DDS Manual

MANUAL

I. SERVICE DELIVERY

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TABLE OF CONTENTS

I. SERVICE DELIVERY................................................Issue/Revision date Current DDS Directives Directive No. 18-1 Manager-on-Call System Issued: February 15, 2018 Directive No. 18-1 Attachment A Public Sector Incident Reporting After Normal Business Hours Directive No. 18-1 Attachment B Private Sector Incident Reporting After Normal Business Hours
I.A. Eligibility and Intake
I.A. Policies
	PO.001 Eligibility for DDS Services (replaces DDS Policy #9 Eligibility for Services)		March 31, 2005
	PO.002 Re-Evaluation of Eligibility for DDS Services		March 31, 2005
I.A. Procedures
	PR.001 Eligibility for DDS Services (replaces DDS Policy #9 Eligibility for Services)		Revised January 27, 2006
	PR.002 Re-Evaluation of Eligibility for DDS Services		Revised January 27, 2006
I.A. Directives/Advisories

I.B. Planning and Resource Allocation For procedures related to the portability of funds, refer to Part II section C, Contracted Services
I.B.1. Planning and Allocation
I.B.1. Policies
I.B.1.Procedures
I.B.1.PR.001	Administration of Requests for Day and Residential Supports and Services		Revised October 15, 2007 Interim Revision: July 23, 2015
	Attachment A	Priority Checklist for People at Home or Living in a CTH	August 31, 2007
	Attachment B	PRAT Request for Service/Support Form
	Attachment C	Level of Need Assessment and Screening Tool	July 1, 2006
	Attachment D	PRAT Referral Consent Form
I.B.1.PR.002	Resource Planning for Students completing Educational Services		March 28, 2007 Interim Revision: July 23, 2015
I.B.1 Directives/Advisories

I.B.2. Waiver Management
I.B.2 Policies
I.B.2 Procedures
I.B.2.PR.001	Application for New or Additional Services/Supports and Enrollment Procedures for the MR HCBS Waiver Working Draft		Revised July 1, 2005
	Attachments:
1. DMR Forms 219, 222, 223, 224, 225, and 296
2. DSS Form W-1518
3. Notification of Enrollment in the DMR HCBS Waiver
4. Notification of Denial of HCBS Application or Services
5. Connecticut HCBS Waiver Fact Sheet
I.B.2.PR.002	Coordination of Waiver Enrollment Activities for Individuals Receiving State Funded Services		Revised July 20, 2004
	Attachments - (See Waiver Manual)
1. DMR Forms 219, 222, 223, 224, 225,
2. DSS Form W-1518
3. Notification of Enrollment in the DMR HCBS Waiver
4. Notification of Denial of HCBS Application or Services
5. Connecticut HCBS Waiver Fact Sheet
I.B.2.PR.003	Enrollment and Eligibility Maintenance for the DMR Comprehensive HCBS Waiver		September 9, 2004
	Attachments - (See Waiver Manual)
1. DMR HCBS Waiver Enrollment Packet Forms:
DMR 219:HCBS ICF/MR Level of Need
DMR 222: HCBS Service Selection
DMR 223: Revised 4/5/04: Home and Community Based Services Notification of Waiver Programs
DMR 224: Reasons for Declining to Submit Medicaid and /or DMR HCBS Waiver Applications
DMR 225: PRAT HCBS Waiver Recommendation
DMR 296: HCBS Waiver Services for People Living with Their Family (as necessary)
DSS Form 1518
2. Notification of Enrollment in the DMR HCBS Waiver
3. Notification of Denial of HCBS Application or Services
4. Notification of Change of Eligibility Status Causing Discharge from the HCBS Waiver
5. Notification of Denial of Request for Additional Waiver Services
6. DSS - Request for Administrative Hearing HCBS Waiver for Persons with Mental Retardation
7. DMR Connecticut HCBS Waiver Fact Sheet
I.B.2.PR.004	Waiver Compliance Review		September 9, 2004
	Attachment - (See Waiver Manual)
Home and Community Based Services Waiver Compliance Review
I.B.2. Directives /Advisories
DIR.001	Maximizing Enrollment in DMR HCBS Waiver(s) for Individuals Receiving or Seeking DMR Services and Supports		February 6, 2004

I.C. Services and Supports
I.C. Policies
PO.001	Utilization and Resource Review Originally issued as Intensive Staffing Review		Revised July 5, 2007
I.C. Procedures
PR.001	Utilization and Resource ReviewOriginally issued as PR.001a-Intensive Staffing Review Committee-Statewide		Revised July 5, 2007
	Attachment A	DMR Utilization Staffing Request Form
	Attachment B	Regional Utilization Resource Review Form

