innovations waiver technical amendment · connectivity and smart home technology. • broad...
TRANSCRIPT
Table of Contents
Assistive Technology Equipment & Supplies .......................................... 1-3
Home Modifications .............................................................................. 3-6
Community Living & Supports .............................................................. 7-9
Community Navigator ......................................................................... 9-11
Community Networking ................................................................... 11-14
Community Transition ...................................................................... 14-16
Crisis Services ................................................................................... 16-17
Day Supports .................................................................................... 17-19
Financial Support Services ............................................................... 19-20
Individual Goods & Services ............................................................ 20-21
Natural Supports Education ............................................................ 21-22
Residential Supports / AFL .............................................................. 22-25
Respite ............................................................................................ 25-26
Specialized Consultive Services ....................................................... 26-28
Supported Employment .................................................................. 28-32
Supported Living ............................................................................. 32-39
Vehicle Modifications ...................................................................... 39-40
Service Name Service NamePurpose/Exclusions/Limitations
Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
What’s changing? What’s Staying the Same?
Assistive Technology Equipment & Supplies
Assistive Technology Equipment & Supplies (continued)
Purpose• To provide
for purchase, lease, or repair of equipment/technology/supplies that increase or maintain community independence and reduce reliance on staffing and increase control over their daily lives while maintaining health and safety.
• Decrease reliance on staff
• Supports individuals to have more control over all aspects of their lives
• Supports individuals to remain in the most inclusive environment of their choice
Exclusions• Items that are not
of direct remedial benefit to the individual
• Recreation items
that would normally be purchased by the family
• Computer desks and other furniture items
• Service and maintenance contracts and extended warranties
• Equipment or supplies purchased for exclusive use at school
• Computer hardware to solely improve socialization or educational skills, provide recreation, provide diversion activities, or to be used by any person other than the individual
• Hot tubs or Jacuzzis• Restraints• Items that are
unsafe, ineffective, or experimental or investigational
Limitations• Subject to Limits on
Sets of Services
What’s changing?• $50,000 combined max
to use for Assistive Technology and Home Modifications over the life of the waiver
• Increased flexibility in access of items and increased the cost limit
• Provides funding for connectivity and smart home technology.
• Broad categories added and exhaustive list removed; however, the request must be directly related to the individual’s disability
What’s staying the same?• Medical necessity is
still a requirement• Allows for the repair of
equipment • NC Innovations Waiver
funding is the payer of last resort. DME or other insurance will be used prior to Innovations.
1 2
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Assistive Technology Equipment & Supplies(continued)
Home Modifications
Home Modifications(continued)
Purpose• Physical
modifications to a private residence that are necessary to ensure the health, welfare, and safety of the individual or to enhance the individual’s level of independence.
• Intended to increase the individual’s capability to access his/her environment and are of direct or remedial benefit to
• Limit of $50,000 of combination of Assistive Technology, Equipment & Supplies & Home Modifications over the duration of the waiver excluding:
- Nutritional supplements - Monthly alert monitoring/ connectivity systems charges
the individual or in some way related to the individual’s disability.
• Covers purchases, installation, maintenance, and as necessary, the repair of home modifications required to enable individuals to increase, maintain or improve their functional capacity to perform daily life tasks that would not be possible otherwise.
• Provides for portable modifications in rented/leased residences
Exclusions • Individuals who
receive Residential Supports may not receive this service
• Modifications shall be made only to already existing structures (bathrooms,
What’s changing?• $50,000 combined max
to use for Assistive Technology and Home Modifications over the life of the waiver excluding nutritional supplements and monthly alert monitoring/connectivity system charges.
• Increased flexibility in access of items and cost limit
• No exhaustive list; however, the request must be directly related to the individual’s disability
What’s staying the same?• Medical necessity is
still a requirement• NC Innovations Waiver
funding is the payer of last resort. DME or other insurance will be used prior to Innovations.
