Reference Guide and Expectations for Active Licensed Providers

Best Practices

Throughout various sections, best practices will be shared to help provide strategies on how to improve an agency’s processes and services. Best practices are established methods and techniques that are proven through experience and research to consistently and efficiently achieve higher results.

Staff Requirements

All staff (paid or unpaid) must have these checks completed every two years. These must be completed before employees can work alone with people supported.

  • Abuse, Neglect, and Exploitation
  • Individual Rights and Responsibilities
  • CPR/First Aid 
  • Emergency Preparedness 
  • Final Rule Training
  • Targeted Case Management (TCM) Training - TCM agencies only (certificate) 
  • Medication Administration 
  • Person Centered Support Plan (PCSP) Training (as plans are revised)
    • Additionally, it is important for direct support staff to be trained on and have read the PCSP and any other support documents (Behavior Support Plan, Risk Assessment, or Informed Consent) for any person they support to ensure that services are delivered in accordance with the person’s PCSP. We encourage agencies to maintain documentation to show that staff have received this training. 

Policies to Review When Developing Staff Training

  • HCBS AIR Management
  • HCBS Background Check Policy
  • HCBS Settings Ongoing-Monitoring
  • Final Rule Policy
  • Conflict of Interest Policy
  • Person-Centered Service Plan (from MCO)
  • Shared Living – See Shared Living Manual for more details

Although there may not be specific regulations regarding additional staff trainings, the following philosophies may be valuable additions when teaching staff how to engage with people supported.

 

General Considerations

  • The language we use is important; labels separate. Using person-centered language promotes respectful and empowering communication for everyone  involved. 

  • One commonly used term is “compliance,” which doesn’t reflect the person’s right to choose. It would be better to articulate the person’s preferences and how they engage with an activity. This may take more words to express, but ultimately presents the information in a more person-centered manner. 

Use: Don't Use:
A person with a disability Special Needs
A person who uses a wheelchair Wheelchair bound
Person Client/Consumer
A person with greater support needs Low-functioning
A person who communicates without using words Non-verbal
  • Presume Competence
    • The idea that a person is capable and can engage in making decisions for their life.
    • The person does not automatically need total support just because they have a disability.
  • Do “with” a person, not “for“ a person
    • Work to ensure that the person participates as much as possible
  • Sympathy (feeling sorry for someone) vs Empathy (understanding and sharing the feelings of others)
    • Understand the difference between sympathy and empathy. Supports shouldn’t be led by sympathy where the person is taken care of due to their lack of ability, instead by empathy to understand their support needs and empower them to do what they can.
  • Challenging behaviors do not coexist in the same moment with learning or living your best life.
    • A person cannot learn while in crisis – instead, consider calm times to pre-teach new skills and coping strategies. Behavior is communication, so if there is a challenging behavior, it could show that this person may need something to change.

Informed Choice

Informed Choice is the process of ensuring people know a wide variety of the options available to them. This should also include the potential risks, benefits, and consequences of the options, not just the options they have chosen in the past. This enables the person the opportunity to express their preferences or try new things once they have been provided enough information to do so. This also enables the person the opportunity to have control over their lives and make a choice that may or may not be in their best interest.

Here are some instructional videos that provide insight on ensuring that the people served are provided a variety of choices and options to ensure their preferences are honored and they live their most fulfilling lives.

Training Opportunities

Kansas Train is a resource provided through KDHE that provides a variety of educational opportunities and best practice ideals. It is no charge, but you must register. View an overview of the program and how to register. We encourage any agency to utilize this resource for additional staff training.

Here is a list of courses offered for Direct Support Workers.

Choice and Referral

Choice and Referral is the process by which a person selects their service provider. If an agency feels it has the capacity to serve more people, it will notify the CDDO Referral Coordinator that it would like to be “open for referrals” on the CDDO website. When an agency feels they are at capacity, they will notify the CDDO Referral Coordinator that they would like to “close for referrals.” When an agency is open for referrals, it may be selected by a person when a choice form is submitted through the CDDO website. Once this is submitted to the CDDO, a referral will be sent to the agency, which will have two weeks to respond.

Article 64’s Uniform Access to Services item notes that a community service provider must serve a person who has selected them, regardless of the severity of the person’s disability. If the provider deems that they cannot support the person referred, they must provide an explanation in writing when responding to the referral received. The CDDO will review the reasoning and respond as needed.