PR.001.b	Intensive Staffing Review Committee – Regional		Rescinded July 5, 2007
PR.002	Community Based Housing Subsidy Program		Revised September 30, 2009
	Attachment A-C	Community-Based Housing Subsidy Program Application
	Attachment D	Rent Subsidy Property Inspection
I.C. Directives/Advisories

1. Case Management/Broker Services
Case Management Definitions		July 30, 2003
Reference guide to Case Management and Related Policies and Procedures		July 30, 2003
I.C.1. Policies
PO.001	Case Management (replaces DMR Policy #8, Case Management)		July 30, 2003
PO.002	Individual Planning(replaces DMR Policy #11 – Overall Plan of Service)		Revised September 1, 2008
PO.003	Master File/Individual Record		Revised November 30, 2008
PO.004	Regional Responsibility for Service Delivery		Revised November 30, 2008
PO.005	Discontinuance of Services(replaces DMR Policy #12 – Discharge)		July 30, 2003
PO.006	STS: Professional Judgment/Most Integrated Setting		September 11, 2013
	For policy related to Transfers see below I.F.PO.002 Transfer
I.C.1. Procedures
PR.001.a	Intake and Initial Visit		Revised November 30, 2008
PR.001.b	Service Coordination		Revised November 30, 2008
PR.001.c	Frequency of Case Management Contact		Revised November 30, 2008
	Attachment A	Guidelines for Case Manager Out-of_State Visits
PR.001.d	Automated Data System Maintenance		Revised November 30, 2008
PR.001.e	Targeted Case Management		Revised November 14, 2016
PR.001.f	Case Transfer Procedures		November 30, 2008
	Attachment A	Case Transfer Request Form (DOC) Case Transfer Request Form (PDF)
	Attachment B	Transition Planning Checklist (DOC) Transition Planning Checklist (PDF)
	Attachment C	Individual Transition Plan (DOC) Individual Transition Plan (PDF)
PR.001.g	Case Management Quality Service Review Procedure		November 30, 2008
PR.002.a	Components of an Individual Plan		Rev. September 1, 2008
	Attachment A	Individual Plan (DOCX)
	Attachment B	Individual Plan Short Form (DOC) Individual Plan Short Form (PDF)
	Attachment C	IP Addendum: Aquatic Activity Screening (DOC) IP Addendum: Aquatic Activity Screening (PDF)
	Attachment D	Individual Progress Review (DOC) Individual Progress Review (PDF)
	Attachment E	IP. 13 Documentation of Professional Judgment/Most Integrated Setting (DOC) IP. 13 Documentation of Professional Judgment/Most Integrated Setting (PDF)
PR.002.b	Planning and Support Team		Rev. September 1, 2008
PR.003	Master File/Individual Record		Revised November 30, 2008
PR.004	Regional Responsibility for Service Delivery		Revised November 30, 2008
PR.005	Discontinuance of Services		July 30, 2003
	For procedure related to Transfers see below I.F.PO.002Pr.001 Transfer Procedure
I.C.1. Directives/Advisories

2. Individual Support
I.C.2. Policies
I.C.2. Procedures
PR.001	Orientation		January 11, 2002
PR.002	Resource Allocation for Individual Supports		Rescinded April 4, 2007
PR.003	Support Broker Assignment		Revised November 29, 2007
PR.004	Fiscal Intermediary Selection by Individuals and Families		Rev. January 26, 2006
PR.005	Individual Support Planning		Rescinded April 4, 2007
PR.006	Individual Budget		Rev. January 26, 2006
PR.007	Individual Support Agreement Authorization Process		Rev. May 1, 2009
	Attachment A:	Self-Directed Support Agreement

	Attachment B:	IP 6 Individual Budget Review Guidelines
PR.008	Individual Support Agreement Fiscal Management		Rev. June 1, 2009
	Attachment A:	Fiscal Intermediary Selection Form
	Attachment B:	Individual Budget Termination Form
	Attachment C:	Fiscal Intermediary Monthly Selection Prototype (.XLS)
PR.009	Individual Support Prior Approval Process		Revised January 1, 2011
	Attachment A	Individual Support Cost Standards and Quick Guide
	Attachment B	Individual Support Prior Approval Form
	Attachment C	DDS Environmental Modification Checklist
	Attachment D	Prior Approval for Hiring Family Members Form See I.C.2.PR.014 Family Hires	Rescinded

