Tracking #2006-00915

I:/06062801.rtf
[I:/06062801.doc]

(9 CCR 2503-1)

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Revisions to Sections 3.360.12, 3.360.13, 3.360.44, 3.460.13, 3.460.14, and 3.460.45, and addition of Sections 3.720-3.720.5 and 3.730-3.738 were final adoption following publication at the 11/3/2006 State Board meeting, with an effective date of 1/1/2007 (Rule-making# 06-6-28-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Office of Performance Improvement, Boards and Commissions Division, State Board Administration.

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3.360.12  Home Care Allowance [Rev. eff. 1/1/07]
In addition to the needs of the applicant or recipient, a home care allowance may be included in the grant of an Old Age Pension applicant or recipient.
See Section 3.720, et seq., for Home Care Allowance eligibility requirements.
3.360.13  Adult Foster Care [Rev. eff. 1/1/07]
In addition to the needs of the applicant or recipient, an adult foster care allowance may be included in the grant of an OAP recipient. A twenty dollar disregard is not allowed. See Section 3.730, et seq., for Adult Foster Care eligibility requirements.

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3.360.44  Old Age Pension (OAP) Standard of Assistance Table [Rev. eff. 1/1/07]
COMPONENTS 
Standard Allowance (Effective January 1, 2006):
Food	$138.00	
Clothing	59.00	
Shelter	221.00	
Utilities	combined with shelter	
Household Supplies	35.00	
Insurance	22.00	
Medicine Chest	28.00	
Routine Transportation	44.00	
Personal Needs	81.00	
TOTAL	$628.00	

Institutionalized Persons:
Personal Needs -		
Medical Institutions	$ 50 or	
(for certain veterans		
or their widow(er)s)	$ 90	

Individuals qualifying for the Home Care Allowance or Adult Foster Care programs may have income higher than the OAP grant standard. These individuals are eligible for a partial Home Care Allowance (HCA) or Adult Foster Care (AFC) payment. See Sections 3.720 and 3.730 of this manual regarding Home Care Allowance and Adult Foster Care. County departments are to operate the Home Care Allowance (HCA) and Adult Foster Care (AFC) programs in accordance with the rules promulgated by the State Board of Human Services.

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3.460.13  Home Care Allowance [Rev. eff. 1/1/07]
In addition to the needs of the disabled or blind applicant or recipient, a home care allowance may be included in the grant of an AND/AB/SSI-CS or State AND/AB applicant or recipient.
See Section 3.720, et seq., for Home Care Allowance eligibility requirements. 
3.460.14  Adult Foster Care [Rev. eff. 1/1/07]
In addition to the needs of the disabled or blind applicant or recipient, an adult foster care allowance shall be included in the grant of an AND/AB/SSI-CS recipient when:
A.  The need for such care has been determined by the county worker;
B.  The care is authorized by the county department; and,
C.  The individual is or will be residing in a certified Adult Foster Care facility. See Section 3.730, et seq., for Adult Foster Care requirements and the Colorado Department of Human Services' Section 7.103 "Program for the Protection of At Risk Adults Unable to Protect Their Own Interests" (12 CCR 2509-2).

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3.460.45  Aid to the Needy Disabled/Aid to the Blind/Supplemental Security Income-Colorado Supplement (AND/AB/SSI-CS) Standards of Assistance Table [Ref. eff. 1/1/07]
AND/SSI-CS and AB/SSI-CS Components :
Standard Allowance:	Percentages	
Food	20.5%	
Clothing	8.8%	
Shelter	37.0%	
Utilities	*	
Household Supplies	5.0%	
Insurance	4.2%	
Medicine Chest	5.0%	
Routine Transportation	5.3%	
Personal Needs	14.2%	
Total Standard Allowance	100%	
*  Shelter and Utilities costs are combined.
The grant amount is computed by multiplying the standard allowance percentage for the component (see table above) by the current standard of assistance for the applicable program.
The total standard allowance may change at any time as necessary to stay within the current appropriation.
Applicants or recipients qualifying for the Home Care Allowance or Adult Foster Care programs may have higher income for eligibility purposes. See Section 3.720 et seq., regarding the Home Care Allowance program and Section 3.730 et seq., regarding the Adult Foster Care program.
County departments are to operate the Home Care Allowance (HCA) and Adult Foster Care (AFC) programs in accordance with the rules promulgated by the State Board of Human Services. 
Institutionalized Recipients in Medical Institutions:
Personal Needs	$50 or	
For certain veterans	$90	