3 4
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
kitchens, etc.)• Adaptations that
add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair)
• Central air conditioning
• General plumbing• Swimming pools• Jacuzzis• Service and
maintenance contracts
• Extended warranties• Locks that restrict an
individual’s rights• Equipment or
supplies purchased for exclusive use at the school/home school
• Replacement of equipment that has
Home Modifications(continued)
Home Modifications(continued)
not been reasonably cared for and maintained
• Items that would ordinarily be provided by the family of a minor child
• New construction, costs associated with building a new home, financing of a new home, down payment of a new home
• Modifications that are not for the direct or remedial benefit of the individual
• Adaptations, improvements or repairs to the residence which are of general utility or in some way not related to the individual’s disability
Limitations• Expenditures of
$50,000 of add-on supports (ATES & Home Modification) over the duration of the waiver
5 6
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
NEW SERVICE
Community Living & Supports
Community Living & Supports(continued)
Purpose• To support the
person to live successfully in his/her own home, the home of his/her family or natural supports and be an active member of his/her community.
• The intended outcome of the service is to increase or maintain the person’s life skills or provide the supervision needed to empower the person to live in the home of his/her family or natural supports, maximize his/her self-sufficiency, increase self- determination and enhance the person’s opportunity to have full membership in his/her community.
• To support individuals to move towards less dependence on
other paid support by learning new skills and retaining skills to maintain health and safety.
• The service is flexible to adapt to an individual’s changing schedule.
• The service occurs in a naturally occurring way and matches the person’s typical day.
Exclusions • May not be
provided at the same time of day as Community Networking, Day Supports, Respite, Supported Employment or other state plan Medicaid services that work with the individual
• Does not provide transportation to/from school or to any community location before/after school
What’s changing?• Blended habilitation
(teaching new skills) and personal care service
• Replaces In-Home Intensive Supports, In-Home Skill Building, and Personal Care
• There is no wrong amount of habilitation or wrong amount of personal care. People will receive a combination of habilitation (teaching) and personal care based on their support needs.
• This service is individualized and based on the individual’s needs.
• Community Living & Supports is now the only service that “Relatives as Providers” can provide.
• Community Living & Support provides technical assistance to unpaid supports who live in the home of the individual to assist the individual to maintain
the skills they have learned. This assistance can be requested by the unpaid support or suggested by the Individual Support Planning team and should be a collaborative decision. The technical assistance should be incidental to the provision of Community Living & Supports.
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Community Navigator
Community Navigator(continued)
Purpose• To promote self-
determination• To support the
individual in making life choices, planning for the future and identifying opportunities for community integration
• Facilitating less reliance on paid supports.
• To provide advocacy
Exclusions • Shall not duplicate
care coordination as defined at 42 CFR 428.208(c)
Limitations• If a provider
does not provide Agency with Choice services, the only other service that they may provide to the same individual in addition to Community Navigator Services is Community Transition.
• An agency may provide both Community Navigator Services and Agency with Choice Services to the same individual, in addition to Community Transition, Financial Support Services, Individual Goods and Services, and Primary Crisis Response Services.
• The Community Navigator Self-
What’s changing?• Community Navigator
is the new name for Community Guide
• Added more distinct roles / activities.
• Clarifies the roles and functions of Community Navigator and Care Coordinator
• Promotes Home Community Based Standards (HCBS)
• Supports the person in the person centered planning process (development of ELP, MAPs, Circles, etc.)
• Optional informational session on Self Determination and Self
Community Living & Supports(continued)
Limitations• Subject to Limits
on Sets of Services• Typically 12
hours per day maximum – may receive 16 hours per day with prior approval for 90 to 180 day periods dependent upon circumstances.
Direction presented by the Community Navigator.
What's staying the same?• Assists individual/
family with the Person Centered Planning Process
• Promotes a neutral advocate in Community Navigator role.
• Supports the person in preparing, participating in and implementing a plan of any type (IEP, ISP, or service plans outside of NC Innovations).
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Community Networking Classes & Conferences
Community Networking
Community Networking (continued)
Purpose• Provides
individualized day activities that support the individual’s definition of a meaningful day in an integrated community setting, with persons who are not disabled.
• Designed to promote maximum participation in community life while developing natural supports within integrated settings.
• Community
Networking services encourage the individual to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community.
• To develop meaningful relationships / social roles with individuals who are not disabled.
• Provides payment for individual to attend a class or conference to increase knowledge / further education
Exclusions • Does not take
place in a licensed facility or any residential setting
• Does not cover cost of hotels, meals materials or transportation
What’s changing?• Allows for
participation in college classes.
• Payment for memberships can be covered when the individual will be participating in an integrated class.
• May be used to support volunteering that occurs in an integrated Setting.