PR.010	Request for Proposals for Fiscal Intermediaries		Revised January 26, 2006
PR.011	Fiscal Intermediary Contracting Process		Revised January 26, 2006
PR.012	Fiscal Intermediary Contracting Management		Revised August 10, 2010
	Attachment A:	Monthly Fiscal Intermediary Cast Adjustment Form
PR.013	Criminal History Background Verification of Applicants for Employment in Self-Directed Supports		Revised July 1, 2023
	I.C.2.PR.013 Attachment A: Employer of Record (EOR) Acknowledgement and Release of Liability Template
PR.014	Family Hires		Effective July 1, 2013
	Attachment A: Case Management Guidelines for Monitoring Family Member, Relative or Significant Other Direct-Hires (DOC) Attachment B: DDS Family Hire Review Form (DOC) Attachment C: Self-Directed Support Agreement (DOCX)
Section Definitions
Individual Supports Definitions		January 11, 2002
I.C.2. Directives/Advisories

3. Family Supports
I.C.3. Policies
PO 001	Respite Centers		April 24, 2007
I.C.3. Procedures
PR 001a	Respite Center Eligibility and Referrals		April 24, 2007
PR 001b	Respite Center Pre-admission		April 24, 2007
PR 001c	Respite Center Admission, Visitation and Discharge		Revised May 18, 2007
PR 001d	Respite Center Operations and Oversight		April 24, 2007
	Attachment A	Family Respite Center Packet
PR.002	Individual and Family Grants		Revised November 1, 2019
I.C.3.PR.002 Attachment D - Individual and Family Grant Provider Payment Log
I.C.3.PR.002 Attachment E - Individual and Family Grant Request & Need Checklist

I.C.3. Directives/Advisories Reserved for future use

4. Children's Services
I.C.4. Policies
PO.001	Birth to Three		November 5, 2010
PO.002	Early Connections		September 13, 2010

Please see the Office of Early Childhood for policies and procedures related to the Birth-to-Three Program I.C.4. Children's Services Procedures
PR.001	Voluntary Services Program Transfer from DCF to DDS		June 1, 2011
Attachment B DDS BSP Family Handbook

PR.002	Out of Home Treatment/Placement Requests		April 4, 2007 Under Review 2015
I.C.4.PR.003 Reserved for Future Use I.C.4.PR.004 DDS Behavioral Services Program (DDS BSP) April 1, 2017 I.C.4.PR.004 Attachment A Eligibility Criteria for DDS Behavioral Services Program I.C.4.PR.004 Attachment B DDS BSP Application I.C.4.PR.004 Attachment C DDS BSP Parent or Guardian Agreement I.C.4.PR.004 Attachment D DDS BSP Family Handbook

5. Employment and Day Supports

I.C.5. Employment and Day Supports Policies
I.C.5.PO.001	Employment First Initiative		April 13, 2011
I.C.5 Employment and Day Support Procedures
I.C.5.PR.001	Employment First Initiative		April 13, 2011
I.C.5 Employment and Day Supports Directives Reserved for future use
6. Living Arrangements