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3.720  HOME CARE ALLOWANCE
3.720.1  DEFINITION [Eff. 1/1/07]
Home Care Allowance (HCA) is a special allowance for the purpose of securing services to an individual in his/her home, based on the case manager's assessment. The Home Care Allowance is a non-entitlement program. The HCA program is designed to serve those recipients with the lowest functional abilities and the greatest need for paid care. Eligibility for, and authorized amounts of, the Home Care Allowance are subject to available appropriations.
3.720.2  FINANCIAL ELIGIBILITY [Eff. 1/1/07]
Eligibility for the Home Care Allowance program shall be based on financial need, the applicant's or recipient's functional capacity score, the applicant's or recipient's need for paid care score, and available appropriations. The applicant or recipient must meet all eligibility criteria required for the appropriate program (OAP, State AND/AB, or AND/AND/SSI-CS). 
In determining financial need, the applicant's or recipient's Home Care Allowance authorized amount is added to the appropriate categorical grant standard for OAP, State AND/AB or AND/AB/SSI-CS. Total countable income is deducted from the total of the Home Care Allowance authorized amount and the categorical grant standard to derive the net payment to the recipient. 
3.720.21  Interim Assistance Reimbursement [Eff. 1/1/07]
The difference in the amount of Home Care Allowance (HCA) payment made to a recipient while he/she was on State AND/AB and the amount of HCA payments made to the recipient when he/she becomes eligible for SSI and the total State AND/AB received by State AND or AB recipients will be recoverable as an interim assistance payment upon SSI approval. The recovery shall be calculated for each month the recipient received a State AND/AB payment and an SSI retroactive payment for that same month, in accordance with the regulations set forth in these rules under AND/AB payment policies. At the time of application, the SSI payment recovery procedure shall be explained to the applicant or recipient and/or designated representative.
3.720.22  Single Entry Point Agencies [Eff. 1/1/07]
Single Entry Point (SEP) agencies shall utilize the State prescribed form to determine Home Care Allowance (HCA) eligibility and authorized amounts for all applicants and recipients.
3.720.3  FUNCTIONAL ELIGIBILITY
3.720.31  Functional Capacity Score [Eff. 1/1/07]
A.  In order to be eligible for the Home Care Allowance Program, each applicant or recipient must meet the minimum functional capacity score of 21 points in the following areas and shall score a minimum of one (1) point on the total need for paid care score:
1.  Activities of daily living: includes transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, eating;
2.  Basic instrumental activities of daily living: includes meal preparation, housework, laundry, shopping;
3.  Supportive services: includes medicine management, appointment management, money management, accessing resources, and telephoning.
B.  The need for skilled personal care shall not be included in the case manager's scoring of the need for paid care score. Skilled personal care is not a paid service of the Home Care Allowance program (see HCPF rules, Section 8.489.30 (10 CCR 2505-10) for the definition of skilled personal care).
3.720.32  Need for Paid Care Score [Eff. 1/1/07]
The need for paid care score shall be based on the frequency of the applicant's or recipient's need for paid care as follows:

Frequency of Need for Paid Care	Need for Paid Care Score	

No need for paid care	
0	

Up to and including once a week	
1	

More than once a week and up to seven days a week	
2	

At least two times per day, five days per week	
3	

3.720.33  Home Care Allowance Authorized Payment Amount [Eff. 1/1/07]
The case manager shall approve each applicant or recipient, who meets the minimum requirements for the HCA program, an authorized amount of Home Care Allowance. The case manager shall determine the authorized HCA amount, up to the maximum amount allowable, based upon the need for paid care score. The three ranges of the need for paid care score are listed below. The maximum HCA authorized amount in each range is approved by the Colorado Department of Human Services and is subject to change. The case manager shall not approve the maximum authorized HCA amount if the applicant's or recipient's needs can be fully or partially met from other paid or unpaid sources, if the HCA provider is able to provide the authorized services for less than the maximum authorized amount, or if the applicant or recipient is unwilling or unable to use the maximum authorized amount. In determining the authorized HCA amount, the case manager shall ensure that there is no duplication of services in accordance with HCPF rules, Section 8.393.23, C, 4 (10 CCR 2505-10).