• If the person requires paid supports to participate / engage once connected with the activity, Community Networking can be
Directed activities, can only to be used to provide support to the individual under Individual and Family Directed Supports: Employer of Record and Agency with Choice Models, as approved in this Waiver.
used to refer and link the individual.
What’s staying the same?• Occurs in settings
separate from a person’s private residence
• There is not a requirement for a fading plan, but the service is intended to fade as community connections are gained.
Community Navigator(continued)
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Community Transition
when not attending conferences
• Activities that would normally be a component of home/residential life or services
• May not volunteer for the agency providing the service or in places that would not typically have volunteers
• May not be provided at the same time of day as Day Supports, Community Living & Support, Residential Supports, Respite, Supported Employment, or one of the state plan Medicaid services that works directly with the individual
• Does not provide transportation to/from school to any community location before/
Community Networking (continued)
Community Networking (continued)
Purpose• To provide initial
set-up expenses for adults to facilitate transition from provider operated residential settings or other settings that are not owned or leased by the individual to a living arrangement
What’s changing?• Can be used once over
the lifetime of the waiver, instead of only once for the lifetime of the individual.
• Person can transition from a residential setting or a family home to an
after school• Payment is not
made for overnight programs of any kind
• Classes that offer one-to-one instruction and are in a nonintegrated community setting are not covered
Limitations• Payment for
attendance at classes and conferences will not exceed $1,000 per plan year
• Subject to Limits on Sets of Services
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Community Transition(continued)
Community Transition(continued)
Crisis Services
Crisis Intervention & Stabilization Reports
Crisis Consultation
Out of Home Crisis
where the individual is directly responsible for his or her own living expenses.
• Individuals have more control over their lives.
• Promotes independence and self-determination.
Exclusions • Only available when
the individual is unable to meet the expense or cannot be obtained from other sources
• Available only once over the life of the wavier ( 1 month prior and up to 3 months after move from provider operated setting)
• Cannot cover monthly expense or diversional/recreational/entertainment items (TV, DVD players, computer, etc.)
• Cannot include monthly mortgage
Purpose• To provide for
intervention and stabilization for the individual experiencing a crisis and the need for a higher level of care.
• To promote the prevention of a crisis through implementation of strategies to
What's changing?• Increased flexibility• Staffing requirement
changes allow use of Qualified Professionals with specialized training in addition to licensed staff to provide service
• More focus on the prevention of a Crisis and name change.
independent leased / owned.
What’s staying the same?• Covered transition
expenses remain the same
and rental payments.
• May only be provided in a private home or apartment with a lease in the individual’s/legal guardian’s/representative’s name or a home owned by the individual.
Limitations• $5,000 over the life
of the waiver• Cannot include
provider overhead expenses
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Day Supports (Individual & Group) (continued)
Day Supports -- Developmental Day
Day Supports (Individual & Group)
Crisis Services(continued)
prevent further crisis.
• Can be used for out of home planned behavioral support
Exclusions • Crisis Prevention
and Stabilization Services is distinct from and may not duplicate services provided through Specialized Consultative Services.
Limitations• Crisis Prevention
and Stabilization: Authorized for periods of up to 14 calendar days per event.
• Out of Home Crisis: Authorized for periods of up to 30 calendar days per event.
Purpose• To support day
activities in a facility-based setting separate
from residential settings – typically in groups that are age and support need appropriate and meet the preferences of the individual
• Activities with Day Supports typically occur in isolation / in settings that are with individuals with similar support needs.
• Is primarily a group, facility-based service that provides assistance to the individual with acquisition, retention, or improvement in socialization and daily living skills and is one option for a meaningful day.
Exclusions • May not be
provided at the same time of day as Community Networking,
What's changing?• Day Supports can
start or end in the community
• Individuals physically attend the Day Supports facility once per week.
• Individuals attending Adult Basic Education are not required to attend the facility once per week.
• Individuals new to the service and 16 years of age and older will receive education on all available options for activities / supports to have a meaningful day.
• Included billable activities for Developmental Day
• Changed from a 15 minute unit to an hour unit.
What’s staying the same?• Primarily a group
service for a meaningful day
• Individual Day Supports are available to meet specific and
What's staying the same? • Crisis Supports
are an immediate intervention available 24 hours per day, 7 days per week, authorization can be granted verbally or planned through the ISP.
• Any needed modifications to the ISP and individual budget will occur within five (5) working days of the date of verbal service authorization.
