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Support Coordination

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Support Coordination- Requirements To Receive

Description

Support coordination is the service of advocating, identifying, developing,
coordinating and accessing supports and services on behalf of a recipient,
or assisting the recipient or family to access supports and services on their
own. These services may be provided through waiver and Medicaid State
Plan services, as well as needed medical, social, educational, other
appropriate services, and community resources regardless of the funding
source through which access is gained. The waiver support coordinator is
responsible for assessing a recipient’s needs, preferences and future
goals (outcomes). From that information, the waiver support coordinator
assists the recipient in developing a support plan and cost plan.
Once a recipient’s support plan is developed and the cost plan is approved
by the APD, the waiver support coordinator assists the recipient to meet
his support plan outcomes or personal goals by linking the recipient with
natural and generic supports and services available through family, friends
and community resources. When natural or generic supports are
unavailable or are in the process of development, the waiver support
coordinator assists the recipient in locating services available through
local, state or federal sources, including Medicaid, the DD waiver and
APD, as authorized.
Waiver support coordinators promote the dignity and respect for each
recipient with regard to the recipient’s personal privacy, sharing personal
information and making decisions.
Support coordinators promote the health, safety and well-being of the
recipient; assist the recipient to identify and access formal and informal
support systems; assist the recipient to increase or maintain the capacity
to direct formal and informal resources; promote advocacy or informed
choice for the recipient; provide information regarding the Medicaid fair
hearing process; increase the recipient’s involvement in the community;
and assist the recipient to achieve personal goals.

Transitional Support Coordination
Transitional support coordination consists of activities that assist the recipient
in transitioning from a nursing facility (NF), Developmental Disabilities
Institution (DDI), or an intermediate care facility for the developmentally
disabled (ICF/DD). These activities include working with the recipient to
arrange for the provision of community-based services and supports upon
discharge, including those available under this waiver and other services and
supports, regardless of funding source, necessary to ensure the health and
welfare of the recipient.
Waiver support coordinators are responsible for working with the institutional
provider and staff and coordinating their activities with the facility’s discharge
planning process. The waiver support coordinator will develop an initial
support plan based on current assessments including the facility’s summary of
the recipient’s developmental, behavioral, social, health and nutritional status
and discharge plan designed to assist the recipient in adjusting to their new
living environment. The support plan will identify the community supports and
services required to meet these identified needs. Waiver support coordinators
can bill for up to 90 days (three months) for services rendered prior to the
recipient’s discharge. These services can be billed only after the recipient is
discharged.
The waiver support coordinator will maintain, at a minimum, weekly contact
with the recipient for the first 30 days following discharge to ensure that
community supports and services are meeting the recipient’s needs. The
waiver support coordinator will update the support plan at the end of the 30-
day period, identifying progress made with the transition to community-based
living and changes in supports and services. At the end of each month
following discharge, if the waiver support coordinator has provided all
necessary services, including the weekly face-to-face visits for the first 30 days
following discharge, they may bill for up to 90 days at the enhanced waiver
support coordination rate.

Limited Support Coordination
Limited support coordination services are less intensive case management
services available upon request by an adult receiving services or the adult’s
guardian. Adults receiving limited support coordination may request to change
to full support coordination due to an increased need for assistance, but must
remain in full support coordination for the remainder of the cost plan year.
Children under the age of 18 who live in the family home shall use only limited
support coordination. Limited support coordination for children living in their
family home may be approved at the full support coordination level by the APD
Area Office for a time limit not to exceed 60 days per cost plan year should a
family emergency warrant increased support from this service. The Area
Office will maintain documentation of the approval and the nature of the
emergency on file. The emergency approval and explanation of the need
should be clearly documented in the case notes for the recipient by the waiver
support coordinator.
Limited support coordination services are billed at a reduced rate and have
reduced contact requirements. The limited support coordinator must conduct
two (2) face-to-face visits per year (including at least one home visit) and one
(1) other billable activity a month as outlined in the Documentation
Requirements section of the handbook for this service.
The face-to-face contacts conducted in the support plan development period
may count as one face-to-face contact. The second face-to-face contact shall
occur toward the middle of the support plan year. The support coordinator
shall:
1. Perform required assessments and develop the annual support and cost
plan. The cost plan shall be submitted for prior service authorization.
2. Document in case notes and other records all activities completed on
behalf of the recipient.
3. Arrange initial providers and complete service authorizations as needed.
4. Continue to ensure that Medicaid eligibility is maintained by providing all
assistance necessary to maintain Medicaid benefits.
5. Enter into an agreement specifying the activities the recipient expects the
support coordinator to conduct as part of the limited support coordination
on his or her behalf and those that the recipients and family will assume.
Limited Support Coordinators will not:
1. Be responsible for ongoing monthly face-to-face contact and other required
monthly contacts, except as identified above.
2. Oversee the delivery of supports and services.

