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Supported Living

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Supported Living - Requirements To Receive

Description

Supported living coaching services provide training and assistance, in a
variety of activities, to support recipients who live in their own homes or
apartments. These services are provided by qualified supported living
coaches to a recipient residing in a living setting meeting the requirements set
forth in rule 65G-5.004, F.A.C., and may include assistance with locating
appropriate housing; the acquisition, retention or improvement of skills related
to activities of daily living such as personal hygiene and grooming; household
chores; meal preparation; shopping; personal finances and the social and
adaptive skills necessary to enable recipients to reside on their own.
Supported living services mean the provision of supports necessary for an
adult who has a developmental disability to establish, live in and maintain a
household of his choosing in the community. This includes supported living
coaching and other supports.
Functional Community Assessment: The basis for identifying the types of
training, assistance and the intensity of support rendered by the provider. It is
a document designed to assist the provider in becoming familiar with the
recipient and his capabilities and needs. This assessment addresses all
areas of daily life including relationships, medical and health concerns,
personal care, household and money management, community mobility,
recreation and leisure. The supported living provider is responsible for helping
the recipient complete a functional community assessment prior to his move to
a supported living arrangement. This assessment shall be updated annually.
The Housing Survey: The basis for surveying a prospective home to ensure
that it is safe. The supported living coach must forward a copy of the
completed survey of the housing that was selected by the recipient, to the
recipient’s support coordinator within ten working days of the selection. This
survey must be updated quarterly and made available for review by the
support coordinator at the time of the support coordinator’s quarterly home
visit. These updates shall include a review of the recipient’s overall health,
safety and well-being status.
Financial Profile: An analysis of the household costs and revenue sources
associated with maintaining a balanced monthly budget for the recipient. The
analysis will substantiate the need for a monthly subsidy or initial start-up
costs and should be a source of information for determining strategies for
assisting the person in money management. The supported living coaching
provider is to assist the recipient in completing the financial profile and
submitting it to the support coordinator no more that ten days following the
selection of housing by the recipient. If the financial profile indicates a need
for a one time or recurring subsidy, the profile must be submitted to the waiver
support coordinator and approved by the APD Area Office before the recipient
signs a lease.
Providers of supported living services shall comply with requirements found in
the Medicaid Waiver Services Agreement, Core Assurances, Chapter 65G-5,
F.A.C., and those specified in this handbook.

Limitations

Supported living coaching services are limited to the amount, duration and
scope of the services described on the recipient’s support plan and current
approved cost plan, not to exceed six hours or 24 quarter hour units per day.
Recipients who also receive in-home support services may receive supported
living coaching services for no more than 20 hours or 80 quarter hours per
month.
The provider shall render supported living coaching services at the time and
place mutually agreed to by the recipient and provider. The provider shall
have an on-call system in place that allows recipient’s access to services for
emergency assistance 24 hours-per-day, 7 days-per-week. If an individual
vendor, the provider must specify a backup person to provide supports in the
event he is unavailable. The specified backup provider must be a certified,
enrolled Medicaid provider and certified as a supported living coaching
provider, pursuant to Chapter 65G-5, F.A.C. Telephone access to the
provider or the backup provider shall be available, without toll charges to the
recipient.
Supported living coaching services are limited to adults (age 18 or over) who
rent or own their own homes or apartments in the community. The supported
living coaching 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 stated in rule 65G-5.004, F.A.C. If renting, the name of the recipient
receiving supported living coaching services must appear on the lease either
singularly, with a roommate or a guarantor. A provider is defined as an
independent provider or a corporation including all board members and any
paid employees and staff of the provider agency, its subsidiaries or
subcontractors.
Supported living coaching encourages maximum physical integration into the
community. The homes of recipients receiving supported living coaching
services shall meet requirements set forth in rule 65G-5.004, F.A.C.
Recipients receiving supported living coaching services shall live where and
with whom they choose. However, recipients receiving supported living
coaching services shall live with no more than two other people who have
developmental disabilities and shall have control over the household and its
daily routines.
Recipients who live in family homes, foster homes or group homes are not
eligible for these services unless the recipients have an outcome (goal) to
move into their own homes or apartments. Within 90 days from moving,
supported living coaching services may be made available to recipients who
are in the process of looking for a place of their own, even though they will
reside in a family, foster or group home during the search process and may
receive residential habilitation services.

Supported living coaching services are provided on a one-on-one basis. The
provider will bill for supported living coaching services in accordance with the
published rate structure for individual supports for the recipient. If services are
provided with two or more recipients present, the amount of time billed must be
prorated based on the number of recipients receiving the service.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the
provider:
1. *Copy of claim(s) submitted for payment;
2. *Service log or time intervention log, which shall be supported by progress
notes including documentation of activities, supports and contacts with the
recipient, other providers and agencies with dates and times, and a
summary of support provided during the contact, any follow up needed and
progress toward achieving support plan goals. This service log and
progress notes shall be placed in the recipient’s record prior to claim
submission; and
3. *Individual implementation plan, or in the case of transition, a transition
plan, must be completed at the time of the first claim submission and
annually thereafter at the time of the support plan update, and at any time
updates and changes are made before they are implemented.
In addition to the minimum required components of the individual
implementation plan described in the definitions section of this handbook,
the individual implementation plan for supported living coaching service
must also contain the following:
The frequency of the supported living service;
How home, health and community safety needs will be addressed and the
supports needed to meet these needs;
The method for accessing the provider 24-hours per-day, 7-days per-week
for emergency assistance; and
A description of how natural and generic supports will be used to assist in
supporting the recipient; a financial profile that includes strategies for
assisting the person in money management, when requested by the
recipient or guardian; and the amount approved for the supported living
subsidy. The financial profile is critical in determining whether or not the
housing selected by the recipient is within his financial means and will
identify the need for monthly subsidy which must be approved by the APD
Area Office;