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Individual Goods and Services
Purpose• To provide for
equipment, services, or supplies not otherwise provided through the wavier or the Medicaid state plan
• Individuals must be in a self-directed model to access Individual Goods and Services
Exclusions • Does not include
experimental goods and services
What's changing?• N/A
Day Supports (Individual & Group) (continued)
Financial Support Services
Financial Support Services(continued)
What's changing?• N/A
Community Living & Support, Residential Supports, Respite, Supported Employment, or one of the state plan Medicaid services that works directly with the individual.
• Does not provide transportation to/from school to any community location before/after school
Limitations• Subject to Limits
on Sets of Services
well documented medical, behavioral or physical support needs.
Purpose• To assure that
funds for self-directed services (Employer of Record) are managed and distributed as intended
Exclusions • May only
additional provide Community Navigator Services, Community Transition Services, and Individual Goods and Services
Limitations• N/A
19 20
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Residential Supports / AFL
Purpose• To provide training
opportunities to enhance decision making capacity of the natural support network
• Payment for natural supports to attend a class or conference to increase knowledge / further education
Exclusions • Cost of
transportation, lodging, and meals are not included in the service
• Service is not available to family members that are employed to provide
What’s changing?• Considered a Non-base
budget service
Natural Supports Education
Natural Supports Education(continued)
Natural Supports Education Classes & Conference
Limitations• $2,000 per
individual plan year
• Subject to individual budgeting
supervision and care to the individual
• Excludes training furnished to family members though Specialized Consultative Services
• Training and education, including reimbursement for conferences, are excluded for family members and natural
• support networks when those members are employed to provide supervision and care to the individual.
Limitations• $1,000 per plan
year
What's changing?• N/A
Purpose• To support
successful living in a group home or alternative
Individual Goods and Services(continued)
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Residential Supports / AFL(continued)
Residential Supports / AFL(continued)
family living (AFL) setting that meets the home and community based characteristics
• The intended outcome of the service is to increase or maintain the person’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination and ensure the person’s opportunity to have full membership in his/her community.
Exclusions • Does not provide
transportation to/from school to any community location before/after school
• Participants that receive are not eligible for Home
• Levels tied to resource allocation model instead of NC-SNAP index score:
- Level 1: Individual Budgeting Categories A - Level 2: Individual Budgeting Category B - Level 3: Individual Budgeting Categories C and D - Level 4: Individual Budgeting Categories E, F, and G• Cannot be provided by
a relative• Respite now available
to individuals residing in AFL homes. Residential cannot be billed on the same day as Respite.
• Provider required to be enrolled to provide crisis services
• Vehicle Modifications are available to individuals, if the vehicle is owned by the individual and can transition with the individual.
• Primary AFL Staff who provide Residential Supports should
Modifications • May not be
provided at the same time of day as Community Networking, Community Living & Support, Day Supports, Respite, Supported Living, Supported Employment, or one of the state plan Medicaid services that works directly with the individual
• Payments do not include room & board or facility maintenance
• Primary AFL Staff who provide Residential Supports should not provide other waiver services to the individual. Agencies providing Residential Supports can provide other waiver services to the individual.
not provide other waiver services to the individual.
What’s staying the same?• Payments for
Residential Supports do not include payments for room and board, the cost of facility
23 24
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Respite (Group, Individual, RN, LPN & Facility)
Respite (Group, Individual, RN, LPN & Facility) (continued)
Specialized Consultive Services
Specialized Consultive Services BCBA
Purpose• To support
unique needs of participants by providing expertise, training, and technical assistance in a
What's changing?• Increased flexibility • May be used for
evaluations when State Plan benefit exhausted
• Additional professionals added to
Purpose• To provide
periodic or scheduled support to the primary caregiver(s).
Exclusions • Cannot be used
as a regularly scheduled daily service
• Not available in facilities licensed as .5600B or .5600C
• Cannot provide care for other family members in the home
• Staff cannot live in the home of the individual
• AFLs may not bill on the same day as per diem respite
What's changing?• May be used by
individuals in AFLs• In AFL situations, per
diem respite will be billed on admission and residential supports will be billed on the day of discharge.
• Enables the individual to receive periodic support and relief from the primary caregiver(s) at his/her choice
• Provided clarification that Respite may be used during school hours for sickness or injury.
