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In-Home Respite Incidental Medical Services Training Protocol

Frequently Asked Questions

  1. What statute authorizes the in-home respite incidental medical services?
  2. How is "in-home respite worker" defined?
  3. Are agencies providing in-home respite incidental medical services vendored by DDS or regional centers?
  4. What is the process for vendorization by a regional center?
  5. Who has the authority to ascertain whether a consumer's condition is stable?
  6. Who is eligible to perform in-home respite incidental medical services?
  7. Do all in-home respite workers need to complete first aid and cardiopulmonary resuscitation (CPR) training?
  8. Are guidelines/criteria available to assist service providers in developing training to in-home respite workers in the provision of incidental medical services?
  9. Who is allowed to provide incidental medical services training?
  10. Who is responsible for developing the training curriculum to train in-home respite workers?
  11. Some service providers do not have a registered nurse on staff. Who pays for a registered nurse to provide training to staff?
  12. Who approves proposed in-home respite incidental medical services training curricula?
  13. What criteria are used to approve a training curriculum?
  14. Are service providers required to submit training curricula for all incidental medical services, even when they plan to provide only one or two incidental medical services?
  15. Where should service providers send their proposed training curricula?
  16. How does DDS communicate the denial or approval of a proposed training curriculum?
  17. The gastrostomy services training protocol includes the administration of medication through the gastrostomy tube. Does this mean that trained in-home respite workers are permitted to administer oral medications?
  18. Is there any reimbursement available to agencies to provide training to in-home respite workers?
  19. Is the fifty-cent ($.50) per hour wage increase and eight-cent ($.08) per hour benefit increase based on the actual rate or the 4.25 percent (4.25%) reduced rate?
  20. Does the $.58 go to the respite worker or the respite agency?
  21. How do service providers bill regional centers for the training session(s)?
  22. Are service providers allowed to bill the regional centers prior to providing in-home respite incidental medical services (as they may need to coordinate writing the plan, training staff, signing of the plan by a physician, etc)?
  23. A restricted health care plan for the provision of incidental medical services is required under California Code of Regulations (CCR) Title 22. Is a restricted health care plan required for the provision of in-home respite incidental medical services under Title 17?

1. What statute authorizes the in-home respite incidental medical services?

A. Assembly Bill (AB) 4th Extraordinary, Chapter 9, Statutes of 2009, made changes to Welfare and Institutions Code (WIC) Section 4686 of the Lanterman Developmental Disabilities Services Act.

This statute expands the incidental medical services that may be performed by an in-home respite worker, who is not a licensed health care professional and who is trained by a licensed health care professional to perform these services for consumers of regional centers with stable conditions. These incidental medical services are restricted to gastrostomy, colostomy/ileostomy, and urinary catheter care.

2. How is "in-home respite worker" defined?

A. The statute defines in-home respite worker as "an individual employed by an agency which is vendored by a regional center to provide in-home respite services. These agencies include, but are not limited to, in-home respite services agencies, home health agencies, or other agencies providing these services." (WIC Section 4686(k))

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3. Are agencies providing in-home respite incidental medical services vendored by DDS or regional centers?

A. DDS does not vendor service providers. Service providers, including agencies providing in-home respite services, are vendored by the regional center in the catchment area the service is located, known as the vendoring regional center. For additional information, please contact your local regional center.

4. What is the process for vendorization by a regional center?

A. The vendoring regional center is responsible for 1) ensuring that the applicant meets licensing and statutory or regulatory requirements for vendorization; 2) determining the appropriate vendor category for the service to be provided; and, 3) approving or disapproving vendorization based upon their review of the documentation submitted by the applicant.

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If you are interested in becoming a vendor, please contact your local regional center. For vendorization questions, please visit the Vendorization, FAQs.

5. Who has the authority to ascertain whether a consumer's condition is stable?

A. WIC Section 4686(f) states "The treating physician or surgeon shall give assurances to the regional center that the patient's condition is stable prior to the regional center's purchasing incidental medical services for the consumer through an appropriately trained respite worker."

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6. Who is eligible to perform in-home respite incidental medical services?

A. An in-home respite worker may perform these services. However, if the worker is not a licensed health care professional, he or she must be trained by a licensed health care professional in order to perform these services (WIC Section 4686(a)).

7. Do all in-home respite workers need to complete first aid and cardiopulmonary resuscitation (CPR) training?

A. Yes. WIC Section 4686(b) states "In order to be eligible to receive training for purposes of this section, an in-home respite worker shall submit to the trainer proof of successful completion of a first aid course and successful completion of a cardiopulmonary resuscitation course within the preceding year."

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8. Are guidelines/criteria available to assist service providers in developing training to in-home respite workers in the provision of incidental medical services?