Limitations

The provider must accept all recipients who select the provider for waiver
support coordination services and not reject any recipient referred to them
or who selects them from within the geographic boundaries previously
approved by the APD Area. The APD may grant exceptions to this
requirement in writing.
The caseload for waiver support coordination is established by the
Legislature. Effective January 1, 2008 the caseload for this service is 43
full time recipients. Each waiver support coordinator shall maintain a
caseload of no more than 43 full time recipients, or as specified in statute,
even when that total includes recipients who are not participants in the
waiver or are not recipients of the Developmental Disabilities Program.
Support coordination services are rendered in a ratio that does not exceed
one certified full-time equivalent (FTE) waiver support coordinator position
to every 43 full time recipients. "Full Time Equivalent" means a person who
is providing support coordination services for 43 full time recipients. A
recipient who receives limited support coordination is considered a half-time
recipient on a caseload. Waiver support coordinators who provide limited
support coordination may have a caseload of more than 43 individuals, not
to exceed 43 full time recipients. Supervisors of waiver support
coordinators within group providers shall limit their caseloads to less than
43 full time recipients and must ensure that adequate supervision is also
provided for support coordination employees. When a provider is planning
to expand services, providers may temporarily exceed the above ratios for
a period not to exceed 60 consecutive days.
The support coordination provider must notify the APD Area Office in
writing of any vacancies or leave of absences granted with a list of
recipients affected by this vacancy, within five days of each occurrence.
Vacancies due to the termination or resignation of a waiver support
coordinator that result in caseloads temporarily exceeding the maximum of
43 full time recipients may be for a period of no more than 60 consecutive
days, per vacancy. The 60 consecutive days begin with the date the
vacancy actually occurs. Failure of the provider to notify the APD Area
Office of the vacancy within the required timeframe will result in recoupment
of funds received by the provider.
Vacancies due to a waiver support coordinator submitting a written request
to the APD Area Office for leave based on the intent of the Family and
Medical Leave Act that result in caseloads temporarily exceeding the
maximum of 43 full time recipients are allowed for a period of no more than
60 working days, per vacancy.

If the support coordination provider cannot fill a reported vacant position within
the time allotted, the APD Area Office must be notified prior to the 60th
consecutive or 60th working day, whichever is applicable to the situation. Upon
receipt of this notification, the APD Area Office will provide 14 calendar days
notice to the affected recipients and agency of the need to select a different
waiver support coordination provider. This notification will enable the APD Area
Office to inform the affected recipients of the impending change in their support
coordination provider. This notification will allow sufficient time for the recipient
to choose an available provider from within or outside the current agency and
the provider to complete needed paperwork and take any other necessary
actions. It will also allow the recipient time to adjust to the anticipated changes.
Vacancies resulting in caseloads exceeding the maximum of 43 full time
recipients for more than the above stated number of days may subject the
provider to recoupment of funds and the recipients served to transition to
another enrolled support coordination provider, chosen by the recipient. All
caseload transfers will be accomplished by the APD Area Office working with
the provider to identify those recipients affected by the vacancy and who will
cause the temporary support coordinator to exceed the maximum caseload of
43 full time recipients.
Expansion of services includes increasing the number of recipients served by a
solo practitioner or an agency, as well as a solo practitioner changing or
expanding their status from solo practitioner to an agency. A provider must
have no alerts or documentation cites indicating recoupment and have attained
a satisfactory overall score on the last quality assurance monitoring conducted
by the APD, AHCA or their authorized representative, and be approved by the
APD Area Office in order to expand services.
The provider and all its employees who supervise staff, train staff or conduct
support coordination activities shall remain free from influences that interfere
with the recipient’s choice of supports and services. This includes, but is not
limited to, the following:
The provider and its employees do not currently, and shall not while
certified to render support coordination services, provide direct services
within the state of Florida, other than support coordination or related
administrative activities to recipients who receive services from APD;
The provider, its board members and its employees shall be legally and
financially independent from and free-standing of persons or organizations
providing direct services within the state of Florida, other than support
coordination and related administrative activities to recipients who receive
services from APD;
The provider and its employees shall not be a subsidiary of, or function
under the direct or indirect control of, persons or organizations providing
direct services within the state of Florida, other than support coordination
and related administrative activities to recipients who receive services from
APD;

