Section 180. Agency-directed companion services

A. Service description. Companion services provide assistance with skill development and with understanding family interaction, behavioral interventions for support and safety, nonmedical care, nonmedical transportation, community integration, and rewarding appropriate behaviors. These include, but are not limited to, nonmedical care, socialization, or support to a client. Companions may assist or support the individual with such tasks as meal preparation, community access and activities, laundry and shopping, but companions do not perform these activities as discrete services. This service is provided in accordance with a therapeutic goal in the ISP and is not purely diversional in nature.

B. Criteria. In order to qualify for companion services, the client shall have demonstrated a need for assistance with IADLs, light housekeeping, community access, reminders for medication self-administration, or support to assure safety.

1. The inclusion of companion services in the ISP is appropriate only when the client cannot be left alone at any time due to the SED. The provision of companion services does not entail hands-on care.

2. Companion services shall not be covered if required only because the client does not have a telephone in the home or because the client does not speak English.

3. There must be a clear and present danger to the client as a result of being left unsupervised. Companion services cannot be authorized for clients whose only need for such services is for assistance exiting the home in the event of an emergency.

C. Service units and service limitations.

1. The amount of companion services time included in the ISP must be no more than is necessary to prevent the deterioration or injury to the client. In no event may the amount of time relegated solely to companion care on the ISP exceed eight hours per day, either separately or in any combination of CD and agency-directed companion services.

2. The hours authorized are based on individual need. No more than three unrelated clients who are receiving waiver services and live in the same home are permitted to share the authorized work hours of the same companion.

3. Companion care will be authorized for family members/caregivers to sleep either during the day or during the night when the client cannot be left alone at any time due to his condition. Companion services must be necessary to ensure the client's safety if he cannot be left unsupervised due to health and safety concerns.

4. Companion services can be authorized when no one else is in the home who is competent to monitor the client for safety.

D. Provider requirements. In addition to meeting the general conditions and requirements for home and community-based participating providers as specified in 12VAC30-135-120 and 12VAC30-135-160, companion service providers must meet the following qualifications:

1. Providers must either be licensed by DMHMRSAS as (i) a residential service provider, (ii) supportive in-home residential service provider; (iii) day support service provider; or (iv) respite service provider; or meet the DMAS criteria to be a personal care/respite services provider.

2. Companions will be employees of providers that have provider participation agreements with DMAS to provide companion services. Providers are required to have a companion services supervisor to monitor companion services. The supervisor must be at least a QMHP.

3. The supervisor must conduct an initial home visit prior to initiating companion services to document the efficacy and appropriateness of services and to establish an ISP for the client. The supervisor must provide follow-up home visits to monitor the provision of services at a minimum of every three months or as often as needed. The client must be reassessed for services annually.

4. Required documentation in the client's record. The provider must maintain a record of each client receiving companion services. At a minimum these records must contain:

a. An initial assessment completed prior to the date services are initiated and subsequent reassessments and changes to the ISP;

b. An ISP containing the following elements:

(1) The client's strengths, desired outcomes, required or desired supports, or both;

(2) The services to be rendered and the schedule of services to accomplish the desired outcomes;

c. Documentation that the ISP goals, objectives, and activities have been reviewed by the provider quarterly, annually, and more often as needed, modified as appropriate, and the results of these reviews submitted to the case manager. For the annual review and in cases where the ISP is modified, the ISP must be reviewed with the client and family/caregiver.

d. All correspondence to the client, family/caregiver, case manager, DMAS, and DMHMRSAS;

e. Contacts made with family/caregiver, physicians, formal and informal service providers, and others involved in the care of the child;

f. The companion services supervisor must document in the client's record in a summary note following significant contacts with the companion and home visits with the client that occur at least quarterly:

(1) Whether companion services continue to be appropriate;

(2) Whether the plan is adequate to meet the client's needs or changes are indicated in the plan;

(3) The client and family/caregiver's satisfaction with the service;

(4) The presence or absence of the companion during the supervisor's visit;

(5) Any suspected abuse, neglect, or exploitation and to whom it was reported; and

(6) Any hospitalization or change in medical condition, functioning, or cognitive status.

g. In addition to the above requirements, the companion record must contain:

(1) The specific services delivered to the client by the companion, dated the day of service delivery, and the client's responses;

(2) The companion's arrival and departure times;

(3) The companion's weekly comments or observations about the client to include observations of the client's physical and emotional condition, daily activities, and responses to services rendered; and

(4) The weekly signature of the companion, or parent/caregiver, as appropriate, recorded and dated on the last day of service delivery for any given week to verify that companion services during that week have been rendered.

Historical Notes

Derived from Volume 24, Issue 02, eff. December 1, 2007.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.