Disability Waiver Rates Management System Manual DRAFT December 2013

Disability Waiver Rates Management System Manual DRAFT December 2013
Lead agency workers use the Rates Management System (RMS) tool to calculate payment rates for specific authorized
services that are then entered into MMIS. This manual will provide users of the RMS tool with operational information
that will help them effectively use this tool.
Table of contents
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Introduction
•
RMS
•
How to use RMS (Steps to entering a rate agreement)
•
RMS information exchange
•
Day service fields
•
Unit-based fields
•
Residential fields
•
Customized Living, 24-Hour Customized Living and Residential Care Fields
•
Banding
•
Exceptions Request Process
•
Appendix A Rate Management Worksheets (data gathering worksheets)
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Appendix B Shared staffing document
Introduction: Disability Waiver Rate System
The Disability Waiver Rate System (DWRS) determines individualized payment rates for the following Medical Assistance
Home and Community Based Services for persons with disabilities: Community Alternatives for Disabled Individuals
(CADI), Brain Injury (BI), Community Alternative Care (CAC) and Developmental Disability (DD) waivers.
After the needs assessment and support planning have occurred, the Disability Waiver Rate System will be used to price
individual services and provide the amount to authorize individual services.
The Disability Waiver Rate System divides disability waiver services into three categories:
•
•
•
framework services
market rate services
pre-determined rate services
The Rate Management System (RMS) tool determines the framework service rates. This occurs when lead agency staff
enters information about an individual disability waiver recipient and the level of service into the RMS tool. The RMS
tool runs an algorithm on the inputs and calculates the payment rate for the service. If approved by all parties, lead
agency staff then authorizes the service in MMIS.
This manual provides direction regarding Disability Waiver Rate System processes as defined in 2013 Minnesota
Statutes, 256B.4914, instructions regarding the processes prescribed by the Commissioner and suggestions about how
to accomplish these.
Rate Management System (RMS)
The Rate Management System is a secure, web-based application accessed by lead agencies through a Social Services
Information System (SSIS) authentication portal. While RMS utilized research data prior to implementation of the DWRS,
none of that information remains in the system for 2014.
The Rate Management System (RMS) is a web-based application, it is important to note that you should not use the
back button while in the system.
If you need SSIS access, please see the DSD E-list link below:
DSD Elist: Disability Waivers Rate System management reopens on Dec. 9 2013
If your SSIS access is not working, please contact SSIS via email dhs.ssishelp@state.mn.us or phone at 651-431-4801. Or
email the DSD Rates team: DSD.Rates@state.mn.us
How to use RMS
Use the following action steps in the RMS tool to determine payment rates for individual services.
Step
1
2
3
Action
Log onto SSIS. Go to Tools and choose DWRS
Under Client Information, click Search by PMI
Enter PMI and DOB and click Search
4
Click Service Plan
5
6
7
To create a new plan, click Add
On the box labeled Waiver click Select
Select waiver type from options listed
8
9
10
11
12
Click Start Date box
Use calendar to select start date or enter date
Click End Date box
Use calendar to select end date or enter end date
Click Save
13
14
15
16
Click Show Services
Check box of service being added to plan, then check Save
Click on underlined service
Enter NPI for provider of service being added to plan and
click Find
Use calendar to select service start/end dates
Select County of Residence
Enter info into all remaining boxes and/or use drop down
menus to select from options listed. (See Day, Unit-Based,
Residential, and Customized Living/24-Hour Customized
Living, and Residential Care tables for info to obtain prior to
RMS data entry.
If not entering a Non-Framework/Rate Exception, click
Calculate
Right click anywhere on Rate Agreement and choose Print.
Send printed copy to provider.
If not adding providers, click Lock Record, and then Close.
If adding providers, click Add, and follow steps 16-21.
If entering Non-Framework/Rate Exception Information,
enter county approved unit rate, select Type from options
listed and briefly describe need in Reason box. Complete
DHS 5820 and submit to DSD. Click Calculate again. Right
click anywhere on Rate Agreement and choose Print. Send
printed copy to provider. Click Lock Record, then Close to
return to Select Services page.
