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Department of Health Rental Assistance 

 Common Questions About Colorado Regulation 8.7000 for Respite Services

1. What is Regulation 8.7000, and how does it impact respite care services across all Medicaid waivers?
   • Regulation 8.7000 establishes standards for the provision of respite care under Medicaid waivers, ensuring consistency in care, monitoring, and medication administration, regardless of the specific waiver your child or family member is on.

1. How will this regulation affect the way my child’s medications are administered during respite care?
   • Caregivers must be QMAP certified under approved CDHPE training programs to safely administer medications. This applies across all waivers, ensuring proper documentation, dosage, and timing of medications for your child.

1. Are there different requirements for medication administration for parent providers caring for their own children?
   • Yes, even parent providers caring for their children are required to be QMAP certified if they are paid through Medicaid waivers. This ensures consistency in medication administration, documentation, and compliance with state regulations.

1. How does Regulation 8.7000 ensure monitoring and oversight of caregivers across different waivers?
   • Caregivers, including parent providers, must meet consistent standards for monitoring and documenting the care provided, including detailed tracking of medications, behavioral needs, and any incidents during respite care. All caregivers are subject to regular supervisory visits and compliance checks.

1. Will I need to take extra steps to comply with these rules if I’m caring for my child over the age of 18?
   • Yes, if you are a paid provider for your child over 18, you must comply with all state regulations, including QMAP certification, documentation requirements, and regular supervisory visits. This applies across all waivers and ensures consistent care standards regardless of your child’s age.

1. What additional documentation or monitoring will be required under Regulation 8.7000?
   • Under the new rules, more detailed documentation is required for medication administration, behavioral support plans, and any health changes. Caregivers, including parents, must also document supervision levels and any significant incidents that occur during care.

1. Does Regulation 8.7000 apply to parent providers caring for their children under Medicaid waivers?
   • Yes, parent providers, whether under waivers like the Children’s Extensive Support (CES) waiver, the Supported Living Services (SLS) waiver, or others, must adhere to the same standards, including certification and monitoring, as professional caregivers.

1. How will respite care providers be monitored for compliance under the new regulation?
   • Regular supervisory visits will be required to monitor respite care providers, including parent providers, to ensure compliance with care plans, medication administration protocols, and safety measures. The frequency of these visits will depend on the waiver and individual needs.

1. What changes will I see if my child has complex medical needs and requires regular medication during respite?
   • Caregivers will be required to undergo updated QMAP certification and maintain strict documentation of all medications administered, including dosage times, reactions, and any necessary follow-up. This applies to all caregivers, including those working under Medicaid waivers.

1. How does this regulation apply to parents who are caring for their children over the age of 18?
   • Parents caring for their children over 18 under Medicaid waivers must follow the same guidelines as other providers, including QMAP certification and compliance with all monitoring and supervisory requirements outlined in Regulation 8.7000.

1. How will the new rules ensure my child’s care is consistently monitored across different waiver programs?
   • The regulation requires consistent care standards, with regular supervisory visits, documentation, and oversight across all Medicaid waivers. Whether your child is under the CES, SLS, or other waiver programs, respite providers must adhere to the same high standards.

1. If I have a concern about medication administration or monitoring under the new regulation, who should I contact?
   • If you have concerns, please contact our compliance team or Family Support Partner (FSP). We are here to address any issues and ensure the care provided meets the strict standards set by Regulation 8.7000.

   Waivers and Services Affected by Colorado Regulation 8.7000 for Medication Administration

1. Children’s Extensive Support (CES) Waiver
   • The CES waiver provides services for children with developmental disabilities or delays who have significant medical or behavioral needs.
   • Under Regulation 8.7000, caregivers, including family or parent providers, must be QMAP certified to administer medications. Supervision and monitoring are critical to ensure proper administration and documentation. This includes oversight of emergency medications like rescue inhalers or EpiPens, which are common in the CES waiver population.
   • Medication errors must be promptly reported, and specialized protocols for children with complex needs must be followed.