7. Forensic Services

I.D. Quality Enhancement
I.D. Quality Enhancement Policies
PO.001	Mortality Reporting & Review(Replaces DMR Policy #30 Mortality Review)		March 15, 2002
PO.002	Root Cause Analysis		Revised June 23, 2011
I.D. Quality Enhancement Procedures
PR.001	Mortality Reporting Deaths of Individuals		March 15, 2002
	Attachment A - Client Death DMR Responsibility
	Attachment B - Death Reporting FORM
PR.002	Sudden Death		Revised March 15, 2002
	Attachment A- Immediate Safety Assessment & Monitoring Form
	Attachment B - Div of Investigations- Sudden -Unexpected Death Admin. Review Form
	Attachment C - Client Death DMR Responsibility Checklist
PR.003	Reporting Death to Chief Medical Examiner		Revised March 15, 2002
	Attachment A - Telephone Report to the Office of the Chief Medical Examiner of Death of DMR Client
PR.004	Autopsies		Revised March 15, 2002
PR.005	Mortality Review		Revised July 12, 2004
	Attachment A:	Mortality Review Form
	Attachment B:	Local Mortality Review Board Form
PR.007	Community Living Arrangement Licensing Inspections (Policy Under Revision)		March 5, 2003
PR.008	Community Training Home Licensing (Policy Under Revision)		March 31, 2005
	Attachment A: CTH Initial Licensure Checklist (Policy Under Revision)
	Attachment B: Request for CTH Licensure Memo (Policy Under Revision)
	Attachment C: Summary Application for Renewal (Policy Under Revision)
	Attachment D: Police Check (Policy Under Revision)
PR.009	Incident Reporting		Revised December 30, 2014
	Attachment A:	DDS Incident Report Form 255 (DOC) DDS Incident Report Form 255 (PDF)
	Attachment B:	DDS Incident Reporting: Instructions for Completing DDS Form 255
	Attachment C:	DDS Incident Report Form 255 Definitions
	Attachment D:	DDS Restraint Log
	Attachment E:	DDS Medication Error Report Form 255m
	Attachment F:	DDS Incident Reporting: Medication Errors Form 255m Instructions and Definitions
	Attachment G:	DDS Incident Report Follow-up Form (DOC) DDS Incident Report Follow-up Form (PDF)
	Attachment H:	DDS Guidelines for Reporting Incidents to Families or Legal Guardians
	Attachment I:	DDS Minor Injury/Communication Log
	Attachment J:	DDS Approved Training Curriculum for Use of Aversive and Physical Restraint Procedures
	Attachment K:	DDS Approved Restrictive Apparati
	Attachment L:	DDS Missing Person Form and Instructions
PR.009a	Incident Reporting for Individuals who live in Own /Family Home & Receive DMR Funded Services		March 13, 2006
	Attachment A: DDS Incident Report form 255OH/Fam
	Attachment B: Definitions form 255OH/Fam
	Attachment C: Instructions for completing report form 255OH/Fam
	Attachment D: Restraint Log OH/Fam
	Attachment E: Instructions for Completing Restraint Log
	Attachment F: DMR Missing Person form
	Attachment G: DMR Missing Person form Instructions
	Attachment H: DMR Incident Report Follow-up Form
PR.010	Missing Person Reporting Topic covered in PR.009 and PR.009a		Rescinded March 9, 2006
PR.011	Use of Video and Audio Technology		November 19, 2018
	I.F.PO.006 Attachment B Request for Human Rights Committee Review Form
PR.012	Root Cause Analysis		Revised June 23, 2011
	Attachment A -	Root Cause Analysis Report Form
PR.013	Risk Management Individual Safety Screening		June 7, 2002
PR.014	Medication Administration Sanctions Process for Certified Non-licensed Personnel		November 8, 2010
PR.014	Attachment A - Public Sector Sanctions for Certified Non-licensed Staff
PR.014	Attachment B - Medication Administration Error Tracking Form
PR.014	Attachment C - Class A Retraining Record
PR.014	Attachment D - Class B Retraining Record
PR.014	Attachment E - Class C Retraining Record
PR.014	Attachment F - Medication Administration Sanction Notification
PR.014	Attachment G - Request for Medication Certification Sanction by Commissioner
PR.014	Attachment H - Acknowledgement of Medication Sanctions for Certified Non-licensed Staff concerning Delegation Suspension
I.D.PR.015	Medication Administration Sanctions Process for Licensed Nurses		November 8, 2010
PR.015	Attachment A: Medication Administration Sanctions for Licensed Nurses
PR.015	Attachment B: Licensed Nurse Medication Administration Error/Prohibited Practice Tracking Form
PR.015	Attachment C: Class A Retraining Record
PR.015	Attachment D: Class B Retraining Record
PR.015	Attachment E: Class C Retraining Record
PR.015	Attachment F: Medication Administration Sanction Notification Form
PR.015	Attachment G: Acknowledgement of Medication Sanctions for Licensed Nurses regarding Medication Administration in DDS Facilities
I.D. Directives/Advisories

I.E. Health and Safety
I.E. Health and Safety Policies
PO.005	Pre-Admission Screening for Persons Applying for Nursing Home Admission (OBRA) See Health Standard No. 22-1 Preadmission Screening for Persons Applying for Nursing Facility Admission (OBRA)		Revised June 28, 2010 Rescinded March 31, 2022
PO.007	End of Life Decisions		May 26, 2004
I.E. Health and Safety Procedures
PR.002	Bed & Side Rail Safety, Assessments and Audits		Effective: August 1, 2023
	I.E.PR.002 Attachment A Individual Bed & Side Rail Assessment
	I.E.PR.002 Attachment B Bed & Side Rail Safety Audit
	I.E.PR.002 Attachment C Bed & Side Rail Safety Checklist
PR.003	Positive Behavior Support Program and Behavior Support Plans		Revised February 1, 2018
	I.E.PR004Attachment A: Request for PRC Date to Review Behavior Modifying Medication or Aversive or Procedures I.E.PR004 Attachment C: PRC Consent for Treatment I.E.PR004 Attachment F: PRC Medication Prescriber's Treatment Plan (Optional Form, used only if prescriber does not have his or her own Treatment Plan form)



PR.004	Program Review Committees Revised August 1, 2022
	Attachment A: Request for PRC Date to Review Behavior Modifying Medication or Aversive or Procedures Attachment B: PRC Face Sheet