17
18
19
20
21
22
23
Expected Result
SSIS welcome page appears
Client Information page appears
Faint grey type appears on Name, DOB, and PMI
boxes
Manage Service Plan section appears containing
any previously created plans
Pop up box appears
Waiver types appear
Waiver box fills with waiver type that was
selected
Calendar feature appears
Start date fills with date selected/entered
Calendar feature appears
End date fills with date selected/entered
Manage Service Plan section showing newly
created plan is displayed
Available service selections are shown
Service becomes underlined
Rate Agreement appears
Name of provider appears
Start and end date boxes fill
Selected county name appears
Boxes fill with information
Service Total displays
Print box appears
Return to Select Services page
Boxes fill with information
RMS information exchange
The RMS tool generates payment rates using the following criteria:
•
•
•
•
•
•
Service providers, with information from the Community Support Plan and oversight by lead agencies, initially
generate the information needed to calculate payment rates.
Providers may use the worksheets developed by DHS for this purpose, or may work with lead agencies to
develop alternate methods for the sharing of this information.
If the lead agency agrees that the information provided reflects the needs of the recipient and the negotiated
level of service, lead agency staff enters the information into the RMS tool.
If the lead agency does not agree, service planning continues until agreement is reached or a different decision
is made.
The lead agency must notify the service provider of the calculated payment rate produced by the RMS tool and
the inputs associated with it.
To accomplish this, lead agencies can take a screen shot and
1) Print and send it using the postal service, or
2) Save and send the screen shot electronically. Use this same screen shot as a reference in authorizing the
service in MMIS.
Day Service Fields
A description of the fields you will see in the Day Service fields within the RMS tool.
The day services include:
Adult Day 15-Minute, Adult Day Bath, Adult Day Daily, DT&H 15-Minute, DT&H Daily, Prevocational Daily, Prevocational
Hourly, Structured Day 15-Minute, Structured Day Daily
Note: Not all services contain all the fields listed below.
Information to obtain prior to
entering RMS data
Provider’s National Provider
Identifier (NPI) or Unique
Minnesota Provider Identifier
(UMPI)
Enter provider’s NPI or UMPI. Do not enter
county UMPI.
Service Start and End Date
What day does service start and
end?
Enter start date and end date to match
MMIS service agreement line
Average Staffing Ratio
Average daily ratio of direct care
staff to recipients
Number of units inclusive of service
start and end date that person is
authorized to receive service
Select staffing ratio from drop down menu
Field
Provider NPI
Total Units
Individual RN Hours/Unit
Action
If Adult Day Daily, Prevocational Services
Daily, or Structured Day Daily are not
provided at least 6 hours per day (not
including transportation to/from), go to
Adult Day (15-minute), Prevocational
Hourly, or Structured Day (15-minute). If
DTH Daily is not provided at least 6 hours
per day (including transportation time
to/from when provided by DTH provider),
go to DTH 15-minute
Assessment and treatment
provided on a 1:1 basis by RN
during a unit of service
Enter amount of time service will be
provided during unit
Individual LPN Hours/Unit
Assessment and treatment
provided on a 1:1 basis by LPN
during a unit of service
Enter amount of time service will be
provided during unit
Meals Per Day
Number of meals per day of service
Enter number of meals per unit of service
AM Snacks Per Day
Number of morning snacks per day
Enter number of AM snacks per unit
PM Snacks Per Day
Number of afternoon snacks per
day
Enter number of PM snacks per unit
CONT. on Pg 6
Field
Customization
Information to obtain prior to
entering RMS data
Does person meet criteria for
deaf/hard of hearing
customization?
Action
Review screening document to determine
if person meets criteria and choose
appropriate option from drop down box
Total Daily To/From DT&H
Transportation
Obtain amount authorized on
MMIS SA for T2002, DT&H
Transportation
Enter amount of DTH Transportation Rate
Exception Unit Rate
Rate that will be requested on DHS
5820
Exception-person will be
discharged/service needs cannot be
met
Manual Banding NeededResidential-Change in Service Plan
DTH Partial Day
Brief description of why exception
was needed
Enter amount of requested rate
Exception Type
Exception Reason
Use drop down menu to select type
Choose reason from drop down box or
enter narrative to describe “other”
Exception Approval
DHS entered field
Leave blank
Exception Approval Reason
DHS entered field
Leave blank
Unit-Based Fields
Here is a description of the fields you will see in the Unit-Based fields within the RMS tool.