1. Supported Living Services (SLS) Waiver
   • The SLS waiver supports adults with intellectual and developmental disabilities by providing services that allow them to live independently.
   • Regulation 8.7000 requires certified providers to administer medications, including prescription and over-the-counter drugs, for individuals on the SLS waiver. This includes ensuring that caregivers maintain accurate documentation of all medications, as well as supervising administration to ensure compliance with the client's care plan.
   • Parent providers caring for adult children under this waiver must meet the same standards for certification and oversight, ensuring the safety and well-being of their adult children.

1. Home and Community-Based Services (HCBS) Waiver
   • This waiver includes services that assist individuals with significant disabilities to live in their homes and communities, instead of institutional care.
   • For HCBS recipients, Regulation 8.7000 enforces strict standards on medication administration, requiring all caregivers to be QMAP certified. Caregivers must document each dose administered and follow care plans specific to the individual’s needs. Any delegation of medication tasks by an RN must follow state guidelines.
   • The regulation also emphasizes the importance of consistent oversight, with regular supervisory visits to monitor compliance with medication administration protocols for individuals receiving HCBS services.

1. Elderly, Blind, and Disabled (EBD) Waiver
   • The EBD waiver provides services for older adults and individuals with physical disabilities who need assistance with activities of daily living, including medication management.
   • Under Regulation 8.7000, caregivers in the EBD waiver must be certified to administer medications, including those with specialized requirements such as insulin or other injectables. Documentation is crucial to track the medication regimen, and any changes must be reflected in the care plan.
   • The regulation impacts how caregivers, including family members providing care, must document and manage medication administration for adults under this waiver.

1. Developmental Disabilities (DD) Waiver
   • The DD waiver provides comprehensive support for individuals with significant developmental disabilities, including residential services and respite care.
   • Regulation 8.7000 requires that all caregivers, whether in residential settings or providing in-home respite care, be QMAP certified to handle medications. The regulation ensures that individuals on the DD waiver receive consistent medication administration in line with their care plans, with supervisory oversight to ensure adherence to protocols.
   • Family or parent providers caring for adult children over 18 must meet the same certification and compliance standards as paid caregivers, maintaining rigorous documentation of all medications.

1. Children's Home and Community-Based Services (CHCBS) Waiver
   • The CHCBS waiver offers medical and non-medical services to children with disabilities to help them remain at home.
   • For this waiver, Regulation 8.7000 ensures that any caregiver administering medications, whether a parent or a professional, must be QMAP certified. It enforces careful oversight for the administration of medications for medically fragile children, with specific protocols to manage emergency medications and monitor for side effects.
   • Supervisory visits are mandated to ensure that caregivers follow the prescribed medication management plan and maintain accurate documentation.

   How the New Regulation Affects Each Waiver and Service:

• Consistent Standards Across Waivers: Regulation 8.7000 ensures uniform medication administration standards across all waivers, meaning that whether your child or family member is on CES, SLS, HCBS, EBD, DD, or CHCBS, caregivers must follow the same certification, documentation, and supervision requirements.
  
• Parent and Family Providers: Even if you are a parent provider caring for your child over the age of 18 or providing care through a waiver, you are subject to these medication administration requirements. QMAP certification is mandatory, and all documentation must be completed accurately.
  
• Regular Supervisory Visits: The regulation mandates regular supervisory visits for all respite and home care providers, including those under parent provider agreements. These visits will review medication administration records, care plan adherence, and overall care quality.
  
• Medication Management Plans: The regulation emphasizes the creation and upkeep of detailed medication management plans for all individuals, ensuring that caregivers across all waivers follow the same high standards for medication handling.

 https://sites.google.com/view/2022-mental-health-acceptance-/resources-and-trainings

 https://www.autismvisionco.org/post/transition-waivers-which-one-is-right-for-me?fbclid=IwAR3P0HE-7KlvEzZUw0qexs32T75fjY47dAJS0oLQabng53ObOsVksM0Nobo

Trying to understand and wade through waivers is confusing. This article will attempt to show the service differences between the transition waivers. We will be looking at the EBD waiver (Elderly, Blind, Disabled), the SLS waiver (Supported Living Services) and the DD waiver (Developmental Disability).