The provider shall not, nor shall employees of the provider, be the guardian,
apply to be the guardian, or be affiliated with an organization or person who
is the guardian of a recipient served by the provider;
The provider shall not, nor shall employees of the provider, render support
coordination services to a recipient who is a family member of the provider or
any employee of the provider, unless the recipient receives services in an
APD service area where the family member is not certified to provide
support coordination;
The provider shall not, nor shall employees of the provider, secure paid
services on behalf of a recipient from a service vendor who is a family
member of the provider or any employee of the provider. Exceptions to this
prohibition may be made in writing by APD; and
The provider and its employees shall not assume control of recipient’s
finances or assume possession of a recipient’s checkbook or cash, nor shall
they become representative payee for recipient benefits.


Support and Service Planning Requirements
The provider must be available to meet the recipient’s needs and to perform the
responsibilities for support coordination. The provider shall have an on-call
system in place that allows recipients to access support coordination services
24-hours per day, 7 days per week. The APD Area Office must approve this oncall
system.
Any time a back-up support coordinator is used during the provider’s absence,
the back-up support coordinator shall be a certified and an enrolled waiver
support coordinator. The name and contact information for the back-up waiver
support coordinator shall be clearly communicated to the recipient and to the
APD Area Office. Access to the provider or back-up provider shall be available,
without toll charges to the recipient.
Waiver support coordinators should assist ADT recipients with information or
referral to rehabilitation, vocational habilitation, and other employment services
and employment opportunities available in their community. On an annual basis,
waiver support coordinators shall provide service counseling for recipients
currently in sheltered workshops or segregated work environments to apprise
them of the options available to them for meaningful work activities and training.
The support coordinator shall provide information to recipients on residential
options available to them including owning or renting their own home with
supports. This shall occur at a minimum of once a year during support planning
but should also occur when anticipating a change in the residential situation.

The waiver support coordinator will complete activities that assist the recipient in
determining their own future. At least once annually the provider will assist the
recipient, primary caregiver, or legal guardian to:
Complete or update tools, including the Personal Outcome Measures and the
APD-approved assessment, necessary to assist in identifying personal goals,
needs and services prior to the development of the support plan; make
decisions and informed choices. The support coordinator is responsible for
administering the APD approved assessment to all recipients on their
caseload; Complete the support plan, including required signature(s) of recipient or legal
guardian; Complete the cost plan; and
Complete the waiver eligibility work sheet.
When a recipient is newly enrolled to receive waiver services the support
coordinator must complete the support plan and cost plan within 60 days of the
recipient’s selection of the support coordinator.
In accordance with section 393.0651, F.S., the provider shall complete an annual
report of progress.
The waiver support coordinator shall provide a copy of the notice of privacy
practices required by HIPAA regulations to the recipient or legal guardian upon
initial contact with the recipient, and at any time there is a significant change that
necessitates the protection of a recipient’s personal health information.
The waiver support coordinator will submit to the APD Area Office, no later than
twenty calendar days prior to the support plan effective date, a new annual support
plan and cost plan with supporting documentation. The APD Area Office will in
turn respond no later than ten working days of its receipt of the cost plan, with a
statement of approval or denial. Copies of the support plan and complete
approved cost plan will be provided to the recipient or his guardian at any time they
are requested, but at a minimum, within ten calendar days of the effective date of
the support and cost plan. If changes to the support plan’s effective date must be
made by the support coordinator for purposes of case load management, the
support coordinator shall notify providers 60 days in advance of the change.