Need for Paid Care Score	
1-23	
24-37	
38 and over	

A.  Payment of the Home Care Allowance authorized grant will begin on the first day of the month following the month in which the HCA is authorized.
B.  There shall be no retroactive Home Care Allowance payments. The hardship provisions shall not apply to Home Care Allowance grant payments.
C.  The Home Care Allowance recipient's grant standard will increase based on the authorized HCA amount which is found in Section 3.360.44 of the Old Age Pension rules, 3.460.13 of the State AND/AB section, and 3.460.45 of the AND/AB/SSI-CS section.
D.  HCA payments shall be adjusted by the Colorado Department of Human Services based on available appropriations. A county conference or State appeal need not be granted unless the reason for an individual appeal is incorrect grant computation.
3.720.4  DUTIES OF SINGLE ENTRY POINT AGENCY FOR HOME CARE ALLOWANCE CASES
3.720.41  Intake [Eff. 1/1/07]
Refer to HCPF rules, Section 8.393.21, A, 1 (10 CCR 2505-10), for SEP intake procedures.
3.720.42  Assessment [Eff. 1/1/07]
Refer to HCPF rules, Section 8.393.21 and 8.393.22 (10 CCR 2505-10), for SEP assessment procedures.
3.720.43  Care Planning [Eff. 1/1/07]
If the applicant or recipient is found eligible for the Home Care Allowance program, the case manager shall work with the applicant or recipient or the designated representative to develop a care plan.
A.  The applicant or recipient may select any person(s), 18 years of age or over, to provide services to be paid for with the Home Care Allowance. The case manager shall make a face-to-face assessment of each care provider's ability and willingness to provide the services, using the guidelines included in the Uniform Long Term Care Assessment Instrument instructions.
B.  The case manager shall negotiate with the applicant or recipient and care provider(s) to arrive at the total number of paid hours to be provided weekly. The applicant or recipient or designated representative and the provider shall sign the State prescribed provider agreement and each shall receive a copy of the agreement.
C.  In all cases, Home Care Allowance payments shall be made directly to the recipient or designated representative. The recipient or representative is responsible for paying the designated provider(s) the authorized amount on a regular monthly basis. No portion of the Home Care Allowance may be withheld for the recipient's personal use. The full HCA payment, including the recipient's contribution, if applicable, must be spent for HCA services each month.
D.  The case manager shall explain that the recipient is responsible to pay each care provider on a monthly basis for the services provided.
E.  With the recipient's agreement per the release of information form, a copy of the provider agreement shall be sent to each care provider specifying the services to be provided, total hours per month, and agreed upon monthly provider reimbursement.
F.  After supervisory review and sign-off, the case manager shall send a signed copy of the Uniform Long Term Care Assessment Instrument to the Colorado Department of Human Services and the county eligibility worker authorizing payment of the Home Care Allowance.
3.720.44  Congregate Settings [Eff. 1/1/07]
A.  Home Care Allowance may be used for recipients residing in congregate settings. A congregate setting is defined as three or more unrelated individuals living in a commonly shared facility which provides room, board, and protective oversight. All congregate settings shall be in compliance with all State and local licensing requirements. The maximum HCA authorized amount shall not cause the amount paid, by the recipient to the facility, to exceed the maximum rate paid for Adult Foster Care.
B.  Authorized HCA amounts for recipients who have been receiving a Home Care Allowance and who have been residing in the same congregate setting since prior to November 1, 1985, may exceed the AFC rate if the recipient is eligible to receive a higher authorized HCA amount.
3.720.45  Services for HCA Recipients [Eff. 1/1/07]
A.  The seventeen (17) areas on page 3 of the ULTC 100.2. See Section 3.370.20;
B.  Electronic monitoring; 
C.  One-time deep cleaning if referral is initiated by Adult Protective Services and determined necessary by the Single Entry Point case manager;
D.  Services shall be monitored in accordance with HCPF rules, Section 8.393.24, E (10 CCR 2505-10); and, 
E.  Single Entry Point agency staff shall complete the reassessment in accordance with HCPF rules, Section 8.393.25 (10 CCR 2505-10).
3.720.46  Notice of Action and Appeal Rights [Eff. 1/1/07]
Home Care Allowance applicants and recipients shall be notified of their eligibility status including initial approval, denial, discontinuation, or changes to the authorized Home Care Allowance amount according to the procedures located in HCPF rules, Section 8.393.27 and 8.393.28 (10 CCR 2505-10).
3.720.5  COUNTY RESPONSIBILITIES
A.  The county department must retain a copy of the State prescribed form (ULTC 100.2) in the physical case record. 
B.  The county department must review each State prescribed form for completion. 
C.  The county department must update any changes in the case record. These changes must be updated in the current computer system and documented in the physical case record. 
D.  The county shall have the case organized and available for State review.
3.730  ADULT FOSTER CARE [Rev. eff. 1/1/07]
Adult Foster Care (AFC) means care provided on a 24-hour basis for no more than sixteen (16) residents in a non-medical facility. The facility is certified by the agency designated by the Colorado Department of Human Services. This program serves the frail elderly, physically or emotionally disabled adults, 18 years of age and over, who do not require 24-hour medical care.