What’s staying the same?• The primary
caregiver(s) is the person principally responsible for the care and supervision
Residential Supports / AFL(continued)
Limitations• Subject to Limits
on Sets of Services• Subject to
Individual Budgeting Tool
Limitations• Cost of 24 hours
cannot exceed the per diem rate for the average community ICF-IID facility.
of the individual and must maintain his/her primary residence at the same address as the individual.
• Respite Care is not provided by any person who resides in the individual’s primary place of residence.
• Respite services are only provided for the individual; other family members, such as siblings of the individual, may not receive care from the provider while Respite Care is being provided/billed for the individual
• May not be used as a regularly scheduled daily service
• Staff sleep time is not reimbursable
25 26
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Supported Employment (Individual & Group)
Purpose• To provide
assistance with choosing, acquiring, and maintaining a job for individuals ages 16 and older for whom competitive employment has not been achieved
What's changing?• Added in Long Term
Follow-up to ensure individuals are receiving the level of support they need on the job site
• Added responsibility of the Job Coach to educate the
Specialized Consultive Services(continued)
Specialized Consultive Services(continued)
specialty area (psychology, behavior intervention, speech therapy, therapeutic recreation, augmentative communication, assistive technology equipment, occupational therapy, physical therapy, nutrition, and other licensed professionals who possess experience with individuals with Intellectual / Developmental Disabilities) to assist family members, support staff and other natural supports in assisting individuals with developmental disabilities.
• Under this model, family members and other paid/unpaid caregivers are trained by a
certified, licensed, and/or registered professional, or qualified assistive technology professional to carry out therapeutic interventions, consistent with the Individual Support Plan.
Exclusions • Cannot duplicate
services provided through Natural Support Education and Crisis Supports
Limitations• N/A
be able to provide the service
• Provided clarification on activities covered
What’s staying the same?• May not duplicate
services provided through Natural Supports Education and Crisis Supports.
• The individual may or may not be present during service provision.
• The professional and support staff are able to bill for their service time concurrently.
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Supported Employment (Individual & Group) (continued)
Supported Employment Long Term Follow-up (Individual & Group)
and /or has been interrupted or intermittent.
• The intent of Initial Supported Employment is to assist individuals with developing skills to seek, obtain and maintain competitive employment or develop and operating a micro-enterprise. The employment positions are found based on individual preferences, strengths, and experiences. Job finding is not based on a pool of jobs that are available or set aside specifically for individuals with disabilities.
• The transition to long-term supported employment should occur within one year
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
of successful competitive employment, at this time it is expected that staff time will reduce as the individual becomes more independent in her/his job duties.
• Supported Employment may be needed if the individual’s job duties change or if a new job is acquired.
Exclusions • Incentive payments
to encourage or subsidize the employer’s participation in a supported employment program
• Payments passed through to the participant
• Payments for training not directly related to the participant’s supported
Supported Employment (Individual & Group) (continued)
employer on ADA accommodations and requirements
• Change in Staff Requirements removing three-year experience requirement.
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
employment program
• Support in positions that would not exist without the supported employment service and/or require the use of a specific supported employment provider
• Does not provide transportation to/from school to any community location before/after school
• May not be provided at the same time of day as Community Networking, Community Living & Support, Day Supports, Respite, Residential Supports, Supported Living, or one of the state plan Medicaid services
that works directly with the individual
Limitations• Subject to
Limits on Sets of Services
• Subject to Individual Budgeting
Supported Employment (Individual & Group) (continued)
Supported Employment (Individual & Group) (continued)
Purpose• To support
successful community living in unlicensed residences that are owned/leased by the resident(s) to increase or maintain life skills
• Provides supports for the individual to live in their own home with different options based on person’s support needs which are determine by budget categories:
What's changing? • The service
includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the individual/s, budget management, attending appointments, and interpersonal and social skills building to support the individual to live in a home in the community.
• Training activities,
NEW SERVICE
Supported Living
- Level 1 - Minimal support to perform activities 31 32
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
of daily living - Level 2 - Moderate support to perform activities of daily living with support staff sleeping overnight in your home. - Level 3 - Consistent support to perform activities of daily living with support staff awake overnight in the individual’s home. • A special adjustment
is available for Levels 1-3. The adjustment does not change the Level designated for the person, but adjusts the Level to meet one or more of the following circumstances:
- The individual is in circumstances that are time limited but that require support at a higher level than described by the Level and the current rate does not cover the
cost. For example, the person has a serious injury or illness or behavioral or mental health crisis requiring additional support on a temporary basis. A special adjustment may be approved for up to 90 days and may be extended for an additional 90 days. - The person needs a roommate and requires a special adjustment until one move in. A special adjustment may be approved for up to 90 days and may be extended for an additional 90 days. - The person is transitioning from a higher level of care setting, i.e. inpatient
supervision, and assistance may be provided to support the person to participate in home life or community activities. Other activities include assistance with monitoring health status and physical condition, and assistance with transferring, ambulation and use of special mobility devices.