For emergency support and cost plan requests, the waiver support coordinator will
notify the APD Area Office of the crisis situation and provide the updated support
plan, cost plan and supporting documentation, within three working days of
becoming aware of the crisis.
The cost plan (plan of care) is updated annually by the support coordinator. An
amendment to the plan to change services or to increase service intensity or
frequency may only be submitted during the year if there is a documented
significant change in the recipient’s condition or circumstance that impacts on
health, safety, or welfare, or when a change in the plan is required to avoid
institutionalization. A comprehensive description of these changes, including
updated assessment information and sufficient information concerning the change
in service needs should be thoroughly documented in an update to the support
plan and the waiver support coordinator’s progress notes. Updates to the cost
plan shall be initiated when the waiver support coordinator becomes aware of the
need for change. The updated support and cost plans are submitted to the APD,
for review and approval within five working days of the date the waiver support
coordinator becomes aware of the need for change. The APD may request copies
of the waiver support coordinator’s progress notes, which support and describe the
need for an updated cost plan. The APD Area Office will in turn respond within ten
days of their receipt of the updated cost plan, with a statement of approval or
denial. Within five working days of receiving the APD Area Office response, the
waiver support coordinator will notify the service provider through submission of a
new service authorization of the updated changes to the cost plan and the change
in the needs of the recipient.
The provider shall assist the recipient in using family, neighborhood and
community supports and services funded by private, city and county sources prior
to seeking services funded by federal and state sources. The provider shall assist
the recipient in using Medicaid State Plan services prior to seeking services
funded by the DD waiver. When services must be purchased by a source other
than the DD waiver, the provider must work cooperatively with the APD Area
Office in locating service vendors who meet the needs of the recipient in the most
cost-beneficial manner possible.

A copy of support plan information, pertinent to the provider, and an approved
service authorization will also be provided to other providers of services to
authorize and initiate service delivery by the effective date of the approved support
and cost plans. Through conversations with the recipient, those who know the
recipient well, and through review of the service vendor's documentation, the
waiver support coordinator monitors the recipient’s involvement in purchased
services to determine if the activities meet the recipient’s expectations, as
identified through use of the personal outcome measures. Along with other
planning sources, the waiver support coordinator will determine that these services
are age and culturally appropriate; address the need for which they are intended;
and provide appropriate challenges, motivation and experiences to meet the
recipient’s identified goals.
When services must be purchased by the DD waiver, the provider shall locate
potential service vendors who are qualified to meet the needs of the recipient in
the most cost-beneficial manner possible. The provider may recruit qualified
vendors who are acceptable to the recipient and assist them with waiver
enrollment procedures. The waiver support coordinator must assure that
purchased supports and services do not exceed the annual limits of the current
approved cost plan(s) for recipients served. The waiver support coordinator shall
use the ABC system to regularly monitor service utilization and expenditures. If
the support coordinator becomes aware that supports and services are in excess
of the annual limits of the approved cost plan, he will notify the APD Area Office
and provider as soon as the excess is known to them.
If paid services are used, the provider shall review with service vendors the goals
to be achieved for the recipient and note these discussions in the recipient’s
progress notes. The agreed upon goal(s) shall be reflected on the service
authorization form for that provider.
The provider shall maintain each recipient’s central record in accordance with APD
procedures. The central records remain the property of the APD. The APD
retains the right to review, retrieve, or take possession of a recipient’s central
record at any time.
The provider shall assist the recipient in maintaining their Medicaid eligibility. The
provider shall also notify other waiver service providers and the APD when it is
determined that a recipient receiving services is ineligible for Medicaid. The
waiver support coordinator will work with providers and the APD to plan for
alternative funding sources.
The provider is responsible for the cost of the electronic access to the APD’s
intranet site as well as entering, updating and assuring the accuracy of
demographic information pertinent to the recipient in the ABC system. Failure of
the waiver support coordinator to enter, update and assure the accuracy of this
information could result in recoupment of funds paid to the waiver support
coordinator.

