Additional Staff Supports During At-Home Day Services (Waiver Funded)

Purpose:

This Information Bulletin addresses the requesting and funding of additional staff supports for people who are participating in At-Home Day Services (37U). This IB will also explain how the Division of Developmental Disabilities (DDD) approaches potential funding of additional staff supports during At-Home Day Program hours.

Under the waiver, Temporary Intensive Staffing, is the mechanism to provide additional staff support for individuals who need it. It provides funding for Adult Waiver participants with additional time-limited intensive staffing to provide temporary intensive supports for individuals receiving Community Integrated Living Arrangements (CILA) or Community Day Services (CDS) who have a need for intensive staffing. This service requires prior approval.

Background:

Additional Staff - CDS (53D)

The waiver only allows 53D to be billed when the person is participating in CDS under the 31C or 31U bill codes. Providers may not apply for or bill 53D to be used in conjunction with 37U.

Additional Staff - Residential (53R)

The waiver only allows 53R to support an individual in CILA. There is no automatic award of 53R hours to cover the time during At Home Day Services (37U). Providers may apply for 53R in CILA to be used in conjunction with 37U.

Note: CILA providers should not bill 53R for At Home Day Program (37U) hours unless they have applied through this process, and have been awarded the hours, from the Division. Providers who use existing 53R for additional staff during At Home day Services (37U) hours will run short of billable hours before the end of the fiscal year. There will not be additional hours awarded at the end of the fiscal year.

Determining Need for 53R:

Individual Need:

The CDS environment is different than the person's home environment. Potentially more people, fewer staff, higher levels of noise and visual distractions, and proximity to others are examples why a person could need additional staff supports in a CDS environment but not necessarily translate to the same need in a residential environment where the individual is in their home, with known roommates and staff.

Provider Expenses:

At Home Day Program (37U) is the same rate/hour as CDS (31U/31C), however, the cost to a residential provider to deliver At-Home Day Services is almost exclusively tied to wages and fringe benefits. Sufficient staff must be provided to allow for each individual in At-Home Day program (37U) to participate in a structured, individualized program as they choose. The Division expects there will be no fewer staff than those provided during second shift, evening shift, and/or weekend staffing models. For Intermittent CILA (including Family CILA) the provider should provide a 1:4, or less, staffing ratio. Note: the DDD does not intend to award additional staff supports for people in Intermittent or Family Intermittent CILA.

The majority of the expenses, including the site (residence) are already covered under the CILA Rate Model. Potentially there will be a minimal cost increase in utilities (gas, water, electric) with people being home for more hours during the day. There is no transportation to and from a CDS site, so there is no daily transportation cost. There will be transportation costs to go on outings or other activities outside of the CILA site. However, the cost of the vehicle is already covered through CILA funding. The only "transportation" cost incurred should be mileage when operating the vehicle.

Calculations:

Based on the interaction between individual need and provider expenses, the Division has determined there are limited situations that would require the need for additional support. They include those individuals who have previously demonstrated need and live in 1 or 2-person CILA.

Process:

The Division will consider, on a case by case basis, requests that fall outside of the above criteria in very limited and special circumstances. These requests should be directed to the ISC who will consult with the Division prior to submission of a formal request.

The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.

Effective Date:

09/30/2020