3.730.1  DEFINITIONS [Rev. eff. 1/1/07]
A.  "Adult Foster Care Facility" means a licensed Assisted Living Residence (ALR) that meets all applicable federal, state, and local laws and regulations, and that has been additionally certified by the Colorado Department of Human Services or its designee as a provider of Adult Foster Care services. AFCs shall provide the following: 
1.  Twenty-four hour residential care for no more than 16 residents;.
2.  An environment which is sanitary and safe from physical harm;
3.  Adequate sleeping and living areas; and,
4.  Adequate recreational areas.
B. "Adult Foster Care Services" means those services which shall be provided by an AFC to each resident. These services shall include, but are not limited to: 
1.  Availability of three balanced meals per day with provision for special diets when those diets have been prescribed as part of a medical plan;
2.  Assistance with transportation;
3.  Protective oversight;
4.  Assistance with basic personal tasks, such as bathing, hair care, and dressing;
5.  Supervision of self-administration of medications;
6.  Housekeeping services such as changing of bed linen, cleaning of living areas, and rearrangement of furniture as needed to promote freer mobility;
7.  Laundering of resident's clothing and bedding; and,
8.  Opportunities for structured recreational activities and socializing.
C.  "Operator" means any person who owns an AFC facility or an individual with authority delegated by the owner who manages, controls or performs the day-to-day tasks for operating an AFC facility.
D.  "Protective Oversight" means guidance of a resident, as required by the needs of the resident or as reasonably requested by the resident, including the following: 
1.  Being aware of a resident's general whereabouts, although the resident may travel independently in the community; 
2.  Monitoring the activities of the resident while on the premises to ensure the health, safety, and well-being of the resident, including monitoring of prescribed medications; 
3.  Reminding the resident to carry out activities of daily living; and,
4.  Reminding the resident of any important activities, including appointments.
E.  "Resident" means an individual who has met all the eligibility requirements for Adult Foster Care, has met the appropriate placement criteria for the AFC program, and has been approved for placement or currently resides in a certified Adult Foster Care facility.
F.  "Restraint" means any physical or chemical device, application of force, or medication which is designed or used for the purpose of modifying, altering, or controlling behavior for the convenience of the facility and excludes medication prescribed by a physician as part of an on-going treatment plan or pursuant to a diagnosis. Restraints as defined herein are prohibited.
G.  Staff" means a paid employee of the facility.
H.  "Substance Abuse" means the use of any mind or mood altering material in a manner which deviates from standard medical practice in the community, which acts to the detriment of the individual residents or the public, and which includes but is not limited to, alcohol, dangerous drugs, or narcotic drugs.
1.  Alcohol refers to beverage alcohol, ethylene alcohol, or ethanol.
2.  Dangerous drugs refers to cannabis or any depressant drug, hallucinogenic drug, stimulant drug, or tranquilizer, or any such mixture or compound with any other substances.
3.  Narcotic drugs refers to any drug to which the Federal Controlled Substance Act of 1970 may apply and any drug found by the State Board of Health to be addiction forming or to have an addiction sustaining character similar to morphine or cocaine.
I.  "Universal Precautions" refers to a system of infection control, which assumes that every direct contact with body fluids is potentially infectious. This includes any reasonably anticipated skin, eye, mucous membrane or potential contact with blood, blood-tinged body fluids, or other potentially infectious materials.
3.730.2  ELIGIBILITY [Eff. 1/1/07]
Eligibility for the Adult Foster Care program shall be based on financial need, the recipient's need for 24-hour supervision and assistance with activities of daily living, appropriateness for the AFC program, and available appropriations. The applicant or recipient must meet all eligibility criteria required for the appropriate program, OAP or AND/AB/SSI-CS.
3.730.21  Financial Eligibility [Eff. 1/1/07]
The county department eligibility worker in the recipient's county of residence shall determine financial eligibility for Adult Foster Care. In determining financial need, the applicant's or recipient's total countable income is subtracted from the AFC grant amount to derive the net payment to the applicant or recipient.
A.  In addition to the needs of the individual, an Adult Foster Care allowance shall be included in the grant of an AND/AB/SSI-CS or OAP recipient when: 
1.  The need for such care has been determined by the Single Entry Point agency;
2.  The care is authorized by the Single Entry Point agency; and,
3.  The applicant or recipient is or will be residing in a currently certified Adult Foster Care facility.
B.  The maximum amount which can be allowed as Adult Foster Care is the difference between the AND/AB/SSI-CS or OAP standard and the State approved Adult Foster Care rate plus $50 personal needs allowance. 
C.  The State approved AFC provider rate per month shall be permitted to rise in a dollar-for-dollar relationship to any increase in the SSI grant standard. In addition, the AFC payment to providers may be adjusted by the State Department, as funding becomes available. 
