented in the assessment(s) used to determine that an increase in service levels is appropriate, and the AAA must approve the increase. In lieu of approvals of individual cases, the AAA may establish policies or guidelines that providers may use to increase service levels.

In other situations of changes in service (such as change in provider, etc.) the AAA should follow the 30-day notification guidelines. When a 30-day notice is not possible, the AAA should ensure that clients are notified as soon as possible.

202.17 Service Termination and Discharge

The AAA staff shall discontinue services when any of the following conditions exist:

  • The individual has moved to a long-term care facility or other community placement for an extended or permanent duration

  • The individual is non-compliant with the Service Plan, or the persistent actions of the individual or the family negate the services provided by the various agencies/individuals involved, AND the AAA staff has documented attempts to counsel with the individual/family to encourage compliance prior to discontinuing services

  • The family has developed or strengthened a support system that is capable of providing adequate and acceptable care, and the family and other service providers are informed of how to contact the area ADRC if a future need for in-home services arise

  • The individual, caregiver, or individual’s family threatens service provider staff (including AAA staff), engages in illegal or hostile/threatening activity, or refuses to remediate unsanitary conditions such that the welfare and safety of service provider staff are in jeopardy AND good-faith attempts at corrective action have failed

  • The individual has relocated outside the service area and any transition assistance has been provided, including coordination with AAA staff, in the area of relocation

  • The individual requests to discontinue in-home services

  • The individual has deceased

Situations may arise in which the current level of service provision is inadequate to ensure the safety and health of the individual. In such situations, the AAA staff must document efforts to educate the individual or family about other community resources including more appropriate levels of care, limitations of current services, and the right of the individual to make informed choices. AAA staff should assist wherever possible to ensure a smooth transition from supportive services. AAA staff must comply with MAN 5300, CH 202.17 when discharging clients or reducing levels of service.

AAA staff will coordinate discontinuation of services with individuals and agencies providing supportive services. Discontinuation of one services should not affect the individual’s receipt of other support services. The AAA staff will develop procedures for supervisory review of pending closures.

202.18 Client Safety and Well-Being

The AAA and subcontracting organizations will establish and implement policies and procedures to protect the safety of individuals, staff, and volunteers. Such policies will address the AAA’s/subcontracting organization’s responsibilities to intervene in management of such risks, and will address the following circumstances, at a minimum, as appropriate to their scope of practice:

  1. Mandatory reporting of suspected abuse, neglect, or exploitation

  2. Protocols for staff and volunteers who interact with clients, and

  3. Reporting of incidents

AAAs and AAA providers will maintain reports of incidents that affect the health, safety, and welfare of the clients, for a minimum of six years.

Providers will furnish adequate identification (ID) to any staff that has direct contact with individuals and caregivers. Each employee must carry the identification and either wear it on his/her person or present it to the individual upon request. An adequate ID is one that is made of permanent materials and that shows the provider agency name, and the name, title, and photograph of the employee. The provider will issue the ID at the time of employment and require its return from each employee upon termination of employment.

202.19A Mandatory Reporting of Abuse / Neglect / Exploitation

Staff of all AAAs and contractors for non-Medicaid Home and Community Based Services are considered mandated reporters under O.C.G.A. 30-5-4.

Any person employed by any program or service funded in part or in full by the statewide aging program, who has reasonable cause to believe that a disabled adult age 18 or older, or elder person age 65 or older, not residing in a long-term care facility, is being abused, neglected, or exploited must report the abuse, neglect, or exploitation situation to DAS of Aging Services Adult Protective Services Central Intake and to a law enforcement agency of appropriate jurisdiction. If the adult is a resident of a long-term care facility, the report should be made to the Department of Community Health, Health Care and Facilities Regulation.

Persons making reports must provide the following information, at a minimum:

  1. Name, age, and address of the resident

  2. Name and address of the person responsible for the care of the client, if available

  3. Nature and extent of the elderly or disabled person’s condition

  4. Basis of the reporter’s knowledge

  5. The type of maltreatment alleged and identify of alleged perpetrator, and

  6. Any other information relevant to an investigation

202.19B Procedures and Protocols for Individuals at Risk of Suicide

AAAs will ensure that procedures and protocols for staff and all volunteers who interact with clients are in place to identify persons at risk of suicide and to provide appropriate interventions to prevent suicide.

Protocols should include, at a minimum:

  1. Linking persons at risk with the Behavioral Health Link Service, Georgia’s crisis and access line (1-800-715-4225)

  2. Facilitating warm transfers when feasible or required by specific program guidelines

  3. Completing an incident report to be submitted to a supervisor for follow-up as needed

  4. Procedures for reporting incidents that occur in the course of service delivery, whether calls originate from offices or homes; case management practice in agency offices and in other community locations, including individuals’ homes. For definitions of what constitutes an incident, see MAN 5600 Section 9000.

  5. Using the Serious Incident Review Team (SIRT) Manual as a guideline, the AAA will identify the nature of incidents to be reported and the manner and timeframe for reporting

Effective Date

Upon Issuance. AAAs will assure that staff and providers subject to these guidelines receive copies of this chapter in a timely manner and will allow providers a reasonable period of time in which to make adjustments to comply.

References

Serious Incident Review Team (SIRT) Process

NASW: Guidelines for Social Worker Safety in the Workplace.

Syracuse University School of Social Work “Social Work Safety Tips.”

Indiana Department of Child Services, Home Visit Safety Protocol

DAS MAN 1000, Chapter 1060, “Technology and Data Management”

DAS MAN 5300, Chapter 110, “Grievance Procedures for Participants in Non-Medicaid Home and Community Based Services”

DAS MAN 5300, Chapter 114, “Guidelines for Client Assessment”

DAS MAN 5300, Chapter 118, “Prioritizing Clients”

DAS MAN 5300, Appendix D, “Forms and Templates”

DAS MAN 5600, Chapter 1060, “Technology and Data Management”

DAS MAN 5600, Chapter 2025, “Fee for Service Overview”

DAS MAN 5600, Chapter 2026, “Cost Share”

DAS MAN 5600, Chapter 2027, “Voluntary Contributions”

DAS MAN 5600, Chapter 2028, “Private Pay Services”

DAS MAN 5600, Chapter 2051, “Eligibility”

DAS MAN 5600, Chapter 2053, “Confidentiality”

DAS MAN 5600, Chapter 2054, “HIPAA”

DAS MAN 5600, Chapter 3012, “Area Agency on Aging Records”

DAS MAN 5600, Chapter 3016, “Targeting Service Delivery”

DAS MAN 5600, Chapter 3017, “Emergency Planning and Management”

DAS MAN 5600, Chapter 3020, “Administrative Appeals”

DAS MAN 5600, Chapter 3030, “Uniform Cost Methodology:

DAS MAN 5300, Chapter 3036, “Criminal History Investigations”

DAS MAN 5600, Chapter 3050, “Compliance with Contractor Responsibilities, Rewards, and Sanctions”

DAS MAN 5600, Chapter 3025, “Financial Management”

DAS MAN 5600, Chapter 9006, “Serious Incident Review Team (SIRT) Process”