The Unit-Based services include:
Behavioral Support, Companion Care, Housing Access Coordination, In-Home Family Support, Independent Living Skills
Training, Night Supervision, Personal Support, Respite Care Services 15-Minute, Respite Care Daily Supported
Employment Services, SLS 15-Minute
Note: Not all services contain all the fields listed below
Field
Provider NPI
Information to obtain prior to entering RMS
data
Provider’s National Provider Identifier (NPI) or
Unique Minnesota Provider Identifier (UMPI)
Action
Enter provider’s NPI or UMPI. Do not enter
county UMPI.
Service Start and End
Date
What day does service start and end?
Enter start date and end date to match MMIS
service agreement line
County of Residence
County where person lives
Staff to Recipient Ratio
Number of individuals receiving ILS Training
or Supported Employment Service at the
same time from the same staff person
Use drop down menu to select county of
residence
Use drop down menu to select 1:1 or 1:2 (ILS
Training) or 1:1, 1:2, or 1:3 (Supported
Employment Services). DD waiver SES is a 1:1
only service
Total Units
Number of units inclusive of service start and
end date that person is authorized to receive
service
Enter number of units
Customization
Does person meet criteria for deaf/hard of
hearing customization?
Review screening document to determine if
person meets criteria and choose appropriate
option from drop down box
Exception Unit Rate
Rate that will be requested on DHS 5820
Enter amount of requested rate
Exception Type
Exception-person will be discharged/service
needs cannot be met
Manual Banding NeededResidential-Change in Service Plan
DTH Partial Day
Use drop down menu to select type
Exception Reason
Brief description of why exception was
needed
Choose reason from drop down box or enter
narrative to describe “other”
Exception Approval
DHS entered field
Leave blank
Exception Approval
Reason
DHS entered field
Leave blank
Residential Fields
Here is a description of the fields you will see in the Residential fields within the RMS tool.
The Residential services include:
Foster Care Corporate Daily, Foster Care Family Daily, SLS Corporate Daily, SLS Family Daily
Note: Not all services contain all the fields listed below
Provider NPI
Information to obtain prior to
entering RMS data
Provider’s National Provider Identifier
(NPI) or Unique Minnesota Provider
Identifier (UMPI)
County of Residence
County where person lives
Service Start and End Date
What day does service start and end?
On Site Awake Shared Staff Hours
Average number of hours per day
person shares the services of direct
care staff
Enter number of hours
Asleep Shared Staff Hours
Average number of hours per day
person has shared asleep night staff
Enter number of hours
Shared Remote Awake Hours
Number of hours per day that shared
electronic monitoring is provided
Enter number
Number of Residents
Licensed capacity
Enter licensed capacity
Number of Remote Monitored
Residents
On Site Awake Individual (1:1) Staff
Hours
Number of people in the home who
Enter number
share electronic monitoring
Enter number
Average number of hours per day
person has a dedicated 1:1 direct care
staff who is not available to others
living in the home
Asleep Individual (1:1) Staff Hours
Average number of hours per day
person has a dedicated 1:1 asleep
staff who is not available to others
living in the home
Individual RN Hours
Assessment and treatment provided
on a 1:1 basis by RN during unit of
service
Field
Action
Enter provider’s NPI or UMPI. Do not
enter county UMPI.
Use drop down menu to select county
of residence
Enter start date and end date to
match MMIS service agreement line
Enter number
How many of the Total Units will
include 1:1 assessment and treatment
by a RN?
CONT. on Pg 9
Field
Individual LPN Hours
Information to obtain prior to
entering RMS data
Direct nursing provided on a 1:1 basis
by LPN during unit of service
Action
How many of the Total Units will
include 1:1 assessment and treatment
by a LPN?
Enter number
Individual Remote Awake Hours
Number of hours per day that remote
electronic monitoring technology is
provided to this person on a 1:1 basis
Transportation
Does person not need to have
transportation is provided by
residential provider, need
transportation in a standard vehicle,
or need transportation in an adapted
vehicle with a lift
Use drop down menu to choose from
Customization
Does person meet criteria for
deaf/hard of hearing customization?