EBD waiver: The EBD waiver provides assistance to individuals who are 65 and older and have a functional impairment and individuals who are 18 and older who are physically disabled or require long-term supports and services in order to remain in a community setting.

SLS waiver: The SLS waiver provides necessary services and supports for individuals (18 and older) with intellectual or developmental disabilities so they can remain in their homes and communities.

DD waiver: The DD waiver provides access to 24/7 supervision/supports through Residential Habilitation and Day Habilitation Services. Living arrangements can range from host home to group home settings and residential supports for individuals who live with and/or are provided services by members of their family.

The SLS and DD waivers can be accessed through your local community centered board (CCB). The EBD waiver can be accessed through Single Entry Points (SEP) in your area.

Here is a basic chart comparing the services provided by each waiver:

I would also like to highlight a few of the service definitions that I am often asked about by people inquiring about the difference in the waivers.

SLS: Personal Care is assistance to enable a client to accomplish tasks that the client would complete without assistance if the client did not have a disability. This assistance may take the form of hands-on assistance by actually performing a task for the client or cueing to prompt the client to perform a task. 

EBD: Services which provide assistance to a client in their own home in order to meet the client's physical, maintenance and supportive needs. This assistance may take the form of hands-on assistance (actually performing a task for the person) or cueing to prompt the participant to perform a task. Personal care services do not require the supervision of a nurse or physician's orders.

SLS: Respite Care means services provided to an eligible client who is unable to care for themself on a short-term basis because of the absence or the need for relief of those persons normally providing care. Respite Care is provided in the client’s residence and may be provided by different levels of providers depending upon the needs of the client. 

EBD: Respite care services are provided to an eligible client on a short-term basis because of the absence or need for relief of those persons normally providing the care. Respite Care may be provided in a Class 1 nursing facility, an alternative care facility or by an employee of a certified personal care agency in the client's home. An individual client shall be authorized for no more than 30 days of respite in each calendar year.

SLS / DD: Day Habilitation Services and Supports include assistance with the acquisition, retention or improvement of self-help, socialization and adaptive skills that take place in a non-residential setting, separate from the client’s private residence or other residential living arrangement, except when services are necessary in the residence due to medical or safety needs. Day Habilitation Services and Supports encompass three (3) types of habilitative environments: 1) specialized habilitation services, 2) supported community connections, and 3) prevocational services.

EBD: Services furnished four or more hours per day in a community-based setting, encompassing both health and social services needed to ensure the optimal functioning of the participant.

SLS: Professional services are provided by licensed, certified, registered or accredited professionals and the intervention is related to an identified medical or behavioral need.

SLS: Homemaker Services are provided in the client’s home and are allowed when the client’s disability creates a higher volume of household tasks or requires that household tasks are performed with greater frequency. There are two types of Homemaker Services: Basic Homemaker Services includes cleaning, completing laundry, completing basic household care or maintenance within the client’s primary residence only in the areas where the client frequents. Enhanced Homemaker Services include Basic Homemaker Services with the addition of either procedures for habilitation or procedures to perform extraordinary cleaning. 

EBD: Homemaker Services are general household activities provided in the home of an eligible client, provided by a Homemaker Provider Agency to maintain a healthy and safe home environment for a client. When the person ordinarily responsible for these activities is absent or unable to manage these tasks. Covered benefits shall be for the benefit of the client and not for the benefit of other persons living in the home. Services shall be applied only to the permanent living space of the client.

SLS: The total cost of home accessibility adaptations, vehicle modifications, and assistive technology shall not exceed $10,000 over the five (5) year life of the HCBS Waiver except that on a case-by-case basis the Operating Agency may approve a higher amount.