3.730.22  County Responsibilities [Eff. 1/1/07]
A.  The county department must retain a copy of the State prescribed form (ULTC 100.2) in the physical case record. 
B.  The county department must review each State prescribed form.
C.  The county department must update any changes in the case record. These changes must be updated in the current computer system and documented in the physical case record. 
D.  The county department shall have the case organized and available for State review. 
3.730.3  FUNCTIONAL ASSESSMENT [Eff. 1/1/07]
A.  Single Entry Point agencies shall utilize the State prescribed form (ULTC-100.2) developed by the State to determine functional capacity and need for paid care. Along with the State prescribed form, the functional eligibility of the applicant or recipient for AFC placement shall be determined using the Appropriateness of Placement form.
B.  The State prescribed form (ULTC 100.2) and the Appropriateness of Placement criteria shall be completed on an annual basis or more frequently if there are changes in the recipient's circumstances.
C.  Persons who are developmentally disabled or who are receiving, or are eligible to receive services administered by the Colorado Department of Human Services, Developmental Disabilities Services, are not eligible for AFC.
D.  Residents with a primary diagnosis of mental illness must be willing to comply with medications prescribed by the physician and must be receiving on-going services from the local mental health center or other mental health professional.
E.  Adult Foster Care recipients shall not receive other public or private funded service, which duplicate those services which are mandated to be provided in the Adult Foster Care program.
3.730.4  ADMISSION PROCEDURE
3.730.41  Applicant Intake [Eff. 1/1/07]
Refer to HCPF rules, Section 8.393.21, A, 1 (10 CCR 2505-10), for SEP intake procedures.
3.730.42  Assessment [Eff. 1/1/07]
Refer to HCPF rules, Section 8.393.21 and 8.393.22 (10 CCR 2505-10) for SEP assessment procedures.
A.  After the State prescribed form (ULTC 100.2) and the Appropriateness of Placement forms have been completed by the case manager, the information from these forms shall be used in determining if the applicant or recipient is functionally eligible for Adult Foster Care.
B.  If determined functionally eligible, the recipient cannot be placed and the AFC payment cannot begin until an appropriate AFC facility is found.
3.730.43  Appropriate Facility Review [Eff. 1/1/07]
The case manager shall review available Adult Foster Care facilities to determine if the applicant's or recipient's needs can be met by a current facility. This review may include contact with other counties which have AFC facilities.
3.730.44  Agreement to Placement Services [Eff. 1/1/07]
A recipient shall not be placed in an Adult Foster Care facility unless one or more of the following conditions are met: 
A.  The competent recipient gives informed consent for placement; or,
B.  The court-appointed guardian of the recipient requests placement; and,
C.  The recipient or his legal representative understands and agrees to adhere to facility rules.
3.730.5  CARE PLANNING [Eff. 1/1/07]
When the decision is made that the applicant is appropriate for Adult Foster Care and that an appropriate AFC facility exists, the case manager shall: 
A.  Discuss the needs of the recipient with the Adult Foster Care provider to determine if the provider is capable of meeting the recipient's needs;
B.  Discuss the facility and the provider with the recipient;
C.  Arrange for an initial visit by the recipient to the facility;
D.  Have a care plan negotiated with and signed by the recipient and case manager prior to admission. The care plan shall be developed in conjunction with the ALR Board and Care Plan required and must be renewed at least every twelve months or sooner if there is a change in the recipient's condition;
E.  Have a current provider agreement signed by the manager of the Adult Foster Care facility prior to placement. This agreement shall be renewed at least annually, contingent upon the facility meeting all requirements for certification as an AFC facility.
F.  After supervisory review and sign-off, the case manager shall send a signed copy of the State prescribed form (ULTC-100.2) to the county eligibility worker authorizing the Adult Foster Care payment; and within thirty (30) days shall also send a copy to the State.
G.  In all cases, Adult Foster Care payments shall be made directly to the recipient or the recipient's designated representative. The recipient or representative is responsible for paying the AFC provider the agreed amount on a regular monthly basis.
H.  The case manager shall explain that the recipient or recipient's designated representative is responsible to pay the AFC provider on a monthly basis.
I.  When the recipient has been determined to be financially and functionally eligible for AFC, the Adult Foster Care payment effective date shall be the date that the applicant was assessed for appropriateness for the AFC program using the Appropriateness of Placement form. The date on the Appropriateness of Placement form shall not exceed a period longer than forty-five (45) calendar days prior to the recipient's placement in an AFC Facility. If the date is past the forty-five day period, the case manager must reassess the recipient, make needed changes on the form, enter the date of the new assessment, and re-sign the form.
3.730.6  SERVICES FOR AFC RECIPIENTS [Eff. 1/1/07]