	Attachment C: PRC Consent for Treatment

	Attachment D: ICF/IID Request for PRC Interim Approval

	Attachment E: Request for Exemption from the PRC Review Process
	Attachment F: PRC Medication Prescriber's Treatment Plan (Optional Form, used only if prescriber does not have his or her own Treatment Plan form)
	Attachment G:DDS Memo Concerning OPA Recommendations for Self-Injurious Behavior
PR.005	Pre-Admission Screening for Persons Applying for Nursing Home Admission (OBRA) See Health Standard No. 22-1 Preadmission Screening for Persons Applying for Nursing Facility Admission (OBRA)		Revised June 28, 2010 Rescinded March 21, 2022
	Attachment A:	OBRA Preadmission Screening Level II
	Attachment B:	Preadmission Screening Determination Notification
	Attachment C:	DDS Contact Sheet
	Attachment D:	Advanced Directive Client Status with DDS
	Attachment E:	Placement Request for OBRA Participant

PR.006	Pre-sedation of Medical/Dental Procedures(Originally issued as PR.008)		Revised July 1, 2009
	Attachment A:	PRC/HRC Review of Pre-Secation for Medical/Dental Care (PDF) or (DOC)
	Attachment B:	Considerations for Pre-sedation for Medical/Dental Care (PDF) or (DOC)
	Attachment C:	Consent for Treatment Form (PDF) or (DOC)
	Attachment D:	Use of Pre-Medication for Medical/Dental Care Tracking (PDF) or (DOC)
PR.007.a	Advance Directives (Living Wills)		May 26, 2004
PR.007.b	Withdrawing or Withholding Medical Treatment		May 26, 2004
PR.007.c	Withholding Cardiopulmonary Resuscitation		Revised September 14, 2010
	Attachment A:	Review of Do Not Resuscitate (DNR) Orders
	Attachment B:	Guidelines for Periodic Reviews of DNR Orders
	Attachment C:	DNR Renewal Form
	Attachment D:	DNR Advanced Directives Status Form
PR.008	RN On Call System		February 28, 2005
	Attachment A:	RN On Call Equipment List
	Attachment B:	RN On Call Documentation Form
	Attachment C:	On Call Log of Non-individual Related Calls
	Attachment D	On Call Time Log
I.E. Directives/Advisories
DIR.001	Prohibited Use of Prone Restraints		Revised January 1, 2009

I.F. Human Rights and Legal Responsibilities
I.F. Policies:

I.F.PO.004 I.F.P.O.005	Interpreter/Translation Services Healthy Relationships		Effective April 8, 2005 Effective June 12, 2014
	I.F. PO. 005 Attachment A: Healthy Relationships Guidelines I.F. PO.005 Attachment B: Rights of persons under supervision of Commissioner of DDS
I.F.PO.006	Human Rights Committee(replaces DMR Policy #6 - Human Rights Committee)		Revised July 1, 2009

I.F. Procedures:

I.F.PR.001	Abuse and Neglect/Allegations: Reporting		Revised June 30, 2021
I.F.PR.002	Abuse and Neglect/Allegations: Intake and Initial Notification Process		Revised June 30, 2021
I.F.PR.003	Abuse and Neglect/Investigations: Assignment, Tracking, Review and Closure		Revised June 30, 2021
I.F.PR.004	Abuse and Neglect/Investigations: Recommendations, Protective Services and Prevention Activities		Revised June 30,2021
I.F.PR.005	Abuse and Neglect/Investigations: Access to Completed Investigations		Revised June 30, 2021
I.F.PR.006a	Abuse and Neglect/DDS Abuse and Neglect Registry		Revised June 30, 2021
I.F.PR.007a	Abuse and Neglect/Access to the DSS Abuse and Neglect Registry		Revised June 30, 2021
I.F.PR.001 to I.F.PR.007a	Abuse and Neglect Attachments:
I.F.PR.001 to I.F.PR.005	Attachment A: DDS A & N Policy and Procedure - Definitions and Examples
I.F.PR.006a to I.F.PR.007a	Attachment L: DDS A & N Registry Policy and Procedure - Definitions and Examples

I.F.PO.001	Abuse and Neglect Attachments:

I.F.PO.001	Attachment A	DDS and OPA Interagency Agreement

I.F.PO.001	Attachment B	DDS Investigation Report

I.F.PO.001	Attachment C	DDS Abuse/Neglect Investigation Review Form

I.F.PO.001	Attachment D	DDS Abuse/Neglect Registry: Monitoring Printable Form

I.F.PO.001	Attachment E	DDS Abuse/Neglect Registry: Monitoring Template Format

I.F.PO.001	Attachment F	Notification of Termination or Separation for Registry Purposes Printable Form


