36-557

36-557. Community developmental disability
services; service providers

A. The department may use state and federal funds appropriated or otherwise
available to it for this purpose to assist in the establishment and maintenance of local
developmental disability services by public or private nonprofit or profit agencies. The
funds may be expended as professional fees for service, in contracts for advancement or
reimbursement or in another appropriate manner and may be used for any purpose necessary
to the provision of local developmental disability services. They may not be used for
departmental salaries, care of developmentally disabled persons by the department or any
other purpose within the department itself, but they may be used for consultation to the
department in the interest of local programs.

B. A local public or private nonprofit or profit agency providing or intending to
provide community developmental disability services and desiring to contract with the
department for the furnishing of such services shall submit a program plan and budget to
the department on the forms and in the manner required by the department. If the program
meets departmental standards and is consistent with the state plan of the department and
the individualized service program plan of the client, the department, notwithstanding
the provisions of title 41, chapter 23, relating to procurement and including services
pursuant to section 36-2943, may contract with that agency for required services on terms
the department requires. The contracts shall provide that the provider of services is
subject to a continuing program evaluation by the department through progress reports,
expenditure reports, program audits or other appropriate evaluation techniques and to
assure that the provider of service is in continued compliance with the terms of the
contract and the department's community developmental disability service standards and
requirements.

C. Contracts between the department and a school district or districts are subject
to approval by the department of education.

D. This article does not make the department or the state responsible for funding
programs beyond the limits of legislative appropriation for the programs. This article
does not require a provider of services to provide unreimbursed services to the
department or its clients.

E. Contracts to provide community developmental disability services shall require
that:

1. The contractor is obligated to operate a program or service in strict accordance
with the standards adopted for that program or service by the department.

2. If state funding is provided for a particular program the contractor, to the
extent of positions available that are being purchased by the department, shall provide
services to a developmentally disabled client who has been evaluated and placed by the
department.

3. All contractors must carry liability insurance in amounts approved by the risk
management division of the department of administration and file proof of insurance with
the risk management division. The director may waive that requirement on a case by case
basis on a finding that insurance for the program or service is not practicably available
at affordable rates and that it is necessary that the program or service be provided by
the contractor.

4. All clients enrolled in programs shall have all the same specified rights as
they would have if enrolled in a program operated directly by the state.

5. Except for emergency placement pursuant to section 36-560, subsection N, payment
shall not be made based on program services provided to a client if a placement
evaluation has not been made, and no individual program has been prepared and when, based
on that placement evaluation, no recommendation has been made to enroll the client in the
particular program service.

F. This article does not require a contracted agency to provide unreimbursed
services to the department or a client of the department.

G. Contracts for the purchase of residential care services other than those
community residential settings licensed pursuant to this chapter, in addition to other
general requirements applicable to purchase of care contractors shall:

1. Provide for mandatory inspection by the department every two years for
facilities other than group homes.

2. Provide for mandatory monitoring by the department for health, safety,
contractual and programmatic standards at least every six months, unless the department
has granted deemed status to the service provider. If the department has granted deemed
status, it shall monitor once each year. On determination by the department that there is
reasonable cause to believe a service provider is not adhering to the department's
programmatic or contractual requirements, the department and any duly designated employee
or agent of the department may enter on and into the premises at any reasonable time for
the purpose of determining the state of compliance with the programmatic or contractual
requirements of the department.

3. Provide for mandatory investigation by the department in response to complaints
within ten working days, except that in those instances that pose a danger to the client,
the department shall conduct the investigation immediately. Health and safety complaints
related to group homes shall be referred to the department of health services on receipt.
The department of health services shall share all incident reports related to health and
safety with the division of developmental disabilities.

4. Except for group homes licensed by the department of health services, specify
the health and safety and sanitation codes and other codes or standards applicable to the
facility or to the operation of the facility by the contractor other than group homes.

5. Provide for mandatory periodic reports to be filed by the provider contractor
with the department with respect to the operation of the facility.

6. Provide that the facility and the books and records of the facility and of the
provider are subject to inspection at any time by employees of the department or
designees of the department.

7. Provide that parents and guardians of developmentally disabled persons residing
at the facility, members of the developmental disabilities advisory council, and members
of other recognized and ongoing advocacy groups for developmentally disabled persons may
inspect the facility at reasonable times.

H. Contracts for purchase of residential care services shall require a community
residential setting, to be licensed pursuant to this chapter other than group homes
licensed by the department of health services.

I. The division shall ensure that all contracted developmental disabilities service
providers rendering services pursuant to this chapter are reimbursed in accordance with
title XIX of the social security act.

J. Contracts for client services issued by the department shall include language
outlining the provisions for a grievance and appeal procedure. The director shall provide
notice to providers not less than thirty days before the issuance of an amendment to a
qualified vendor agreement. The decision of the director regarding qualified vendor
agreement amendments may be appealed pursuant to title 41, chapter 6, article 10. The
grievance process applicable to these contracts shall comply with title XIX requirements.

K. As a condition of contracts with any developmental disabilities service
provider, the director shall require terms that conform with state and federal laws,
title XIX statutes and regulations and quality standards. The director shall further
require contract terms that ensure performance by the provider of the provisions of each
contract executed pursuant to this article.

L. The division shall establish a rate structure that ensures an equitable funding
basis for private nonprofit or for profit agencies for services pursuant to subsection B
of this section and section 36-2943. In each fiscal year, the division shall review and
adjust the rate structure based on section 36-2959. A rate book shall be published and
updated by the division to announce the rate structure that shall be incorporated by
reference in contracts for client services.

M. The division shall disclose to a service provider in the individual program plan
defined by section 36-551, and in all meetings resulting from a response to a vendor
call, any historical and behavioral information necessary for the provider to be able to
anticipate the client's future behaviors and needs including summary information from the
program review committee, unusual incident reports reviewed by the human rights committee
and behavioral treatment plans. The division shall redact the client's identification
from this information.

N. Service providers are authorized to engage in the following activities in
accordance with a client's individual program plan:

1. Administer medications, including assisting with the client's
self-administration of medications.

2. Log, store, remove and dispose of medications.

3. Maintain medications and protocols for direct care.

4. Serve as the client's representative payee if requested by the client or the
client's guardian and approved by the payer.

O. The department may adopt rules establishing procedures for engaging in the
activities listed in subsection N of this section.

P. To protect the health and safety of a client, a provider must notify the
division within twenty-four hours if an emergency situation exists in which the provider
is unable to meet the health or safety needs of the client.

Q. On notification of an emergency situation, the department shall hold an
individual program plan meeting within fifteen days after notification to recommend any
changes, including whether there is a need for temporary additional staffing to provide
appropriate care for a client, and develop a plan within thirty days after notification
to resolve the situation.