A.  Single Entry Point agency staff shall monitor recipient records to ensure that a recipient with a primary diagnosis of mental illness is receiving on-going services from the community mental health center or other mental health professional.
B.  Reassessment
1.  Single Entry Point agency staff shall conduct the reassessment in accordance with HCPF rules, Section 8.393.25 (10 CCR 2505-10).
2.  An Appropriateness of Placement form must also be completed at the time of the reassessment. If a recipient is determined to be inappropriate for the Adult Foster Care program, that recipient must be discontinued from the AFC program (see HCPF rules, Section 8.393.28, D, 2, b(2); 10 CCR 2505-10).
3.  The case manager must also determine if the facility continues to meet the recipient's needs. If the facility no longer meets the recipient's needs, the case, manager must review other AFC facilities to determine the possibility that one will meet the recipient's needs.
4.  If there is no other AFC facility which meets the recipient's needs, the recipient will be discontinued from the Adult Foster Care program and discharged from the facility (see HCPF rules, Section 8.393.28, D, 5). 
3.730.7  SINGLE ENTRY AGENCY FUNCTIONS [Eff. 1/1/07]
For complaints and service functions of a Single Entry Agency, refer to the Colorado Department of Health Care Policy and Financing rules, Section 8.393.2 (10 CCR 2505-10).
3.730.8  NOTIFICATION OF ACTION AND APPEAL RIGHTS [Eff. 1/1/07]
Adult Foster Care applicants and recipients shall be notified of their eligibility status including initial approval, denial, discontinuation, or changes to the authorized Adult Foster Care amount according to the procedures located in HCPF rules, Section 8.393.27 and 8.393.28 (10 CCR 2505-10).
3.731  OPERATOR/STAFF QUALIFICATIONS [Eff. 1/1/07]
Qualifications for operator(s), staff, and volunteers shall be as follows: 
A.  Any person providing any service under these rules shall strictly comply with all federal, state and local laws, regulations and ordinances.
B.  All operators and staff shall read, be familiar with, and follow the rules and regulations for the operation of AFCs. Ignorance of these rules and regulations is not an acceptable defense for their violation.
C.  All operators and staff must be trained as defined in Section 3.733.
D.  The operator or staff person responsible for protective oversight of the residents must be able to recognize and respond to emergencies, including contacting emergency services such as 911, ambulance, fire and police departments.
E.  At all times mere must be at least one staff person on duty who is 18 years of age or older and who is trained to provide protective oversight.
1.  If a facility can document to the State or its designee the provision for one staff person on duty at all times may be waived in writing by the State Department.
2.  The criteria which must be met and documented in order for the State to waive the requirement that one person shall be on duty at all times shall include, but not be limited to: 
a.  All residents must be in a day treatment program, in a job training program or on the job. This must be written in each resident's treatment or care plan. A staff person must be at the facility at the time the first resident returns.
b.  If a resident becomes ill, leaves the day treatment program, job training or work early, the facility must have a telephone number which is manned at all times for the resident to call. A staff person who can meet the resident at the facility and stay with him/her until permanent staff arrives must be available at all times.
3.  If a resident cannot be depended upon to follow his/her treatment plan and either stay at day placement or call the designated telephone number, then s/he is not appropriate for that facility and must be moved into a licensed facility that is staffed 24 hours per day or a waiver cannot be granted to that facility.
4.  If a resident is ill or refuses to go to day placement or work, a staff member must stay with him/her or s/he must be taken to a licensed/certified residential facility that is staffed 24 hours per day.
5.  At no time may a resident be present in an Adult Foster Care facility without a staff member also being present in the facility who is trained to provide protective oversight.
F.  The operator and staff must, prior to beginning duties, have a doctor's statement that they are free of communicable and infectious diseases.
G.  All operators, staff, and volunteers providing direct client care or food preparation must have TB testing prior to beginning duties and annually thereafter.
H.  Facilities must maintain a 1:10 staff-to-resident ratio unless the operator can document to the Colorado Department of Human Services or its designee that a ratio of less than 1:10 does not jeopardize the health and safety of the residents. Based on adequate documentation, a written staffing waiver may be issued by the State.
A written request for a staff-to-resident waiver must be submitted to the State Department. The State may request further information which will be reviewed along with the most current Assisted Living Residence deficiency report and fire safety survey. Information which must be submitted to the State for review includes, but is not limited to: 
1.  The types of physical/mental limitations of residents in the facility such as confusion, Organic Brain Syndrome or Alzheimer;
2.  A diagram of the layout of the facility;
3.  The number and type of staff and their location during day and night;
4.  The number of back up staff who will respond to the emergency and the distance they must travel;