The provider shall comply with all written procedures established by the APD
regarding the transition of recipients from developmental disabilities support
coordinators or other waiver support coordinators to the provider.
For recipients residing in supported living arrangements or licensed residential
facilities and who are taking any psychiatric or anti-epileptic medications, the
support coordinator will document in the progress notes attempts and efforts
to assure:
A comprehensive psychiatric medication review is completed annually by
a licensed psychiatrist, neurologist, or an advanced registered nurse
practitioner (ARNP.) who acts pursuant to a protocol with the psychiatrist
or neurologist.
A medication review by a licensed consultant pharmacist is conducted at
least annually.
The recipient receives follow-up reviews by the psychiatrist, neurologist or
ARNP at a frequency established by these practitioners. If the frequency of
review established by the psychiatrist, neurologist or ARNP is less frequent
than every ninety days, documentation for their rationale will be provided.
This documentation will be maintained in the recipient’s central record.
If while serving a recipient, the recipient chooses another support coordination
provider, the current provider shall render quality services for the recipient until
the end of the month, when the transfer to the new support coordination
provider takes place, unless otherwise instructed by the APD. Additionally,
the current provider shall assist the recipient in making a smooth transition to
the new support coordination provider.
When a new support coordination provider is selected by the recipient; the
support coordination services agency is downsized; or the support
coordination services are terminated, either voluntarily or involuntarily, the
waiver support coordinator shall assure that all appropriate central record
information is transferred to the new provider or to the APD Area Office, as
directed, within two weeks of the effective date of the action.
Note: Refer to the medication review service section for additional
information.

Documentation Requirements
For reimbursement* purposes, the provider must meet certain basic billing
requirements. These include progress notes, which adequately document the
support coordination services rendered. Exceptions granted by the APD to
any requirements set forth in the assurances or policy must also be
documented. All documentation must be filed in the recipient’s central record
prior to billing. For full support coordination, the provider must have, at a
minimum, two contacts with or activities on behalf of recipients each month in
order to bill to Medicaid. For limited support coordination, the provider must
have a minimum of one contact with or activity on behalf of recipient each
month in order to bill Medicaid. Prior to submitting a claim for payment of
support coordination services for a recipient, the provider shall complete the
following:
1. *Have on file in the recipient’s central record, the recipient’s current
support planning information to include the personal outcome measures
information and outcome notes, the APD-approved assessment, a current
waiver eligibility worksheet, a current support plan and current approved
cost plan; and
2. Full support coordination: *Have at least one face-to-face contact monthly
with recipients living in a licensed residential facility or supported living
situation. Have at least one face-to-face contact every three months for
recipients living in their family home, and two of those contacts per year
will be held in the recipient’s residence at six-month intervals.
3. Limited support coordination: Have at least two face-to-face contacts per
year, with a minimum of one of the contacts being in the recipient’s home.
One face-to-face contact should occur at the time of support planning and
the second face-to-face contact should occur at approximately a six month
interval.
4. Face-to-face contacts shall relate to or accomplish one or more of the
following:
(a) Assist the recipient to reach outcomes on the support plan, including
gathering information to identify outcomes;
(b) Monitor the health and well-being of the recipient;
(c) Obtain, develop and maintain resources needed or requested by the
recipient to include natural supports, generic community supports and
other types of resources;
(d) Increase the recipient’s involvement in the community;
(e) Promote advocacy or informed choice for the recipient; or
(f) Follow-up on the recipient’s or family's concerns.

*For recipients in supported living, residing in their own home or residing in
licensed facilities, a face-to-face visit with the recipient in the recipient’s place of
residence is required every three months. If the recipient lives with his family,
the face-to-face contact with the recipient in the residence is required every six
months for full support coordination, and once a year for limited support
coordination. The recipient or family may not waive the required visit(s) in the
home. The need for more frequent face-to-face-visits may be determined by the
recipient, family or primary caregiver. The waiver support coordinator shall
document this preference in the support plan.
*For recipients receiving supported living coaching services, it is the waiver
support coordinator’s responsibility to schedule a quarterly meeting with the
recipient and the supported living coach. The purpose of this meeting is to
review supported living needs with the recipient and the coach to determine if
services are being provided at a satisfactory level and to assure that housing,
health, safety and financial support are adequate. The waiver support
coordinator shall document the results of each meeting in the progress notes.
This quarterly meeting with the recipient and the supported living coach, unless
the supported living coach is excluded at the request of the recipient, may satisfy
the quarterly face-to-face meeting requirement above, provided the meeting
takes place in the recipient’s home.
*Conduct at least one other contact or activity per month. These contacts or
activities are not merely incidental, but are planned and shall relate to or
accomplish those items, previously identified in 4 (a-f). These contacts or
activities may be either with the recipient or with other persons, such as family
members, service vendors, community members and others, and may be
conducted face-to-face or by phone. Administrative activities such as typing,
filing, mailing, or leaving messages shall not qualify as contacts or activities.
*Letter writing would qualify as another contact if related to services and benefits
specific to a recipient’s needs. This would exclude form letters to confirm
meetings, etc. Additionally, scheduling time to develop the support plan, setting
up the face-to-face contact, setting up meetings with other persons, and meeting
with one’s supervisor or coworkers shall not qualify as contacts or activities.
Upon receipt of a determination that terminates or reduces the level of services,
the support coordinator will, within ten business days of receipt of the
determination, inform the recipient of the decision and submit a revised service
authorization to the service provider. If the determination affects the provider
immediately, the support coordinator must contact the provider by phone call, fax
or other method to inform him of the need to immediately revise the services
being provided with notification that the service authorization will be sent to the
provider to document the change. If the support coordinator does not follow
these procedures and this results in the provider not being notified of the service
change, the support coordinator may be subject to recoupment of the services
that were provided when the service provider was unaware of the need to
change the level of service provision. Upon receipt of a determination of
approval of a new service, the support coordinator must issue a service
authorization within ten business days of receipt of the determination.

