Provider Requirements and Service Limitations
From The May 2010 Florida Medicaid Provider Handbook
In Home Supports - Requirements To Receive
In-home supports are services that provide recipients who live in their own homes with up to 24 hours-a-day assistance from a support worker or support workers. The support worker may live in the recipient’s home or apartment and share living expenses (rent, utilities, phone, etc.) with the recipient. The support worker provides companionship and personal care and may assist with or perform activities of daily living and other duties necessary to maintain the recipient in supported living. The support worker may perform grocery shopping, housekeeping, and cooking responsibilities or may conduct training programs designed by the supported living coach to teach these and other daily living skills. The in-home support services are separate and not a replacement for the services performed by a supported living coach. Some recipients in supported living may need only the services of an in-home support worker or only the services of a supported living coach. Other recipients may need both services. When both services are used, the providers must coordinate their activities to avoid duplication.
The support worker, to the extent properly qualified and licensed, may maintain the recipient’s home and property as a clean, sanitary and safe environment. The support worker’s services may include heavy household chores to make the home safer, such as washing floors, windows and walls; tacking down loose rugs and tiles; replacing a broken window; or moving heavy items or furniture.
This service offers individualized training and is provided for the express purpose of providing access to the community-based activities that cannot be provided by natural or other unpaid supports, and are defined as activities most likely to result in increasing ability to access community resources without paid support.
In-home support services are available only to recipients residing in their own homes, excluding family home or sharing of a home with family members. The APD Area Office may also approve the use of in-home, live-in, and hourly live-in services at the appropriate live-in and hourly rate for the service, for recipients who are in need of support and who reside in a licensed foster or group home, limited to no more than three recipients living in the home. A recipient receiving in-home support services is not eligible to receive personal care, or residential habilitation services. In-home support services may be billed up to 365 days a year when the recipient is present.
Reimbursement* and monitoring documentation to be maintained by the provider:
*Copy of claims submitted for payment;
- *Copy of service log;
- Monthly summary notes; and
- Staffing documentation such as in-home staffing schedules, payroll records indicating identified in-home support staff and hours worked, and other supplemental in-home support staffing schedules which document required staffing ratios.
Documentation to be submitted to the waiver support coordinator by the provider:
- Copy of service log, monthly; and
- Monthly summary notes at the time of claims submission.
If the provider plans to transport the recipient in his private vehicle, at the time of enrollment, the provider must be able to show proof of valid: 1) driver’s license, 2) car registration, and 3) insurance. Subsequent to enrollment, the provider is responsible for keeping this documentation up-to-date.
Note: *Indicates reimbursement documentation.
Place of Service:
In-home support services are provided in the recipient’s own home or if authorized by the APD Area Office in a licensed foster or group home where three or less recipients reside in the home. The in-home support services worker may also accompany the recipient to activities in the community.
The in-home support provider or the provider’s immediate family shall not be the recipient’s landlord or have any interest in the ownership of the housing unit, as required by rule 65G-5.004, F.A.C. If renting, the name of the recipient receiving Inhome support services must appear on the lease either singularly or with a roommate or a guarantor. Provider is defined as an individual or corporation including all board members and any paid employees and staff of the provider agency, its subsidiaries or subcontractors.
In-home supports provided by a provider or an employee of a provider who is living in a recipient’s home must be billed at the live-in stepped rate for the service listed on the DD Provider Rate Table, which is incorporated by reference in 59G-13.081, F.A.C. The live-in rate shall be determined based on from one to three recipients in the home receiving the service. The live-in rate includes a relief factor for primary staff performing the support. Additional in-home supports above the live-in rate may be approved by the APD Area Office with concurrence from the APD Central Office based on the support needs of the recipient.
Up to 6 hours or 24 quarter hours above the live-in rate may be approved to provide additional supports that shall be billed by the quarter hour. In-home supports billed by the quarter hour above the live-in rate may be approved under the following circumstances:
- Recipient requires additional supervision due to intense behavioral challenges that make the recipient a danger to themselves or others. In this situation, the recipient must have a behavioral services plan that is implemented by the inhome support services provider, and the recipient requires visual supervision during all waking hours and intervention as determined by a certified behavioral analyst. The behavioral services plan and its effects on the behavior must be reviewed by the Local Review Committee (LRC) on a regular schedule as determined appropriate by the LRC.
- Recipient requires temporary additional supervision and assistance to recover from a medical condition, procedure or surgery. The additional supports may only be approved on a time limited basis during the recipient’s recovery. This must be documented by medical information signed by the recipient’s physician.
A provider or employees of a provider do not have to “live-in” a recipient’s home for the live-in rate to be applied for the service.
When the in-home support worker lives in the recipient’s home, and the home is considered the support worker’s primary residence, the support worker or provider will pay an equal share of the room and board for the home. The equal share determination shall be made prior to any stipend calculation for the recipient(s).
The recipient has the option to negotiate with the support worker for a share of the household expenses during the time that the support worker shares the living arrangement when it is not the primary residence.
In-home support services that are provided on an hourly basis instead of live-in shall be billed by the quarter hour in accordance with the stepped rate for in-home supports awake staff for up to eight hours a day. If in-home hourly supports are required in excess of eight hours a day, or 32 quarter hour units, the service must be billed at the inhome live in daily rate. The live-in daily rate provides from 8 to 24 hours of supports. When periodic additional staff assistance is required for in-home live in services, an inhome hourly support service may be billed for up to six hours a day in addition to the live in support if approved by the APD Area Office with concurrence from the APD Central Office. The rate for the service will be determined based on from one to three recipients in the home receiving the service. The rate ratio is determined by what is the usual and customary service delivery pattern and does not fluctuate with incidental absences of one or more recipients included in the rate ratio.
The in-home support services worker is prohibited from paying rent or the cost of other living expenses directly to the recipient, since such financial transactions could jeopardize the recipient’s eligibility status as a Medicaid recipient. The support worker should instead pay his portion of the rent directly to the landlord and his portion of other living expenses (utilities, phone, etc.) directly to the service companies. If the recipient owns the home, the waiver support coordinator or APD Area Office staff must assist the recipient in negotiating the provider’s fee, and then negotiate offsetting the fee by the amount the provider owes the recipient for rent and other living expenses.
When a recipient receives supported living coaching and in-home support services, the providers must work together and with the waiver support coordinator to avoid duplication of services.
In-home support providers are not reimbursed separately for transportation and travel costs. These costs are integral components of in-home support services and are included in the basic rate.
In-Home Support Services Provider Requirements
Providers of in-home support services are independent vendors, who are either individuals or employees of agencies, must be at least 18 years of age and have at least a high school diploma or equivalent and one year of experience working in a medical, psychiatric, nursing or childcare setting or working with recipients who have a developmental disability. College, vocational or technical training equal to 30 semester hours, 45 quarter hours or 720 classroom hours may substitute for the required experience. Licensure, certification, or registration is not required.
Proof of training in the areas of Cardiopulmonary Resuscitation (CPR), HIV/AIDS and infection control is required within 30 days of initially providing in-home supports. Proof of annual or required updated training shall be maintained on file for review.
The provider is responsible for all training requirements outlined in the Core Assurances.
Note: Refer to the Core Assurances in Appendix A for the provider training requirements.