EBD: There is a $10,000 lifetime maximum for the home modification benefit.

SLS/DD: Non-Medical Transportation enables clients to gain access to Day Habilitation Services and Supports, Prevocational Services and Supported Employment services.

EBD: Non-medical transportation services shall include, but not be limited to, transportation between the client's home and nonmedical services or resources such as adult day services, shopping, therapeutic swimming, dentist appointments, counseling sessions, and other services as required by the care plan to prevent institutionalization

SLS: Vehicle modifications are adaptations or alterations to an automobile or van that is the client’s primary means of transportation; to accommodate the special needs of the client; are necessary to enable the client to integrate more fully into the community; and to ensure the health and safety of the client.

SLS: Assistive Technology includes services, supports or devices that assist a client to increase maintain or improve functional capabilities. This may include assisting the client in the selection, acquisition, or use of an assistive technology device.

SLS: Mentorship Services means services provided by peers to promote self-advocacy and encourage community living among clients by instructing and advising on issues and topics related to community living, describing real-world experiences as example and modeling successful community living and problem-solving.

SLS/DD: Integrated employment services (supported employment) provides individuals with considerable ongoing job-related services and supports to obtain and maintain paid work in a regular community work setting.

SLS/DD: Prevocational services are designed to assist individuals with developmental disabilities in acquiring and maintaining work habits and work-related skills. Prevocational services are intended to have a more generalized result as opposed to vocational training for a specific job.

SLS/DD: Behavioral Services are services related to a client’s developmental disability which assist a client to acquire or maintain appropriate interactions with others.

SLS/DD: Dental Services means dental services that are inclusive of diagnostic, preventive, periodontal and prosthodontic services, as well as basic restorative and oral surgery procedures to restore the client to functional dental health and not available through the Medicaid State Plan. Vision Services means services that include eye exams and diagnosis, glasses, contacts, and other medically necessary methods to improve specific vision system problems when not available through the Medicaid State Plan.

SLS/DD: Specialized Medical Equipment and Supplies include: devices, controls, or appliances that are required due to the client’s disability and that enable the client to increase the client’s ability to perform activities of daily living or to safely remain in the home and community.

DD: Under Residential Habilitation Services and Supports (RHSS) the responsibility for the living environment rests with the service agency and encompass two types of living environments: Individual Residential Services and Supports (IRSS) and Group Residential Services and Supports (GRSS).

The following activities are performed by staff and are designed to assist individuals to reside as interdependently as possible in the community:

• Self-advocacy training may include training to assist in expressing personal preferences, self-representation, individual rights, and to make increasingly responsible choices.
• Independent living training may include personal care, household services, child and infant care (for parents themselves who are developmentally disabled), and communication skills such as the telephone.
• Cognitive services may include training involving money management and personal finances, planning and decision making.
• Implementation of recommended follow-up counseling, behavioral or other therapeutic interventions by residential staff, under the direction of a professional, that are aimed at increasing the overall effective functioning of an individual.
• Emergency assistance training includes developing responses in case of emergencies; prevention planning and training in the use of equipment or technologies used to access emergency response systems.
• Community access services that explore community services available to all people, natural supports available to the individual, and develop methods to access additional services/supports/activities desired by the individual
• Travel services may include providing, arranging, transporting, or accompanying a person with developmental Disabilities to services and supports identified in the Individualized Plan (plan of care).
• Supervision services may include a person safeguarding an individual with developmental disabilities and/or utilizing technology for the same purpose. 

IRSS can be provided through the Family Care Giver Option. This allows an individual to stay in their home and have a family member or non-related person become a paid provider to implement services.

EBD: In-Home Support Services (IHSS) is a participant-directed service option that enables participants to direct who is providing their care, as well as the type of care to be provided. IHSS enables consumers to decide which services to use, which workers to hire, and what time of day they will come.