Shared Living Service Overview for Independent Living with Supports

Slide Note

The Shared Living Service, facilitated by Deanna L. Parker, MPA VA DBHDS, offers individuals aged 18 and above the opportunity to live independently with some support. This service is available under all three waivers and entails a one-to-one living arrangement where a roommate provides agreed-upon limited supports in exchange for rent, food, and utilities reimbursed by Medicaid. The service promotes companionship, security, and some assistance with daily tasks while emphasizing the importance of a roommate supports agreement. Additionally, it is compatible with various waiver services, enhancing the quality of life for participants seeking shared living arrangements.

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Introducing the Shared Living Service Deanna L. Parker, MPA VA DBHDS

SHARED LIVING OVERVIEW Participants 18 years or older desiring to live independently but needing some supports Available in all three waivers Not a standalone waiver service One to one arrangement Roommate resides with the individual providing agreed upon, limited supports in exchange for rent, food and utilities reimbursed by Medicaid Roommate not responsible for individual s medical/habilitative care, health, welfare or development. Roommate is not an employee of the individual and is not compensated for providing supports, but may be employed outside of the Shared Living arrangement Roommate may not be a parent, step-parent, grandparent or guardian of the individual. May be a sibling, cousin, friend, etc. Individual must be primary on the lease (not occupant ) Slide 2

SHARED LIVING OVERVIEW Designed to meet a variety of shared living/roommate situations Can be paired with rental assistance Provider helps prepare the individual and roommate prepare for the arrangement and serves as a pass-through agency routing reimbursement monies to the individual for the roommate s portion of room and board Provider receives a flat fee reimbursement for oversight of the service. Provider and SC share oversight of service through traditional monitoring oversight activities. Slide 3

SHARED LIVING OVERVIEW Includes fellowship and companionship supports: conversation, games, crafts, accompanying the person on walks, errands, appointments and social and recreational activities; Enhanced feelings of security: necessary social and emotional support inside or outside the residence; Limited supports with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) provided by the roommate. Personal care and routine daily tasks that do not exceed 20% of companionship time such as meal preparation, light housework, assistance with and the physical taking of medications. Individual and roommate together sign a roommate supports agreement which outlines what they do together and the supports to be provided. Slide 4

Compatible Waiver Services Shared Living Compatible Waiver Services Companion Services Agency-Directed and Consumer-Directed* Community Coaching Community Engagement Group Day Support Services In-Home Support Services Personal Assistance Services Agency-Directed and Consumer-Directed* Group and Individual Supported Employment Workplace Assistance Services Independent Living Skilled Nursing Private Duty Nursing Service compatibility will depend on which waiver the individual is enrolled in. Slide 5

ROS and NOVA Differential For purposes of billing rates provided under the Waivers, the localities below are considered "Northern Virginia" (NOVA). Any city/county not included should be considered "Rest of State" (ROS) and billed accordingly (per FY 2015 FMR localities for Northern Virginia). Northern Virginia Differential Effective July 1, 2015 Locality FIPS Code Alexandria City Arlington County Clarke County Fairfax City Fairfax County Falls Church City Fauquier County 510 013 043 600 059 610 061 Fredericksburg City 630 Loudoun County Manassas City 107 683 Manassas Park City 685 Prince William County 153 Spotsylvania County 177 Stafford County 179 Slide 6

Monthly Reimbursement Rent/Utilities Reimbursement Rest of State(ROS) N. Virginia (NOVA) Maximum reimbursement is up to 50% of the roommate s rent per month, not to exceed the maximum rate allowable for the ROS and Northern Virginia. $553.50 (maximum reimbursement for 50% of rent) $729.00 (maximum reimbursement for 50% of rent) Maximum reimbursement for utilities (under rate methodology) is up to $100.00 per month for the roommate s portion. If all of the utilities are included in the rent they are not reimbursable under the Shared Living Service. Expense Monthly Reimbursement Amount Internet Service $25.00 Monthly reimbursement $240.90 Monthly Reimbursement Based on USDA Low-Cost Plan for 1 19-50 year old male, June 2015. If the live-in roommate receives monthly SNAP benefits, the benefit amount would be deducted from the monthly reimbursement amount. NOTE: If an individual has rental assistance with Shared Living, the roommate is only eligible to be reimbursed for internet and food. Food Flat rate Slide 7

Shared Living Service Incentives Flexible funding may be accessed by the Shared Living Provider. These funds can be used to cover the costs required to initiate the service for an individual (one time) no more than 60 days prior to service authorization (at SC rate). Reimbursable activities include: Background checks Conducting training Roommate matching activities, including development of the Supports Agreement Flexible funds may also be accessed by the individual for start-up housing costs to include deposits for rent and utilities, etc. Weekly checklist is used in place of progress notes Quarterly review template (4 questions) for quarterly face to face reviews The Supports Agreement replaces the Shared Living Provider s Part 5. Jump Start funding is available to be used to help develop this service model. Slide 8

