441—77.52 (249A) Community-based neurobehavioral rehabilitation services.
	   77.52(1) Definitions.
“Assessment” means the review of the current functioning of the member using the service in regard to the member’s situation, needs, strengths, abilities, desires, and goals.
“Brain injury” means a diagnosis in accordance with rule 441—83.81(249A).
“Health care” means the services provided by trained and licensed health care professionals to restore or maintain the member’s health.
“Intermittent community-based neurobehavioral rehabilitation services” means services provided to a Medicaid member on an as-needed basis to support the member and the member’s family or caregivers to assist the member to increase adaptive behaviors, decrease maladaptive behaviors, and adapt and accommodate to challenging behaviors to support the member to remain in the member’s own home and community.
“Member” means a person who has been determined to be eligible for Medicaid under 441—Chapter 75.
“Neurobehavioral rehabilitation” refers to a specialized category of neurorehabilitation provided by a multidisciplinary team that has been trained in, and delivers, services individually designed to address cognitive, medical, behavioral and psychosocial challenges, as well as the physical manifestations of acquired brain injury. Services concurrently work to optimize functioning at personal, family and community levels by supporting the increase of adaptive behaviors, decrease of maladaptive behaviors and adaptation and accommodation to challenging behaviors to support a member to maximize the member’s independence in activities of daily living and ability to live in the member’s home and community.
“Program” means a set of related resources and services directed to the accomplishment of a fixed set of goals for eligible members.
“Standardized assessment” means a valid, reliable, and comprehensive functional assessment tool(s) or process, or both, approved by the department for use in the assessment of a member’s needs.
	   77.52(2) Eligible providers. The following agencies may provide community-based neurobehavioral rehabilitation residential and intermittent services:
	      a.    	 An organization that is accredited by a department-approved, nationally recognized accreditation organization as a specialty brain injury rehabilitation service provider.
	      b.    	 Agencies not accredited by a department-approved, nationally recognized accreditation organization as a specialty brain injury rehabilitation service provider that have applied for accreditation within the last 16 months to provide services may be enrolled. However, an organization that has not received accreditation within 16 months after application shall no longer be a qualified provider.
	   77.52(3) Provider standards. All community-based neurobehavioral rehabilitation service providers shall meet the following criteria:
	      a.    	 The organization meets the outcome-based standards for community-based neurobehavioral rehabilitation service providers as follows:
	       (1)  	 The organization shall provide high-quality supports and services to members.
	       (2)  	 The organization shall have a defined mission commensurate with members’ needs, desires, and abilities.
	       (3)  	 The organization shall be fiscally sound and shall establish and maintain fiscal accountability.
	       (4)  	 The program administrator shall be a certified brain injury specialist trainer (CBIST) through the Academy of Certified Brain Injury Specialists or a certified brain injury specialist under the direct supervision of a CBIST or a qualified brain injury professional as defined in rule 441—83.81(249A) with additional certification as approved by the department.
	       (5)  	 A minimum of 75 percent of the organization’s administrative and direct care personnel shall meet one of the following criteria:
	      1. 	  Have a bachelor’s degree in a human services-related field;
	      2. 	  Have an associate’s degree in human services with two years of experience working with individuals with brain injury;
	      3. 	  Be an individual who is in the process of seeking a degree in the human services field with two years of experience working with individuals with brain injury; or
	      4. 	  Be a certified brain injury specialist or have other brain injury certification as approved by the department.
	       (6)  	 The organization shall have qualified personnel trained in the provision of direct care services to people with a brain injury. The training must be commensurate with the needs of the members served. Employees shall receive training and demonstrate competency in performing assigned duties and in all interactions with members, including but not limited to:
	      1. 	  Promotion of a program structure and support for persons served so they can re-learn or regain skills for community inclusion and access.
	      2. 	  Compensatory strategies to assist in managing ADLS (activities of daily living).
	      3. 	  Quality of life issues.
	      4. 	  Behavioral supports and identification of antecedent triggers.
	      5. 	  Health and medication management.
	      6. 	  Dietary and nutritional programming.
	      7. 	  Assistance with identifying and utilizing assistive technology.
	      8. 	  Substance abuse and addiction issues.
	      9. 	  Self-management and self-interaction skills.
	      10. 	  Flexibility in programming to meet members’ individual needs.
	      11. 	  Teaching adaptive and compensatory strategies to address cognitive, behavioral, physical, psychosocial and medical needs.
	      12. 	  Community accessibility and safety.
	      13. 	  Household maintenance.
	      14. 	  Service support to the member’s family or support system related to the member’s neurobehavioral care.
	      b.    	 The organization provides training and supports to its personnel. Training shall be provided before direct service provision and must be ongoing. At a minimum the training includes the following:
	       (1)  	 Completion of the department-approved brain injury training modules.