I.F.PO.001	Attachment H	DDS Intake Printable Form
I.F.PO.001	Attachment I	DDS Intake Template Format

I.F.PO.001	Attachment J	DDS False Claims Act/Misuse of State Funds Report Form

I.F.PO.001	Attachment K	OPA Sample Intake Referral
I.F.PO.001	Attachment L	OPA Sample M-5
I.F.PO.001	Attachment M	DDS and OPA Frequent Reporting Protocol









I.F.PO.004	Interpreter/Translation Procedures:

I.F.PR.008	Interpreter/Translation Services		Revised August 14, 2009
I.F.PO.006	Human Rights Committees Procedures:
I.F.PR.006	Regional Human Rights Committee		Revised July 1, 2009
I.F.PO.006	Human Rights Committee Attachments:
I.F.PO.006	Attachment A	Guidelines to Prepare for Human Rights Committee Presentation

I.F.PO.006	Attachment B	Request for Human Rights Committee Review Form

I.F.PO.006	Attachment C	Consent for Treatment Form

I.F.PO.006	Attachment D	Human Rights Committee Flow Chart

I.F.PO.006	Attachment E	Human Rights Committee Face Sheet

I.F.PO.006	Attachment F	Respite Center Letter

I.F.PO.006	Attachment G	Choosing PRC or HRC Review

I.F.PR.007	Personal Funds Financial Management Procedures:

I.F.PR.007	Personal Funds Financial Management		Effective January 26, 2007

I.F.PR.007	Personal Funds financial Management Attachments:
Attachment A - Financial Management Agreement
Attachment B - Funds Withdrawal Request (xls)
Attachment C - Personal Funds Tracking Report (xls)
Attachment D - Monthly Report of Client Funds (xls)
Attachment E - Personal Funds Daily Cash Count Log (xls)
Attachment F - In-House Cash Reimbursement Request (xls)
Attachment G - Personal Funds Tracking Voucher (xls)
Attachment H - CO 853
Attachment I - Daily Collection Report (xls)
Attachment J - Acceptable Client Purchases
Attachment K - Request for Additional Funding from DAS
Attachment L - Notification of Client Admin/Discharge/Transfer/Death Form
Attachment M - Probate Application PC212

I.F.PR.009 DDS ADA Grievance Procedure: I.F.PR.009 DDS ADA Grievance Procedure Effective: July 1, 2017 I.F.PR.009 Attachment A DDS Grievance Procedure Under the ADA I.F.PR.009 Attachment B DDS Notice Under the ADA
I.F.PR.010 Respectful and Person-First Language Procedure: I.F.PR.010 Respectful and Person-First Language Revised: December 7, 2017 I.F. PR.010 Attachment A DDS Self Advocate Coordinator's Disability Awareness/People First Language Pledge
I.F.PR.011 Programmatic Administrative Reviews (PAR) Procedure: I.F.PR.11 Programmatic Administrative Reviews (PAR) Revised November 15, 2019 (Formerly DMR Policy #7)
I.F.PR.012 Prevention and Reporting of Fraud, Waste and Abuse
I.F.PR.012 Prevention and Reporting of Fraud, Waste and Abuse Revised: April 1, 2023 (Formerly II.A.PR.002 False Claims Act)
I.F.PR.012 Attachment A Fraud Information

I.F.PR.013 Residential Transfers
I.F.PR.013 Residential Transfers Revised: July 1, 2023 (Formerly I.F.PO.002 PR.001 Transfer)
I.F.PR.013 Attachment A Sample Notice of Intent to Transfer
I.F.PR.013 Attachment B Sample Notice of Emergency Transfer
I.F.PR.013 Attachment C Sample Objection to Transfer
I.F.PR.013 Attachment D Residential Transfers Fact Sheet

I.F. Human Rights and Legal Responsibilities Directives/Advisories
I.F.Adv. 001	The use of Client Personal Funds for Transportation to & from or while at a DMR funded Day Program		Revised February 14, 2005
I.F.Adv.003	The Use of Clients’ Personal Funds for Donations to Their Support Provider		Effective February 14, 2005
I.F.DR.004	Use of Consumer Funds to Procure Prescription and Non-Prescription Medications, and Outpatient Services		Revised July 19, 2010