For monitoring review purposes the provider must have on file, for the period
being reviewed:
1. A copy of all of the recipients’ support plans and approved cost plans in their
central records;
2. Documentation in the central records that the basic billing requirements were
met for the months in which the provider was reimbursed for services;
3. Progress notes which adequately detail support coordination provided to the
recipient and his family or guardian;
4. Documentation in the central records that a face-to-face visit with the
recipient was conducted in their place of residence, including those
recipients in supported living, quarterly meetings with the recipient and their
supported living coach;
5. Copies of the annual reports and individual implementation plans submitted
by other providers, as required and appropriate to each service;
6. Current and correct demographic information for each recipient, including
current health and medical information and emergency contacts;
7. Results of the annual satisfaction survey; and
8. Performance data on the selected service outcomes projected in this
document.
In addition, the provider is expected to document in all recipient central records
all other support coordination services, activities or contacts that assisted him in
meeting support plan outcomes or personal goals, become more integrated into
communities and address each recipient’s or family’s concerns. Progress notes
should adequately and clearly document all support coordination services
provided to a recipient.
If the provider plans to transport the recipient in his private vehicle, at the time of
enrollment, the provider must be able to show proof of valid: 1) driver’s license,
2) car registration, and 3) insurance. Subsequent to enrollment, the provider is
responsible for keeping this documentation up-to-date.
*Indicates reimbursement documentation.

Place of Service

This service may be provided in the recipient’s residence or anywhere in the
community.

Special Considerations
Support coordination services may be rendered in any community location
conducive to the contact or activity being provided, including the waiver support
coordinator’s office, the recipient’s residence, a library, a park, or any other
community location. In order to get to know each recipient well, waiver support
coordinators are encouraged to interact with and observe each recipient in a
variety of settings during different times of the day and on different days of the
week.

Support coordination may be provided while a recipient is a temporary patient
in a hospital or nursing facility. The waiver support coordinator may not
duplicate the services of the hospital or nursing facility case manager or
discharge planner and may not bill until after the recipient is discharged.
Providers of support coordination services must participate in monitoring
reviews conducted by the APD, AHCA or an authorized representative of the
state. Support coordinators are expected to meet the needs of the recipients
receiving services; regardless of the number of contacts it takes to meet those
needs. Waiver support coordinators should not assume that meeting the basic
billing requirements will necessarily result in a successful monitoring review
and approval to continue services.
The provider will be responsible for the cost to access any APD or AHCA
required management, claim submission information or data collection
systems.

Support Coordination Provider Requirements

Support Coordination Provider Requirements

Provider Qualifications
Providers of support coordination services may be either solo providers or
agency providers.

Training and Experience
Solo providers and waiver support coordination supervisors employed by
agencies shall meet the following minimum qualifications: a bachelor's
degree from an accredited college or university and three years of
professional experience in developmental disabilities, special education,
mental health, counseling, guidance, social work or health and
rehabilitative services. A master’s degree can substitute for one year of
the required experience.
Support coordinators employed by agencies shall meet the following
minimum qualifications: a bachelor’s degree from an accredited college or
university and two years of professional experience in developmental
disabilities, special education, mental health, counseling, guidance, social
work or health and rehabilitative services. A master's degree can
substitute for one year of the required experience.
For applicants who have other employment at the time of application to
become a waiver provider and intend to remain in the current employment,
the application must include a statement addressing a plan for dual
employment. The plan should address the type of employment held at the
time of the application, the total number of hours involved in that employment
on a weekly basis, a plan for the manner in which the applicant may be
contacted by recipients receiving services during the hours employed in the
other job, and how conflicting priorities, emergencies and meetings will be
handled. The plan shall also address any long-range plan for reducing or
terminating the other employment should a full waiver caseload be assumed.
The APD Area Office shall approve the dual employment plan as a part of the
waiver enrollment process. If it is determined that the applicant cannot be
available to meet the needs of recipients on the applicant’s caseload, the
application may be denied. In no instance may the dual employment include
providing services to recipients with developmental disabilities, unless
services are provided within the role of case manager or support coordination.