SHARED LIVING FOR SUPPORT COORDINATORS: Ensure that the individual has completed readiness steps for independent living. If needed, complete and forward a referral form for rental assistance through DBHDS. Visit the Provider Development page on the DBHDS website and download the current version of the Shared Living toolkit and templates. Assist the individual in locating a Shared Living provider to help in identifying a roommate and completing the background check and training. Initiate service authorization Assist with oversight and monitoring of service. Slide 9

SHARED LIVING FOR PROVIDERS: Ensure you have an active DBHDS license for any service Update your participation agreement with DMAS Update your policies and procedures to reflect the Shared Living option. Complete the DBHDS Provider Survey as a provider of the Shared Living Service Contact local CSB s as new Shared Living provider. Visit the Provider Development page on the DBHDS website to download current version of Shared Living toolkit and templates. Assist the individual with locating a roommate, completing the supports agreement and completing the background check and required training. Route funds to individual on behalf of roommate Assist with oversight and monitoring of service. Slide 10

Steps in Accessing Shared Living Two paths to initiate service authorization for Shared Living 1. The individual has secured his/her roommate and has a signed lease or, The individual has demonstrated an intent to utilize the Shared Living waiver service, has demonstrated housing readiness, but has NOT yet secured a roommate or housing. 2. Slide 11

Steps in Accessing Shared Living The individual should an express to the SC/CM a desire to live independently, but may need some supports to be successful (ADL/IADL s, physical, social, emotional, etc.) The Shared Living Service should incorporate individualized planning and preparation in advance of service. The service should relate to an outcome in the ISP. The Support Coordinator (SC) will work with the individual in advance of formal service authorization, to help the individual locate a Shared Living provider. Within 60 days, using a person-centered process and a matching tool/inventory, the Shared Living provider will assist in locating a roommate, if one has not been identified, and completing screening requirements. The roommate must be identified in advance if the individual will be using rental assistance. Once the roommate is identified, the SC will work with the individual to complete a housing referral form, indicating interest in Shared Living and the name of the roommate. Slide 12

Steps in Accessing Shared Living If using a rental subsidy, the SC, in conjunction with a DBHDS Housing Coordinator, will assist the individual in working through the process of securing rental assistance and obtaining housing. New waiver services may be used to help with this process, including the Housing Community Guide and Peer Mentor Supports. The DBHDS Housing Coordinator will review the referral and any other information submitted which shows readiness to access independent housing (i.e., completion of the DBHDS Housing Assessment Form) and any supports needed to be successful. The DBHDS Housing Coordinator investigates all options for rental assistance and facilitates PHA involvement to determine the individual s eligibility for rental assistance (if needed). If eligible for rental assistance, the individual and the roommate will agree on the status of the roommate in accordance with PHA guidance. Slide 13

Steps in Accessing Shared Living TheShared Living provider should work with the individual and the roommate to help facilitate discussions regarding service expectations, limitations and allowances. The Shared Living provider will help identify what the needs are under the arrangement, and facilitate completion of the Supports Agreement. A back up plan (natural supports) must be included in the agreement. The Supports Agreement will outline what supports are provided to the individual, time to be spent together and activities; including any other expectations under the service arrangement, such as: Personal preferences Divisions of chores Exiting agreement Slide 14

Service Authorization Process Once the individual has secured a lease and a roommate has been identified, service authorization is initiated with review and approval of information submitted by the SC/CM. SC will obtain a copy of the signed lease and complete the Shared Living Attestation Form SC will request and obtain proof of roommate training, background check and copy of Supports Agreement The SC will upload the completed attestation form, documentation of roommate training and background check, and signed Supports Agreement as attachments in WaMS with the requested reimbursement amount for service authorization. If the individual is receiving rental assistance, reimbursement to the individual on behalf of the roommate is limited to food an internet only. Slide 15

Service Authorization Process SA Consultant will review documentation and populate the Shared Living Determination Form with reimbursement amount and upload to WaMS. Shared Living Provider will review reimbursement amount with the individual and the roommate. Upon agreement, SA consultant will finalize service authorization in WaMS. Slide 16

Service Monitoring and Documentation The provider submits monthly claims for reimbursement based upon the amount determined through the service authorization process. The roommate and the individual will complete and sign off on a weekly checklist submitted to provider monthly. Quarterly reviews should incorporate information or issues identified in weekly checklists The Shared Living Provider will maintain: o Weekly support checklists o Proof of roommate training (as needed) o Shared Living Determination Form o Supports Agreement o Quarterly review forms o Documentation of monthly payments made to the individual Slide 17

SHARED LIVING Backup support plans The individual and family members are expected to provide a back-up plan for the individual for times when the roommate is unavailable to provide the agreed upon supports. In the event that prearranged back-up support is not available, paid supports may be authorized as a back-up or temporarily increased.