I.G. Qualified Providers
I.G. Qualified Providers Policies
I.G.PO.001	Portability of Funds		Effective February 1, 2011
I.G.PO.002	Private Agency Vacating Licensed Residential Facilities		Effective March 1, 2002
I.G. Qualified Providers Procedures
I.G.PR.001	Portability of Funds		Revised February 1, 2011
I.G.PR.001	Attachment A: Personal Control of Resources Checklist (DOC)
I.G.PR.002	Private Agency Vacating Licensed Residential Facilities		Revised October 28, 2003
I.G.PR.003	Enhanced Monitoring		Effective August 1, 2008
I.G.PR.004	RFP Process for Selecting Qualified Providers for Participant Supports		Effective August 1, 2011
I.G.PR.004	Attachment A: DDS Standard Evanulation(DOCX)
I.G.PR.005	One-time Funding Service Authorizations(DOCX)		Revised May 21, 2014
I.G.PR.005	Attachment A Request for One-Time Non-Annualized Funds(DOCX)
I.G.PR.005	Attachment B Supplemental Information for One-Time Requests(XLS)
I.G.PR.005	Attachment C CLA/CRS Transitional One-Time Invoice(DOCX)
I.G.PR.006	Purchase of Service Contract Procurement		Revised April 16, 2009
I.G.PR.007	Qualifying Providers		Effective October 1, 2012
	I.G.PR.007 Attachment A Application for Qualified Providers
	I.G.PR.007 Attachment B Agency Assurance Agreeement
	I.G.PR.007 Attachment C Clinical Behavioral Support Services Assurance Agreement
	I.G.PR.007 Attachment D Healthcare Coordination Assurance Agreement
	I.G.PR.007 Attachment E Confidentiality and HIPAA Assurance Agreement
	I.G.PR.007 Attachment F DSS Provider Agreement
	I.G.PR.007 Attachment G Acknowledgement of Receipt of DDS False Claims Act Policy and Procedure
	I.G.PR.007 Attachment H Criminal Background Verification Certificate for a Change in Principal of the Entity, Connecticut Administrator, Partnership or LLC
	I.G.PR.007 Attachment I Supports and Services Policy and Procedure Guide
	I.G.PR.007 Attachment J Provider Minimum Qualifications for Support Categories
I.G.PR.008	Personal Funds Financial Management - Qualified Providers		Revised: August 1, 2018
	I.G.PR.008 Attachment A Cash-on-Hand Ledger (Sample) I.G.PR008 Attachment B Personal Possessions Inventory (Sample)
I.G.PR.009	Independent Contractor or Consultant Ethics Compliance Protocol		Revised: November 14, 2016
	I.G.PR.009 Attachment A Hiring of a Relative by an Independent Contractor or Consultant Check List
	I.G.PR.009 Attachment B Approval of Staff Expense Payments for Accompanying an Individual to an Activity or Event Check List
	I.G.PR.009 Attachment C Related Party Transactions Check List
I.G.P.R.010	Qualified Provider State Criminal Background Checks for Purposes of Employment		Effective: March 1, 2020