5.  Types of training regular staff and back up staff has had in fire safety and other emergency procedures and how often this is done;
6.  The facility's procedure for evacuation in case of fire or other emergency;
7.  The number of fire drills held each year;
8.  Time scores in evacuating residents during a fire drill;
9.  The distance of the nearest fire department that will respond to the call;
10.  A description of the facility's sprinkler system, smoke alarms, special items for fire safety which have been installed in the facility (dedicated alarm line directly to fire station, 2 hour fire wall, alarms in each room hooked to a central alarm, etc.);
11.  Assurance that staff carry two-way radios or pagers for use in an emergency; and,
12.  Staff-to-resident ratio requested.
I.  Any person who is involved in substance abuse, uses alcohol excessively, uses narcotic drugs or dangerous drugs shall not be approved as an operator; nor be employed, act as a volunteer, or reside in a certified facility.
3.732  TRAINING [Eff. 1/1/07]
A.  Facility operators must satisfactorily complete an introductory training on AFC rules and regulations prior to certification of the facility. This introductory training shall be conducted by the State Department or its designee.
B.  Certified facilities having operators who have not yet had this introductory training will be required to have their operator attend the next available training offered or document to the State Department or its designee that they have had previous training equivalent to the required training.
C.  The operator, staff, and volunteers who provide direct recipient care or protective oversight must be trained in First Aid and in emergency procedures prior to assuming responsibilities. Facilities certified prior to the effective date of this rule shall have sixty (60) days to satisfy this training requirement.
D.  The operator and staff must have training specific to the needs of the populations served (e.g., chronically mentally ill, frail elderly, Acquired Immune Deficiency Syndrome, Alzheimer's disease).
E.  Thereafter, periodic training may be required of facility operators and/or staff, addressing needs identified by operators and/or by the agency designated by the State and/or Colorado Department of Health Care Policy and Financing.
F.  Training in the use of universal precautions for the control of infectious or communicable disease shall be required of all operators, staff, and volunteers. Facilities certified prior to the effective date of these rules shall have sixty (60) days to satisfy this training requirement.
3.733  APPROPRIATENESS OF PLACEMENT [Eff. 1/1/07]
Only residents whose needs can be met by the facility shall be admitted to that facility. A facility shall not admit or keep any resident requiring a level of care or type of service which the facility does not provide or is unable to provide. In no event shall a facility admit or keep a resident who: 
A.  Needs skilled services on more than an intermittent basis. If skilled services are provided on an intermitted basis, they must be provided by a skilled provider.
B.  Is unable or unwilling to meet his/her own personal hygiene needs under supervision.
C.  Has an acute physical illness which cannot be managed through medications or prescribed therapy.
D.  Has a substance abuse problem, unless the substance abuse is no longer acute and physician determines it to be manageable.
E.  Has ambulation limitation, unless compensated for by an assisting device with minimal assistance from staff.
F.  Has a reportable communicable or infectious disease, unless the transmittal of the disease can be managed through the use of universal precautions and appropriate medical and/or drug treatment.
G.  Is consistently disoriented to time, person, and place to such a degree that he/she poses a danger to self or others.
H.  Has seizure disorders which are not adequately controlled by medications.
I.  Requires tray food services on a continuous basis.
J.  Exhibits behavior which poses a physical threat to self or others. Such behavior includes, but is not limited to, violent and disruptive behavior and/or any behavior which involves physical, sexual or psychological force or intimidation.
K.  Requires intravenous or tube feeding.
L.  Is consistently unwilling to take medications prescribed by a physician.
M.  Is incapable of self-administration of medications unless the facility has a staff member trained in medication administration, in accordance with Section 25-1-107, C.R.S., et seq., or who possesses all necessary licenses to do so.
N.  Is a person whose, physical safety cannot be assured in an AFC.
O.  Is consistently, uncontrollably incontinent of bowel or bladder that cannot be managed by resident with assistance from staff.
P.  Needs restraints, as defined herein, of any kind.
Q.  Has a primary diagnosis of mental illness and is unwilling to comply with medications prescribed by the physician and is not receiving services from the local community mental health center or other mental health professional.
R.  A copy of the ALR Board and Care Plan, jointly developed by the resident, family, caseworker, and operator, must be provided to all parties prior to admission to the facility.
S.  Any client admitted for respite care in an AFC must meet the requirements for appropriate placement described above.
3.734  RESIDENT RIGHTS/HOUSE RULES [Eff. 1/1/07]
All facilities must ensure that the following residents rights are not violated: 
A.  Residents may voluntarily participate in performing housekeeping duties and other tasks but cannot be required to perform duties of staff.