Review screening document to
determine if person meets criteria and
choose appropriate option from drop
down box
Exception Unit Rate
Rate that will be requested on DHS
5820
Exception-person will be
discharged/service needs cannot be
met
Manual Banding NeededResidential-Change in Service Plan
DTH Partial Day
Brief description of why exception
was needed
Enter amount of requested rate
Exception Type
Exception Reason
Use drop down menu to select type
Choose reason from drop down box or
enter narrative to describe “other”
Exception Approval
DHS entered field
Leave blank
Exception Approval Reason
DHS entered field
Leave blank
Customized Living, 24-Hour Customized Living and Residential Care Fields
A description of the fields you will see in these categories in the RMS tool:
Field
Provider NPI
Information to obtain prior to entering
RMS data
Provider’s National Provider Identifier
(NPI) or Unique Minnesota Provider
Identifier (UMPI)
Action
Enter provider’s NPI or UMPI. Do not enter county
UMPI.
Service Start and
End Date
What day does service start and end?
Enter start date and end date to match MMIS service
agreement line
County of Residence
County where person lives
Use drop down menu to select county of residence
Select Group of
Services, Service
within that group,
and enter Units per
Day of Service
Category of service that will be
provided:
• Meals
• Home Management
Socialization
• ADL Assistance
• Transportation
• Mental Health Management
• Health Related
Use drop down menu to select Group (e.g., Meals,
Home Management, Socialization).
Use drop down menu to select Service (e.g., LaundryLinens (Hour)) from that Group.
Enter units per day of service (e.g., 2 Hours of
Laundry-Linens). Click Add Service to move to next
Group (e.g., ADL Assistance). Use drop down menu to
select Service (e.g., Assistance Dressing-Hour) from
that group. Enter units per day of service (e.g., 2 hours
of Assistance Dressing-Hour). Repeat for each Group
of services person will receive and for each service
within that group. After you have finished entering all
groups/services within group, click Calculate.
*If authorizing Summoning Device, be sure to enter
0.033 to reflect one charge per month as opposed to
one charge per day.
Exception Unit Rate
Rate that will be requested on DHS
5820
Exception-person will be
discharged/service needs cannot be
met
Manual Banding NeededResidential-Change in Service Plan
DTH Partial Day
Brief description of why exception was
needed
Enter amount of requested rate
Exception Type
Exception Reason
Use drop down menu to select type
Choose reason from drop down box or enter narrative
to describe “other”
Exception Approval
DHS entered field
Leave blank
Exception Approval
Reason
DHS entered field
Leave blank
Banding
Banding creates limits for changes in framework service payment rates that change because of DWRS implementation. A
0.5% rate stabilization adjustment (band) applying to the unit rate is in effect for all of 2014. This 0.5% band will take
effect when you create a new waiver span or renew a waiver span. This means that in 2014, existing payment rates for
framework services will not increase or decrease by more than 0.5%.
Banding rules change depending upon the type of service and the circumstance. Most of the time, banding rules are
built into the Rate Management System but, in some cases, manual banding or un-banding will be required.
When banding rules are not built into the system for specific services or situations, we refer to them as Non-Framework
Rates. Non-Framework rates require adjustments to get the correct banded rate.
Non-Framework Rates Processes
Below are scenarios, which explain the processes, needed to determine rates for services, which the RMS does not
correctly band:
1. Manual Banding
2. Partial Day DT&H
3. Residential Change in a Service Plan.
1. MANUAL BANDING NEEDED
Situation A:
A Service Agreement renewal for individual receiving service in December 2013 with same provider but other changes
(amount or intensity) to service agreement since December 2013.
IF you have a service agreement renewal for an individual who was, in December 2013, receiving a residential service
(adult foster care, customized living, 24 hour customized living, or residential care service), a daily unit of a day service
(DT&H, adult day, structured day, prevocational service), a 15 minute unit of a day service (DT&H, structured day, or
adult day), or hourly prevocational service,
AND the intensity of the service has changed since December 2013,
THEN you will need to complete the appropriate framework to reflect the service intensity before the change,
AND THEN you will need to complete the appropriate framework to reflect the new service intensity,
AND THEN complete the Non Framework Rate Information section, choosing “Manual Banding Needed” for type and
filling in a unit rate for the service that is equal to the previously authorized unit rate, plus or minus 0.5% up to the rate
produced by the framework, plus or minus the difference between the previous (before the intensity change) and
current (reflecting the intensity change) framework rates.