Pre-Service Training Requirements
A minimum of 60 hours of pre-service training is required for solo providers
and for the director or managers and the waiver support coordinator
supervisor of provider agencies. This pre-service training shall consist of 34
hours of statewide pre-service training that is conducted by APD or by a
trainer certified by APD and 26 hours of Area training. The Area training shall
include orientation to the Area staff and responsibilities, Area resources, ABC
training regarding entry and maintenance of recipient’s demographic
information, and general Area operational procedures. The Area training
content must be approved by the APD Central Office to ensure statewide
uniformity and must be provided by the Area within 90 days of the completion
of the statewide pre-service training.
The Area will also be responsible for training and certifying each support
coordinator in the proper administration of the APD approved assessment
process for ascertaining the recipient’s level of need. This training is separate
from, and in addition to, the 26 hours of Area training identified for pre-service
requirements.
Support coordinators employed by agencies are required to receive the same
number of training hours and are to be trained on the same topics covered in
the statewide training; Area training and training in the proper administration
of the APD-approved assessment. This training may be conducted by the
support coordination agency once approved by APD. Agency trainers must
attend a train-the-trainer session conducted by APD and mandatory refresher
courses, as required by APD.
Agency trainers and the agency training plan must be prior approved by the
APD’s Central and Area Office. Agency trainers cannot certify a support
coordinator in administration of the APD-approved assessment. Support
coordinators trained by their agency in the administration of the APDapproved
assessment must undergo certification by the Area.
Waiver support coordinators currently enrolled as DD waiver support
coordination providers must become certified in the administration of an APD
assessment within 90 days of the effective date of the implementation of this
rule. Failure to become certified in the use of the APD-approved assessment
will result in termination as a DD waiver support coordination provider.
Proof of annual or required updated training shall be maintained on file for
review.
The provider is responsible for all training requirements outlined in the Core
Assurances.
Note: Refer to the Core Assurances in Appendix A for the provider training requirements.

Continuing Training Requirements
All waiver support coordinators and agency supervisors, directors or managers
shall attend 24 hours of job-related in-service training annually. Internal
management meetings, held by agency providers, shall not apply toward the 24
hours requirement unless approved by the Area. For support coordination
supervisors and employees of agency providers, 12 hours of the 24 hours inservice
requirement must be provided by trainers outside of the agency.
All waiver support coordinators shall attend Personal Outcome Measures training
conducted by the APD or an APD certified trainer within 90 days of receiving a
certificate of enrollment from the Area. This training shall satisfy the annually
required 24 hours of job related training for that year. Support coordinators who
have not completed the Personal Outcome Measures training must have a
trained waiver support coordinator in attendance when conducting the Personal
Outcome Measures interview, as part of the annual support planning process.
In order to remain eligible to provide support coordination services under the DD
Waiver, support coordinators shall maintain certification on the APD approved
assessment. Recertification shall occur every two years. Certification includes
the capability to access and finalize the assessment on APD’s intranet site.
Documentation of all training will be maintained on file by the solo provider or the
agency provider and be available for monitoring and review.

Projected Service Outcomes
Projected service outcomes are goals used to determine, through monitoring and
review, the accomplishments of providers and the effectiveness of service
provision, which include:
Recipients receiving support coordination services have freedom of choice in
all areas of their lives, including setting personal goals, being fully informed
about service options and making all possible decisions with regard to the
conduct of their lives.
Recipients receiving services demonstrate an increase in abilities, selfsufficiency
and changes in their lives consistent with their support plan.
There is evidence that the provider advocates for the individual on an
ongoing basis to achieve a personally identified goal.
All recipients served, who have responded to the annual satisfaction survey,
are satisfied with the services based on the results or that the provider has
addressed any concerns raised during the survey.