B.  If a resident is reimbursed by the facility for services performed, there must be a written agreement regarding duties and reimbursement between the resident and the operator. The amount of compensation must be reported to the income maintenance staff of the county department of human/social services and the Single Entry Point agency case manager.
C.  All house policies regarding smoking and the use of alcohol shall apply equally to operator, staff, volunteers, residents, and others residing in the facility.
D.  The withholding of food and water is prohibited unless indicated by written physician's orders or a pharmacist's medication instructions.
E.  The facility must provide an environment free from physical restraint, involuntary confinement, and financial, sexual or any other exploitation or threat of intimidation.
F.  The facility must provide an accessible telephone with toll free local calls; and,
G.  The facility shall provide residents with written information about the individual's rights under state law to accept or refuse medical treatment; the right to formulate advance directives, and the providers' policies respecting the implementation of such rights. Documentation shall be kept in the individual's record as to whether the individual has executed an advance directive.
H.  The operator must have the resident or designated guardian sign that the house rules and resident rights have been read, were explained, and are understood.
3.735  SERVICES PROVIDED [Eff. 1/1/07]
Facilities shall provide those services indicated in Section 3.730.1, A and B, of these rules.
3.736  PROVIDER AGREEMENT [Eff. 1/1/07]
A.  Providers who meet all the AFC certification requirements in this staff manual may enter into a provider agreement with the Colorado Department of Human Services or its designee.
B.  Facilities shall not accept Adult Foster Care payments from AFC recipients unless the facility is currently licensed as an Assisted Living Residence, certified as an AFC, and has signed a provider agreement with the Colorado Department of Human Services or its designee.
3.737  RECORDS AND REPORTING REQUIREMENTS [Eff. 1/1/07]
A.  The facility shall maintain records sufficient to document compliance with the Colorado Department of Human Services rules and contract requirements, including proof of insurance, licenses, permits, and surety bonds for a period of at least six (6) years.
B.  The facility shall notify the State Department or its, designee within five (5) working days of any suspension, revocation or termination of any required license, permit, insurance, or surety bond.
C.  Facilities which accept responsibility for resident's personal funds shall post a surety bond in a minimum amount of $10,000.
D.  Personnel records for each employee or volunteer must include name, age, sex, home address and phone number, documentation of training and/or work experience, and results of TB testing for any employee or volunteer providing direct care to residents or involved in meal preparation or food handling.
E.  Residents' records shall include, as appropriate, the name and address of a spouse, the date of termination or transfer from the facility, and the new forwarding address of the resident.
F.  The facility shall notify the case manager within five (5) days of the need for changes to the Board and Care Plan.
G.  The facility shall, within twenty-four (24) hours, notify the case, manager of the death or serious injury of any recipient living in an AFC facility with an ALR Board and Care Plan, and any severe deterioration in a resident's medical condition or behavior.
3.738  REIMBURSEMENT METHOD FOR ADULT FOSTER CARE [Eff. 1/1/07]
A.  AFC facilities shall negotiate a standard rate of payment per resident, per month with the agency designated by the State. For maximum allowable rate, refer to Section 3.730.2, A and B.
B.  AFC facilities shall not submit bills or otherwise attempt to collect payments from recipients or recipients' estates for any services provided to the recipient which are benefits reimbursable under the program in accordance with the rules of the Colorado Department of Human Services.
C.  AFC facilities shall charge private pay residents an amount at least equal to that charged to AFC residents.
D.  Adult Foster Care payments shall not be made to residents in non-certified facilities.
E.  AFC operators must immediately notify the Single Entry Point agency of any planned or unplanned absence of a resident for more than 24-hours. The Single Entry Point agency may continue to fund an Adult Foster Care placement while a resident is on medical, programmatic or non-medical leave; however, the combined leave may not exceed a total of forty-two (42) days in a 12 month period beginning with the date the client was admitted into the program. The three types of leave are defined as follows: 
1.  "Medical leave" is the absence of the resident from the Adult Foster Care facility due to admittance to a hospital or other institution. This must be on the order of a physician and there must be a presumption on the part of the physician that the resident will be returning to the AFC facility.
2.  "Non-medical leave days" are defined generally as days of leave from the AFC for non-medical reasons and are not part of a recipient's care plan.
3.  "Programmatic leave days" are days of leave prescribed by a physician for participation in therapeutic and/or rehabilitative programs and may entail visits to family, friends, or guardians. Any therapeutic and/or rehabilitative programs and visits to family, friends, or guardians must be prescribed by a physician and documented as part of the recipient's care plan to qualify as programmatic leave. 
3.740  (None)