Service and Unit Types:
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Residential
All Day Services with Day Units
Prevocational with Hourly Units
Adult Day with 15 Minute Units
Process example to follow:
Historic rate in MMIS of $247.50/Day
Step 1: Calculate framework rate with previous level of intensity ($225)
Step 2: Calculate framework rate with new level of intensity ($325)
Step 3: Subtract (or add) RMS rate resulting from Step 2 from RMS rate resulting from Step 1 ($325-$225 = $100)
Step 4: Add (or subtract) result from Step 3 to historic rate from Step 1 ($100 + $247.50 = $347.50)
Step 5: Subtract (or add) 0.5% from result in Step 4 ($347.50 – $1.74 = $345.76)
Step 6: Enter a Non Framework Rate in RMS for $345.76 with a type of Manual Banding Needed. Input details of
calculation in notes sections.
Situation B:
All service Agreement renewals for individuals receiving DT&H Pilot or Structured Day services in 2013.
IF you have a service agreement renewal for an individual who was receiving 15 minute DT&H or 15 minute structured
day in December 2013
AND there have been no changes in service intensity,
THEN you will need to complete the 15 minute DT&H or 15 minute structured day framework,
AND THEN complete the Non Framework Rate Information section, choosing “Manual Banding Needed” for type and
filling in a unit rate for the service that is equal to the previously authorized unit rate, plus or minus 0.5% up to the rate
produced by the framework.
Service and Unit Types:
•
•
DT&H 15 Minutes
Structured Day 15 Minutes
Process example to follow:
Historic rate in MMIS of $16.25/15 minute unit
Step 1: Calculate framework rate in Rate Management System using DT&H 15 minute framework ($15.00)
Step 2: Compare MMIS 2013 historic rate of $16.25 to the RMS framework rate of $15.00
Step 3: If MMIS 2013 historic rate is greater than RMS rate, subtract 0.5% from MMIS 2013 rate ($16.25-$.08 = $16.17)*
Step 4: Enter a Non Framework Rate in RMS for $16.17 with a type of Manual Banding Needed. Input details of
calculation in notes sections.
*If MMIS 2013 historic rate is less than RMS rate, add 0.5% to MMIS 2013 rate.
2. PARTIAL DAY DT&H
Situation:
All service Agreement renewals for individuals receiving DT&H partial day services in 2013.
IF you have a service agreement renewal for an individual who was receiving partial day DT&H service in December
2013,
THEN you will need to complete the DT&H 15 minute framework,
AND THEN complete the Non Framework Rate Information section, choosing “Partial Day DT&H” for type and fill in the
(previously contracted) rate for the service.
Service and Unit Types:
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DT&H Partial Days
Process example to follow:
2013 MMIS historic rate of $147.50/Day
Step 1: Use DT&H 15 Minute framework in Rate Management System
Step 2: Disregard the Rate Management System unit totals
Step 3: Enter a Non Framework Rate in RMS for $147.50 (2013 unit rate) with a type of Partial Day DT&H. Input
applicable details in notes sections.
3. RESIDENTIAL CHANGE IN SERVICE PLAN
Situation:
A service agreement is initiated for an individual who is receiving service on 12/1/2013 who changes to a different but
existing provider on 12/1/2013.
IF you have a service agreement initiated for an individual who was receiving a residential service in December 2013 but
changes the provider for the same residential service,
THEN you will need to complete the appropriate framework,
AND THEN complete the Non Framework Rate Information section, choosing “Residential Change in Service Plan” for
type and filling in a unit rate for the service as determined by the lead agency.
Service and Unit Types:
•
Residential
Process example to follow:
Step 1: Complete appropriate framework in Rate Management System
Step 2: Enter a Non Framework Rate in RMS using historical rate setting methodology used by county
Step 3: Select a reason type of Residential Change in Service Plan. Input applicable details in notes sections.
Exceptions Process
Recipient Criteria
Exceptions may be requested by recipients with exceptional needs that cannot be met by a DWRS framework rate. Lead
agencies must submit exception requests to the state. Individual recipients may request lead agencies to submit an
exception request.
Exceptions are available to:
• New recipients, or
•
Existing recipients who have a change (of provider or intensity) in service plan.
Request Criteria
An application should be made when:
1. An individual has service needs that cannot be met through additional units of service, or
2. A framework rate results in an individual being discharged
Applications must include a thorough account and documentation of:
1. Summary of recipient need
2. Extraordinary program/service response (to meet need) that is not acknowledged by the framework
3. Price of extraordinary program/service response
4. The duration of the requested rate exception
5. ISP/CSSP and cost documentation
6. Any contingencies for approval
An online Exceptions Request Application form (DHS-5820) has been developed and will be available. Exception requests
may also be submitted to DHS by mail.