• Transportation is an inclusive component of Supported Living to achieve goals and objectives related to these activities with the exception of transportation to and from medical services covered through the Medicaid State Plan.
• This service is distinct from Residential Supports in that it provides for a variety of living arrangements for individuals who choose to live in their own home versus the home
of a provider. • A person’s own home
is defined as the place the person lives and in which the person has all of the ownership or tenancy rights afforded under the law.
• Persons living in a Supported Living arrangement shall choose who lives with him/her, are involved in the selection of direct care staff, and participate in the development of roles and responsibilities of staff.
• Persons receiving Supported Living have the right to manage personal funds as specified in the Individual Support Plan.
• A formal roommate agreement, separate from the landlord lease agreement, is established and signed by individuals whose name is on the lease.
NEW SERVICE
Supported Living (continued)
NEW SERVICE
Supported Living (continued)
33 34
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
hospital, ICF/ IID, and a rate adjustment are needed to ensure success during the transition process. - Individuals who require a continued Special Needs Adjustment due to medical or behavioral health issues may be reassessed for appropriateness of Level.
Exclusions • Not available to
anyone under 18• May not be
provided at the same time of day as Community Networking, Community Living & Support, Day Supports, Respite, Residential Supports, Supported
Employment, or one of the state plan Medicaid services that works directly with the individual
• Home shall not be owned by the provider, or be affiliated with any entity that leases or rents a place of residence to an individual if such entity requires, as a condition of renting or leasing, the individual to move if the individual wishes to change service provider
• Shall not be provided in a home where an individual lives with family individuals unless such family individuals are another individual receiving Supported Living, a spouse, or a minor child
- Family individual is defined as a parent, grandparent,
NEW SERVICE
Supported Living (continued)
NEW SERVICE
Supported Living (continued)
35 36
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
sibling, grandchildren, step-parents, non-minor step- children and step- siblings and non-minor adoptive relationships• Shall not include
payment for services provided by the spouse of a person or to family individuals as defined in this service definition or legal guardian
• Shall not reimburse for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the individual and who provides services in the individual’s home
• Shall not reimburse for the cost of maintenance of the dwelling
• Shall not be provided in licensed
settings• Individuals shall
not receive Community Living and Supports, Respite, or state plan Personal Care Services
• Individuals may only receive permanent Home Modifications if the home is owned by the individual
• Individual’s home shall have no more than three residents including any live-in caregiver providing supports per Session Law 2011-202 House Bill 509
- A live-in caregiver is defined as an individual unrelated to the individual who provides services in the individual’s home through the Supported Living provider agency
NEW SERVICE
Supported Living (continued)
NEW SERVICE
Supported Living (continued)
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Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
- The live-in caregiver does not own or lease the home.
Limitations• Subject to Limits on
Sets of Services• Subject to Individual
Budgeting
NEW SERVICE
Supported Living (continued)
Service Name Purpose/Exclusions/Limitations
What’s changing? What’s Staying the Same?
Vehicle Modifications
Vehicle Modifications(continued)
Purpose• To support
increased community access for participants with mobility issues through modifications to the individual’s vehicle
Exclusions • Individuals
who receive Residential Supports may not receive this service
• Does not cover renting/leasing a vehicle with adaptations, services and
maintenance contracts, extended warranties, or adaptations for exclusive use at school
Limitations• Limited to
$20,000 over the life of the wavier
What's changing?• Allows for lifting and
lowering devices• Language to increase
clarity• Removed language
regarding depreciation of lift
• Vehicle Modifications are available to individuals who reside in a Residential Facility, if the vehicle is owned by the individual and can transition with the individual.
What’s staying the same?• The installation, repair,
maintenance, and training in the care and use of these items are included.
• The individual or his/her family must own the vehicle.
• The vehicle must be covered under an automobile insurance policy that provides coverage
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