Choice and Referral Contact: David Gibbs, CDDO Referral Coordinator

Welligent

Welligent is the CDDO’s Electronic Health Record (EHR) system. This is where the CDDO’s records for people in IDD services within Johnson County are maintained and can be shared with the selected provider(s). This includes basic information for people, family contacts, providers, assessments, and documents. Each agency will determine who from that agency will have access to the people within their services.

To gain access, complete the application. Each person will be issued a username and password. For security purposes, login credentials should not be shared.

Here is the link to log in: welligent.com

To troubleshoot any technical issues, please use the contact information below:

Functional Assessment

Every person utilizing HCBS waiver services will have an annual functional assessment completed by the CDDO to reevaluate their eligibility for services.

The current functional assessment tool is called the Medicaid Functional Eligibility Instrument (MFEI). The CDDO’s functional assessors will contact the person’s TCM to assist with coordinating this assessment when it is due.

Human Rights Committee (HRC)

An HRC is a group made up of persons served, guardians of persons served, family members of persons served, interested citizens, and providers, where at least one third of whom shall be otherwise unassociated with the provider. They review any plans that outline restrictive interventions and work to ensure that these plans meet the requirements of Article 63 when working to justify the need for a restriction. An agency can develop its own HRC or utilize another previously established one.

Any restriction of a person’s rights requires due process, which is the methodology that ensures their rights are not infringed upon and is truly required/justified. This will need to be documented in their PCSP, Behavior Support Plan, Risk Assessment, or Informed Consent with approval from an HRC before implementation. Article 63 (K.S.A. 30-63-23) requires that an agency either develop its own HRC or utilize an already established HRC.

Best Practice

Dignity of Risk

It is important that the people in service still have the same rights and options to direct their lives and experiences. Below are some instructional videos that can provide some guidance on determining when that is necessary.

Here is an additional video providing some education on Rights Restrictions.

Records for People Supported

Required Records (Article 63)

  • Person Centered Support Plan (from TCM)
  • Behavior Support Plan (when applicable)
  • Risk Assessment (when applicable)
  • Informed Consent for Psychotropic Medications (when applicable)
  • Financial/Service Agreement
  • Incident Reports
  • Health Assessment (every two years)
  • MFEI
  • Person Centered Service Plan (from MCO)
  • Releases of Information (as needed)
  • Consent for Emergency Medical Release/Other Treatment
  • Authorization for Publication
  • Documentation of Rights Training

Other Required Files for Each Setting

  • Final Rule Certificate
  • Documentation of Completed Fire and Tornado Drills

Best Practice

  • Face Sheet
  • One Pager (Brief overview of person’s preferences, abilities and supports)
  • Emergency Contacts
  • Daily Documentation
  • Insurance/Identification Cards
  • Guardianship/Power of Attorney Documents
  • Advanced Medical Directives
  • Medical Summaries/Discharge Documentation

Behavior Support Resources

Community Behavioral Health Team (CBHT)

This is a group that works as a partnership between Johnson County Developmental Supports and Johnson County Mental Health to support people with intellectual and developmental disabilities who also have a co-occurring mental health diagnosis. They provide case management, therapy services, and positive behavioral supports.

Additionally, they can provide a broad overview of positive behavior supports to an agency’s staff through one of their Behavioral Health Specialists. To inquire about these services, contact the Director of Health Services, Carla Sadler, at carla.sadler@jocogov.org.

MCOs

Each of the Managed Care Organizations has a behavioral health function. See your MCO for more details.

Board Certified Behavior Analyst (BCBA) Services

The CDDO was awarded a grant that allows people in Johnson County to connect with BCBA services. BCBAs will meet with the person and their team to make observations, complete assessments, and provide recommendations to their team. There is currently a waiting list for this service, and it is limited by funding each year. If someone served may benefit from this service, please reach out for more information.

Other Positive Behavior Supports (PBS) and Crisis Resources

Below you will find additional resources to support behavioral needs. Each agency should research which method they may elect to incorporate into the services they provide. This is not a comprehensive list. There are other PBS options that can be researched as needed.

Extraordinary Funding

If a person served has complex or extraordinary needs, most typically for extreme medical or behavioral needs that require a day or residential provider can apply to receive additional funding to assist with ensuring sufficient staffing can be provided. All requests should be submitted to the person's specific Managed Care Organization. View the Extraordinary Funding Policy.

State Aid Fund

State Aid is discretionary funds that the CDDO can use to assist people eligible for IDD services. All other community resources will need to be exhausted before the application. An application can be submitted at the link below for the person, and then the CDDO determines whether it meets the criteria. This application must be for a specific individual and not for a group. An agency or provider must be willing to accept the payment to assist the person; it cannot be given directly to them. Additionally, this cannot be for an ongoing expense. Access the State Aid Funds Application.