A. Yes. Based on the criteria listed in WIC Section 4686(d), DDS has developed an In-Home Respite Incidental Medical Services Training Curriculum Review Protocol. The Review Protocol is a checklist intended to assist service providers planning to offer incidental medical services. The document has been mailed to all in-home respite agencies, regional centers, and home health agencies.

9. Who is allowed to provide incidental medical services training?

A. Only physicians or registered nurses are allowed to give the training. Training in gastrostomy services must be provided by physicians or registered nurses, or clinical staff in a gastroenterology or surgical center in an acute care hospital (WIC Section 4686(c)).

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10. Who is responsible for developing the training curriculum to train in-home respite workers?

A. WIC Section 4686(d) states "The in-home respite agency providing the training shall develop a training protocol which shall be submitted for approval to the State Department of Developmental Services."

11. Some service providers do not have a registered nurse on staff. Who pays for a registered nurse to provide training to staff?

A. There is no provision in the statute that requires the agency to have someone on staff to do the training. The agency that recruits a registered nurse to provide the training pays the registered nurse (WIC Section 4686(j)).

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12. Who approves proposed in-home respite incidental medical services training curricula?

A. DDS is responsible for approving training curriculums. WIC Section 4686(d) states "The in-home respite agency providing the training shall develop a training protocol which shall be submitted for approval to the State Department of Developmental Services."

13. What criteria are used to approve a training curriculum?

A. DDS uses the criteria listed in WIC Section 4686(d) and the In-Home Respite Incidental Medical Services Training Curriculum Review Protocol checklist to evaluate all training curriculums for approval.

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14. Are service providers required to submit training curricula for all incidental medical services, even when they plan to provide only one or two incidental medical services?

A. No. DDS acknowledges that not all service providers will propose to provide all incidental medical services. Therefore, the service providers planning to offer incidental medical services should submit training curriculum(s) for only the incidental medical service(s) that they plan to provide.

15. Where should service providers send their proposed training curricula?

A. Service providers who would like to provide in-home respite incidental medical services should send their proposals for DDS review/approval via email to JoEllen Fletcher or mail to:

Department of Developmental Services
1600 Ninth Street, Room 330, MS 3-8
Sacramento, CA 95814
Attn: Health Development Section

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16. How does DDS communicate the denial or approval of a proposed training curriculum?

A. DDS communicates the approval or denial of a proposed training curriculum via correspondence to the service provider.

17. The gastrostomy services training protocol includes the administration of medication through the gastrostomy tube. Does this mean that trained in-home respite workers are permitted to administer oral medications?

A. No. There is no provision in the statute that permits the administration of oral medications by trained in-home respite workers.

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18. Is there any reimbursement available to agencies to provide training to in-home respite workers?

A. Yes. WIC Section 4686(j) provides for $200 twice per year reimbursement for the training costs the agency incurs in providing the training to their in-home respite workers. The agency is reimbursed by the regional center.

19. Is the fifty-cent ($.50) per hour wage increase and eight-cent ($.08) per hour benefit increase based on the actual rate or the 4.25 percent (4.25%) reduced rate?

A. The fifty-cent ($.50) per hour wage increase and eight-cent ($.08) per hour benefit increase are based on the actual rate. However, the in-home respite rate in total is subject to WIC Section 4686(i) which states "The hourly rate for an in-home respite agency shall be increased to provide a fifty-cent ($.50) per hour wage increase and an eight-cent ($.08) per hour benefit increase for the hours the in-home respite agency is providing incidental medical services."

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20. Does the $.58 go to the respite worker or the respite agency?

A. WIC Section 4686(i) states, "The hourly rate for an in-home respite agency shall be increased to provide a fifty-cent ($.50) per hour wage increase and an eight-cent ($.08) per hour benefit increase for the hours the in-home agency is providing incidental medical services."

21. How do service providers bill regional centers for the training session(s)?

A. DDS has informed the regional centers of the new sub-codes for in-home respite incidental medical services training and the provision of these training services. Please discuss further billing questions with your regional center.

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22. Are service providers allowed to bill the regional centers prior to providing in-home respite incidental medical services (as they may need to coordinate writing the plan, training staff, signing of the plan by a physician, etc)?

A. No. All services must be completed before the service provider is allowed to bill the regional centers?

23. A restricted health care plan for the provision of incidental medical services is required under California Code of Regulations (CCR) Title 22. Is a restricted health care plan required for the provision of in-home respite incidental medical services under Title 17?

A. No. CCR Title 22 governs community care licensed facilities. By definition, in-home respite services are provided in the family home, not in licensed residential facilities. All applicable Title 17 regulations regarding in-home respite service agencies continue to apply, in addition to the new provisions in WIC Section 4686.

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Last Updated: 4/14/2011