Provider Requirements and Service Limitations
From The May 2010 Florida Medicaid Provider Handbook
Supported Living - Requirements To Receive
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.
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 inhome 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.
Reimbursement* and monitoring documentation to be maintained by the provider:
- *Copy of claim(s) submitted for payment;
- *Service log, which includes 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
- *Individual implementation plan, or in the case of transition, a transition plan within 30 days of the initiation of a new service or within 30 days of the support plan effective date for continuation services and annually thereafter. A copy of the implementation plan, approved by the individual or their guardian shall be furnished to the individual or their guardian and to the waiver support coordinator at the end of the 30 day period.
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 to include a personal emergency disaster plan;
- The method for accessing the provider 24-hours per-day, 7-days per-week for emergency assistance;
- A description of how natural and generic supports will be used to assist in supporting the recipient; and
- 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;
- A quarterly written report, which summarizes quarterly activities and 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 quarter, as well as recommendations. The third quarterly summary which includes a summary of the activities of the current and previous quarters of the support plan and shall be considered the annual report.
- The quarterly review which reflects activities completed at the quarterly home visit. This review shall include: a review of the supported living services to ensure services are assisting the individual with identified support plan goals, a review of the person’s financial status including a review of the financial profile, financial records and the status of the subsidy if provided, review of the individual’s health and safety status including identified need for follow-up, a review of the housing survey. Documentation of the quarterly home visit and subsequent recommendations shall be made in the individual’s record.
- . 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;
- 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.
Documentation to be submitted to the waiver support coordinator by the provider:
- Copy of service log or time intervention log, monthly
- Copy of individual implementation plan or in the case of transition, a transition plan, completed within 30 days of the initiation of a new service or within 30 days of the support plan effective date for continuation services and annually thereafter; and
- Third quarterly summary which includes a summary of the activities of the current and previous quarters of the support plan and shall be considered the annual report.
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.
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
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.
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.