Crisis and Exception Requests

Crisis and Exception Requests allow a person who is currently on the waitlist for services to circumvent the waitlist due to an emergent need.

See what qualifies for a crisis or exception in the Crisis & Exception Policy and complete a Crisis & Exception Request.

Medically Fragile Exceptions

If a person served is determined to be frail or medically fragile, day services may be provided in their home by submitting a Medically Fragile Exception request. These requests must include a current signed Person-Centered Support Plan, MCO Person Centered Service Plan, and a signed letter from their physician on the physician’s letterhead. These should be submitted every six months or two years, as determined by KDADS, to cddo@jocogov.org. Once approved, the Quality Assurance team will notify you and provide the approval. View the Medically Fragile Exception Memo.

Inclement Weather Exceptions

If there is an inclement weather event that impedes or affects the person or their service provider, a licensed day provider may bill for day services in the home by submitting an Inclement Weather Exception Request to cddo@jocogov.org.

Adverse Incident Reports (AIRs)

KDADS requires that an AIR be submitted for any event meeting the definition of an Adverse Incident within 24-hours of becoming aware of the incident. If requested, the CDDO will coordinate a training for you with KDADS Program Integrity & Compliance Specialist. See the policy and event type definitions here: AIR Policy and Event Definitions.

Additionally, Johnson County CDDO requires that a PDF copy of the AIR be submitted to cddo@jocogov.org within that same 24-hour period and that you CC the targeted case manager.

The Quality Assurance team may follow up with questions or suggestions depending on the information included in the AIR. Provide as much detail as possible!

View Quick Access to Submitting AIRs.

Additional instructions can be found in the Notice in the link above, but can also be found here:

*It is required that each agency develop and maintain its own internal incident reporting process for all other incidents that do not qualify as an Adverse Incident.

KDADS Program Integrity & Compliance Specialist: Matthew Mackey

Quality Assurance (QA)

Every CDDO is required to have a team that reviews overall quality. Johnson County’s CDDO engages in this practice through the following methods. The goal of the quality team is to ensure that agencies are meeting regulations, ensuring satisfaction with services, and that the rights of each person served are being respected.

Affiliate Reviews

These will occur once a year. Agencies will be contacted by a Quality Assurance team member to schedule the annual review. These are made up of interviews with people served, a staff that works directly with them, a visit to either their day or residential setting, and a complete file review. Findings will be shared after these have been completed and there is an optional meeting offered to review findings. A written response is required within 30 days on what the agency’s plan is to address findings, and the expectation is that all findings be addressed within 90 days of the findings being provided.

Drop-In Visits

In addition to Annual Affiliate Reviews, QA team members may complete visits randomly or if a concern has been brought to their attention. These are generally comprised of brief interviews with the people served, staff, spot check of files and meds, and a walk-through to ensure that both safety measures are in place and that the Final Rule is being met. The QA team member will communicate any necessary feedback via email.

Concerns

The QA team may receive complaints through various means. The team will request any additional information on the subject, how it will be addressed by the provider/team, and provide follow-up requests depending on that information. This can lead to additional meetings with the agency and/or the team of the person involved, or a Corrective Action Plan.

Corrective Action Plans (CAP)

If the QA team observes an ongoing trend within an agency that shows deficiencies in supports or not adhering to state regulations, a Corrective Action Plan may be developed. This will outline the deficiencies and regulations not being met and provide a list of Corrective Action steps that the agency will need to complete. Until those steps are completed, the agency will be closed for referrals and will not have the ability to accept new people into service.

CDDO QA Contacts

  • Ashae Amerine, Affiliate Coordinator
  • Joe Thomas, Quality Assurance Analyst
  • Tasha Markovich, Quality Assurance Analyst
  • Marlo Silva, Targeted Case Manager Liaison
    • Will conduct all TCM annual affiliate reviews and assist with any TCM related questions or concerns.

CDDO Communication

Overview Trainings

The CDDO provides bi-annual trainings virtually to review all CDDO functions. This is recommended for new providers.

Affiliate Meetings/Newsletters

The CDDO facilitates quarterly virtual meetings for all current affiliates. Providers are encouraged to attend to stay up to date on relevant updates, trainings, resources, and ask any questions. For the months that the Affiliate Meeting does not occur, the CDDO will communicate this information via electronic newsletter.

CDDO Contact Information

View CDDO email boxes and staff contacts.