I.H. Health Standards
I.H. Health Standards Health Standard No. 22-1 Preadmission Screening for Persons Applying for Nursing Facility Admission (OBRA) Revised: March 31,2022 Replaces I.E.PO.005 and I.E.PR.005 Preadmission Screening for Persons Applying for Nursing Home Admission (OBRA) HS No. 22-1 Attachment A OBRA Preadmission Screening Report Level II Summary HS No. 22-1 Attachment B Preadmission Screening Determination Notification HS No. 22-1 Attachment C DDS Contact Sheet HS No. 22-1 Attachment D SNF Code Status Change Form HS No. 22-1 Attachment E Placement Notification for OBRA Form Health Standard No. 21-2 Medication Administration Certification Guidelines for Developmental Services Supported Living Workers Within the Individual Family Supports Division Effective: October 1, 2021 Health Standard No. 21-2 Attachment A Quarterly Medication Administration Audit Form and Instructions Health Standard No. 21-1 Osteoporosis Guidelines for Individuals Receiving DDS Supports Effective: July 28, 2021 Health Standard No. 21-1 Attachment A Osteoporosis Information Sheet Health Standard No. 19-1 Consent Required for Medical or Dental Procedures including Emergency Surgery Effective: July 1, 2019 Health Standard No. 18-1 Homeopathic Remedies, Herbal Products, and Supplemental Products or Treatments Effective: November 19, 2018 Health Standard No. 17-1 Water Safety Effective: December 1, 2017 (Replaces I.E.PO.001 & I.E.PR.001 Water Safety) HS No. 17-1 Attachment A Aquatic Activity Screening Form Health Standard No. 16-2 Safe Eating and Drinking Guidelines for Individuals with Swallowing Difficulties (Dysphagia) Revised: December 1, 2016 HS No. 16-2 Attachment A Swallowing Episode Report Form (SERF) and Instructions HS No. 16-2 Attachment B Bedside Swallow Evaluation HS No. 16-2 Attachment C Aspiration Precautions Sample Protocol HS No. 16-2 Attachment D Reflux Precautions Sample Protocol HS No. 16-2 Attachment E Guidelines for Consistency Modifications of Food and Liquids HS No. 16-2 Attachment F Site Meal Observation Documentation Form HS No. 16-2 Attachment G Individual Meal Observation Documentation Form Health Standard No. 16-1 Healthcare and Nursing Services for Individuals Receiving DDS Individualized Home Supports (IHS) Health Standard No. 14-1 Interpretive Guidelines for the DDS Regulations Concerning the Administration of Medication by Certified Unlicensed Personnel Health Standard No. 09-2 Guidelines for Deferred, Limited, or Declined Healthcare HS 09-2 Attachment A Deferred Limited and Declined Care Progress Note HS 09-2 Attachment B Deferred Limited and Declined Care Review Form Health Standard No. 09-1 Routine Preventative Health Care HS 09-1 Attachment A Attachment A - Minimum Preventative Care Guidelines for Persons with Intellectual/Developmental Disabilities HS 09-1 Attachment B Attachment B - Health Problem and Health History List HS 09-1 Attachment C Attachment C - Family Health History Form Health Standard No. 2000-1 Infection Control Health Standard No. 98-6 Guidelines for Neurological Care of DDS Clients with Epilepsy Health Standard No. 98-3 Practical Guidelines for Care of Persons with Down Syndrome and Dementia Health Standard No. 98-2 Guidelines for Management of Clients with Vancomycin Resistant Enterococci in DDS Operated or Funded Facilities or Programs Health Standard No. 98-1 Guidelines for Management of Individuals with Methicillin- Resistant Staphylococcus aureus in DDS Operated or Funded Facilities or Programs Health Standard No. 97-3 Guidelines for Prevention of Bloodborne Pathogens (HIV & HBV) for DDS Clients I.H. Nursing Standards, Protocols and Guidelines Nursing Protocol No. 11-1 Fall Prevention NP 11-1 Attachment A Fall Risk Prevention Plan NP 11-1 Attachment B Fall Risk Factors NP 11-1 Attachment C Post Fall Evaluation NP 11-1 Attachment D Fall Risk Screening Tool Nursing Protocol No. 09-2 Care of Persons with Jejunostomy Tubes or Gastrojejunal Tubes NP 09-2 Attachment A Check feeding tube placement by comparison of tube markings NP 09-2 Attachment B Checking feeding tube placement by measurement of tube length Nursing Protocol No. 09-1 Care of Persons with Gastrostomy Tubes NP 09-1 Attachment A Checking Placement of Feeding Tubes By Comparison of Tube Markings NP 09-1 Attachment B Checking Placement of Feeding Tubes Using Measurement of Tube Lengths Nursing Standard No. 09.4 On-Site Practicum Process NS 09.4 Attachment A-1 On-Site Practicum/Checklist A NS 09.4 Attachment A-2 Guidelines for Checklist A of the On-Site Practicum Process NS 09.4 Attachment B-1 On-Site Practicum/Checklist B NS 09.4 Attachment B-2 Guidelines for Checklist B of the On-Site Practicum Process Nursing Standard No. 09.3 LPN Participation In Medication Administration Certification Process NS 09.3 Attachment A LPN Authorization Qualifications and Application NS 09.3 Attachment E Authorized LPN Performance Evaluation Nursing Standard No. 09.2 Medications Administered On An As Needed/PRN Basis Nursing Standard No. 09.1 Nursing Process Nursing Standard No. 99.1 Medication Administration by Licensed Staff NS 99.1 Attachment A I.D.PR.015 Medication Administration Sanctions Process for Lecensed Nurses NS. 99.1 Attachment B Med Cert Recertification Manual (part 1) NS 99.1 Attachment C Med Cert Recertification Manual (part 2) Nursing Standard No. 97.1 Nursing Delegation to Unlicensed Staff Nursing Standard No. 96.3 Nursing Documentation NS 96.3 Attachment A DDS Nursing Notes NS 96.3 Attachment B Nursing Documentation Guideline I.H. Health Services Memos CO - Guardian's Authorization - Off Label - COVID-19 April 3, 2020 DDS Response to Novel Coronavirus - January 2020 FAQ - End of COVID-19 Public Health Emergency (PHE) May 31, 2023 First Aid Kit Contents - August 2018 Reminder - Health Concerns and the Summer - June 2018
I.H.1. Privacy
I.H.1. Policies
PO.001	Privacy of Health Information		May 13, 2005
I.H.1.Procedures
I.H.1. Directives/Advisories
I.H.2. Security
I.H.2.Policies
PO.001	Security of Health Information		May 13, 2005
I.H.2.Procedures
I.H.2. Directives/Advisories