4. An annual written report, summarizing the recipient’s progress toward
achieving the goal(s) from the support plan. The annual report shall
include objective, fact-based, information reflecting the results of training
and supports provided to the recipient over the course of the year, as well
as subjective information (opinions) and recommendations. The annual
report shall be submitted to the recipient or guardian and the support
coordinator 30 days prior to the end of the support plan year;
5. An annual satisfaction survey as described in rule 65G-5.007, F.A.C. At
least annually, recipients receiving supported living coaching services will
be asked to complete a survey that addresses satisfaction with supported
living services. While it is the provider’s responsibility to assure the
recipient has the opportunity to complete the survey, staff providing direct
supported living services to the recipient may not assist in the survey
activity for that recipient. The results of the survey will be maintained in
the recipient’s record and a copy forwarded to the waiver support
coordinator for review;
6. The recipient’s waiver support coordinator is responsible for arranging,
scheduling and documenting a quarterly meeting in which the recipient, the
waiver support coordinator and the provider of services review the current
supported living services. The purpose of this visit is to update the
housing survey to assure that the home continues to meet basic health
and safety standards and to determine if supported living coaching
services are being carried out as identified on the support plan. The
supported living coach and the waiver support coordinator are to review
the recipient’s bank statements and other financial records at the time of
the quarterly visit. This review will be documented, unless the supported
living provider is excluded from the meeting at the request of the recipient,
in the progress notes contained in the provider’s service log;
7. An initial housing survey containing quarterly updates of the recipient’s
health and safety status. The housing survey will be updated quarterly and
made available to the waiver support coordinator at or prior to the quarterly
meeting. Documentation of the meeting and subsequent recommendations
will be made in the recipient’s record;
8. Up-to-date information regarding the demographic, health, medical and
emergency information, and a complete copy of the current support plan, if
approved by the recipient or guardian, for each recipient served; and
9. Performance data on the selected service outcomes projected in this
document.

Documentation to be submitted to the waiver support coordinator by the
provider:
1. Copy of service log or time intervention log, monthly
2. Copy of individual implementation plan or transition plan (must be
completed at the time of first claim submission and annually thereafter at
the time of the support plan update, and at any time updates and changes
are needed and before they are implemented;
3. Annual report prior to annual support plan update.
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.
*Indicates reimbursement documentation.
Place of Service Supported living coaching services are provided in the recipient’s place of
residence or in the community.

Special Considerations
Providers of supported living coaching services must participate in monitoring
reviews conducted by the APD or its authorized representatives.
When a recipient receives supported living coaching, in-home supports,
personal care assistance or companion services, the providers must work
together to avoid duplication of activities with coordination by the waiver
support coordinator.
Supported living coaching services are not to be provided concurrently with
residential habilitation services, except for the 90 days prior to the recipient
moving into the supported living setting.
Supported living coaching services may not duplicate services available from
programs funded by the Rehabilitation Act of 1973 or Public Law 94-142 or
their subsequent updates.

Supported Living Coaching Services Provider Requirements

Supported Living Coaching Services Provider Requirements

Provider Qualifications
Providers of supported living coaching services may be independent vendors,
solo providers or employees of agencies.
Independent vendors, employees of agencies and solo providers who render
these services shall have a bachelor’s degree from an accredited college or
university with a major in nursing; education; or a social, behavioral or
rehabilitative science. In lieu of a bachelor’s degree, a person rendering these
services shall have an associate’s degree from an accredited college or university
with a major in nursing; education; or a social, behavioral or rehabilitative science
and two years of experience. Experience in one of the previously mentioned
fields shall substitute on a year-for-year basis for the required college education.

Training Requirements
Agency employees, independent providers and solo providers are required to
attend 12 hours of pre-service training prior to assuming job responsibilities, and
eight hours of annual in-service training. Agency employees and independent
providers enrolled after October 2003 are required to attend eighteen hours of
pre-service training prior to assuming job responsibilities, and eight hours of
annual in-service training. Training will consist of a curriculum provided by APD,
an overview of affordable housing options and home modifications, and Chapter
65G-5, F.A.C. The pre-service training content must be approved by APD’s
Central Office to ensure statewide uniformity.
Providers of supported living coaching services must, at a minimum, also
complete training covering CPR, infection control, HIV/AIDS, maintaining current
certification.
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.

Projected Service Outcomes
Projected service outcomes are goals used to determine, through monitoring and
review, the accomplishments of providers and the effectiveness of service
provision.
Recipients in supported living are the lessee or owner of the home in which
they reside.
All recipients served who have responded to the annual satisfaction survey
are satisfied with the services based on the results or that the provider has
addressed any concerns raised during the survey.
Recipients are supported to live in their own homes.
Recipients who use the supports increase their level of participation or
independence in the community.
Recipients demonstrate freedom of choice in all areas of their lives as
evidenced by setting personal goals, being fully informed about service
options and making all possible decisions with regard to the conduct of their
lives.
Recipients achieve goals on their support plan.