Authorized Exception Rate
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•
•
Exceptions are calculated from and apply to the framework rate
Exceptions are not banded (neither increased nor decreased by +/- 0.5%)
Exceptions are managed through lead agency allocations
Process and Timelines
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•
•
•
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According to statute, lead agencies have 30 days to process an exception application, and DHS has 30 days to
process an exception application.
When all parties agree that an exception request is extremely urgent, an expedited process will be available. The
expedited exception process gives lead agencies and DHS 3 business days each to process an application.
Approved exceptions are effective upon initiation of the exceptional level of service, not to precede the date of
the exception application to the lead agency, for the duration stated on the application.
Approved Exceptions expire after 1 year. Recipients must reapply for an exception rate or revert to the
framework rate.
For new recipients who apply for an exception, are denied, and appeal; only the framework rate is authorized
during the proceedings if the service is initiated. If the denial is overturned, the exception rate is authorized
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•
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retroactively to the date the exceptional service provision began, not to precede the date of the exception
application to the lead agency.
For existing recipients with a need change who apply for an exception, are denied, and appeal, the currently
authorized rate will continue through the proceedings. If the denial is overturned, the exception rate will be
authorized retroactively to the date the exceptional service provision began, not to precede the date of the
exception application to the lead agency.
Exceptions that have been approved by the lead agency will be approved by DHS unless one of the following is
true:
o The application fails to identify the recipient need
o The application fails to identify exceptional service provision to meet the defined need
o The application fails to identify cost information to quantify the cost of the exceptional service
o The exceptional service provision is not a covered benefit, is a benefit covered by another payer or is
incompliant with MA regulation.
DHS may request further information or the revision of an application. If the request for further information not
granted by the lead agency, provider, or recipient, DHS will render a denial of the exception. If the request is
granted, DHS may consider new information presented and/or a revised application.
Process Review
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•
•
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DHS will perform random audits of exception applications, which are denied by lead agencies.
The Exceptions internal approval process will be done by DHS staff.
All Exceptions denials will be reviewed by two additional DHS staff with expertise in disability services policy.
A quarterly report with exceptions request reasons, approvals, denials and appeals will be provided to an
external review team.
Appendix A
Rate Management Worksheets
2013 legislation regarding the Disability Waiver Rate System suggests that rate-setting inputs originate with service
providers who submit the information to lead agencies for review and entry into the Rate Management System. The
Rate Management Worksheets are vehicles for service providers to organize that information and communicate it to
lead agencies.
Appendix B
The following chart should be used to determine appropriate staffing ratios for entry into the Rates Management
System:
Disability Waiver Rate System: Residential Staff Hours
Shared
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total Weekly
Average Daily
On Site Awake
Direct Care Staff
/7=
Remote Awake
Direct Care Staff
/7=
Asleep Direct
Care Staff
/7=
On Site Awake
Direct Care
Staff
Remote Awake
Direct Care
Staff
Asleep Direct
Care Staff
Individual
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total Weekly
On Site Awake
Direct Care
Staff
Remote Awake
Direct Care
Staff
Asleep Direct
Care Staff
RN Assessment
and Treatment
LPN
Assessment
and Treatment
Average Daily
/7=
On Site Awake
Direct Care Staff
/7=
Remote Awake
Direct Care Staff
/7=
Asleep Direct
Care Staff
/7=
RN Assessment
and Treatment
/7=
LPN Assessment
and Treatment
Definitions
Direct Care Staff: Provide direct support and assistance with activities of daily living, instrumental activities of daily living, and training to participants, in their
home or during community activities, as directed in the individual service plan. Can be provided by nurses or supervisors acting as direct care staff. Can be
shared or individual.
Shared: Direct care staff serve or are available to all residents in a home. This includes many individual services provided to a resident in the home when these
services are provided within the shared staffing pattern.
Individual: Direct care staff brought in solely to provide support as a one-to-one interaction specific to an individual client’s needs.
Awake: Direct care staff who must remain awake and engaged. Can be on site or remote.
On Site: Direct care staff who are physically present in the setting. Can be awake or asleep.
Remote: Direct care staff who are not physically present in the setting, but are engaged in real-time service provision. Only awake.
Asleep: Direct Care Staff who are allowed to sleep, but are available to respond to planned or unplanned participant events. Only on site.