	       (2)  	 Member rights.
	       (3)  	 Confidentiality and privacy.
	       (4)  	 Dependent adult and child abuse prevention and mandatory reporter training.
	       (5)  	 Individualized rehabilitation treatment plans.
	       (6)  	 Major mental health disorder basics.
	      c.    	 Within 30 days of commencement of direct service provision, employees shall complete cardiopulmonary resuscitation (CPR) training, a first-aid course, fire prevention and reaction training and universal precautions training. These training courses shall be completed no less than annually.
	      d.    	 Within the first six months of commencement of direct service provision, employees shall complete training required by 441—subparagraph 78.54(3)“a”(6).
	      e.    	 Within 12 months of the commencement of direct service provision, employees shall complete a department-approved, nationally recognized certified brain injury specialist training.
	      f.    	 The organization shall have in place an outcome management system which measures the efficiency and effectiveness of service provision, including members’ preadmission location of service, length of stay, discharge location, reason for discharge, member and stakeholder satisfaction, and access to services.
	      g.    	 The organization shall have in place a systematic, organization-wide, planned approach to designing, measuring, evaluating, and improving the level of its performance. The organization shall be required to:
	       (1)  	 Measure and analyze organizational activities and services quarterly.
	       (2)  	 Conduct satisfaction surveys with members, family members, employees and stakeholders, and share the information with the public.
	       (3)  	 Conduct an internal review of member service records at regular intervals.
	       (4)  	 Track major and minor incident data according to subrule 77.37(8) and unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof; and analyze the data to identify trends annually to ensure the health and safety of members served by the organization.
	       (5)  	 Continuously identify areas in need of improvement.
	       (6)  	 Develop a plan to address the identified areas in need of improvement.
	       (7)  	 Implement the plan, document the results, and report to the governing body annually.
	      h.    	 The organization shall have in place written policies and procedures and a personnel training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.
	      i.    	 The organization’s governing body shall have an active role in the administration of the organization.
	      j.    	 The organization’s governing body shall receive and use input from local community stakeholders, members participating in services, and employees and shall provide oversight that ensures the provision of high-quality supports and services to members.
	      k.    	 The organization shall implement the following outcome-based standards for rights and dignity:
	       (1)  	 Members are valued.
	       (2)  	 The member and the member’s treatment team mutually develop an individualized service plan (ISP) that takes into account the member’s individual strengths, barriers and interests. The service plan shall include goals which are based on the member’s need for services and shall address the neurobehavioral challenges and environmental needs as identified in the member’s individual standardized comprehensive functional neurobehavioral assessment.
	       (3)  	 The member and the member’s treatment team evaluate the member’s progress towards treatment goals regularly and no less than quarterly. Treatment plans are reviewed regularly, but not less than quarterly, and are revised as the member’s status or needs change to reflect the member’s progress and response to treatment.
	       (4)  	 The member and the member’s legal representative have the right to file grievances regarding the provider’s implementation of the organizational standards, or its employee’s or contractual person’s action which affects the member. The provider shall provide to members the policies and procedures for member grievances and appeals at the commencement of services and annually thereafter.
	       (5)  	 When a member requires any restrictive interventions, the interventions will be implemented in accordance with 481—subrule 63.23(4), rule 481—63.33(135C), and rule 481—63.37(135C). When a member has a guardian or legal representative, the guardian or legal representative shall provide informed consent to treat and consent for any restrictive interventions that may be required to protect the health or safety of the member. Restrictive interventions include but are not limited to:
	      1. 	  Restraint, including chemical restraint, manual restraint or mechanical restraint;
	      2. 	  Alarms added to a member’s natural environment including doors, windows, refrigerators, cabinets, and other home appliances and fixtures;
	      3. 	  Exclusionary time out;
	      4. 	  Intensive staffing for control of behavior;
	      5. 	  Limited access or contingency access to preferred items or activities naturally available in the member’s environment;
	      6. 	  Reprimand;
	      7. 	  Response cost; and
	      8. 	  Use of psychotropic medications to control the occurrence of an unwanted behavior.
	       (6)  	 Members receive individualized services.
	       (7)  	 Members or their legal representatives provide written consent regarding which personal information is shared and with whom.
	       (8)  	 Members receive assistance with accessing financial management services as needed.
	       (9)  	 Members receive assistance with obtaining preventive, appropriate and timely medical and dental care.
	       (10)  	 The member’s living environment is reasonably safe and located in the community.
	       (11)  	 The member’s desire for intimacy is respected and supported.
[ARC 2341C, IAB 1/6/16, effective 2/10/16]