Current through Register Vol.. 38, No. 17, April 11, 2022
A. Service description. Sponsored residential
service means a residential service that consists of skill-building, routine
supports, general supports, and safety supports that are provided in the homes
of families or persons (sponsors) providing supports under the supervision of a
DBHDS-licensed provider that enable an individual to acquire, retain, or
improve the self-help, socialization, and adaptive skills necessary to reside
successfully in home and community settings. This service shall include skills
development with the provision of supports, as needed. Sponsored residential
service shall be covered in the CL waiver.
Criteria and allowable activities.
1. This service shall only be authorized for
Medicaid reimbursement when through the person-centered planning process this
service is determined necessary to meet the individual's needs. This service
may be provided individually or simultaneously to up to two individuals living
in the same home, depending on the required support.
Allowable activities shall include:
a. Skill-building and routine supports
related to ADLs and IADLs;
Skill-building and routine and safety supports related to the use of community
resources, such as transportation, shopping, restaurant dining, and
participating in social and recreational activities. The cost of participation
in the actual social or recreational activity shall not be
c. Supporting the
individual in replacing challenging behaviors with positive, accepted behaviors
for home and community environments;
d. Monitoring and supporting the individual's
health and physical condition and providing supports with medication management
and other medical needs;
Providing routine supports and safety supports with transportation to and from
community locations and resources;
f. Providing general supports, as needed;
g. Providing safety supports to
ensure the individual's health and safety.
Service units and limits.
1. The unit of service shall be one day and
billing shall not exceed 344 days per ISP year, as indicated in the plan for
supports of the individuals who are authorized to receive this
2. This service shall be
provided on an individual-specific basis according to the ISP and service
residential service shall be a tiered service for reimbursement purposes and
providers shall only be reimbursed for the individual's assigned level and
4. DMAS coverage of this
service shall be limited to no more than two individuals per residential
setting. Providers shall not bill for service rendered to more than two
individuals living in the same residential setting.
5. This service shall be provided to
individuals up to 24 hours per day by the sponsor family or qualified
6. Room and board shall not
be components of this service.
This service shall not be simultaneously covered for individuals who are
receiving personal assistance or other residential service under the waiver,
such as shared living service, supported living service, in-home support
service, or group home residential service that provide comparable supports, as
determined by DMAS.
meet all of the requirements set forth in 12VAC30-122-110
residential service shall be provided by agencies licensed by DBHDS as a
provider of sponsored residential service.
3. Providers of this service shall have a
current, signed participation agreement with DMAS. Providers as designated on
this agreement shall render this service directly and shall bill DMAS directly
for Medicaid reimbursement.
Providers shall ensure that sponsors providing sponsored residential service
meet provider training and competency requirements as specified in
direct support staff shall be provided consistent with the requirements in
by a supervisor meeting the requirements of
Providers shall make available for inspection documentation of supervision, and
this documentation shall be completed and signed by the staff person designated
to perform the supervision and oversight. This documentation shall include, at
a minimum, the following:
(i) date of contact
contacted or observed,
summary about the direct support professional's performance and service
(iv) any action
planned or taken to correct problems identified during supervision and
residential settings shall comply with the HCBS setting requirements per 42 CFR
. In these settings, lease or residency agreements shall comply with and
support individual choice of service and setting.
Service documentation and requirements.
Providers shall include signed and dated
documentation of the following in each individual's record:
A copy of the most current, completed,
standard, age-appropriate assessment form as detailed in
plan for supports per requirements detailed in 12VAC30-122-120
Documentation as detailed in
. Data shall be collected as described in the ISP, analyzed to
determine if the strategies are effective, summarized, then clearly documented
in the progress notes or supports checklist.
d. Documentation to support units of service
delivered, and the documentation shall correspond with billing. Providers shall
maintain separate documentation for each type of service rendered for an
e. A written review
supported by documentation in the individuals' record that is submitted to the
support coordinator at least quarterly with the plan for supports, if modified.
For the annual review and every time supporting documentation is updated, the
supporting documentation shall be reviewed with the individual or
family/caregiver, as appropriate, and such review shall be documented.
f. All correspondence to the
individual and the individual's family/caregiver, as appropriate, the support
coordinator, DMAS, and DBHDS.
Written documentation of contacts made with the individual's family/caregiver,
physicians, providers, and all professionals concerning the
documentation shall support all claims submitted for DMAS reimbursement. Claims
for payment that are not supported by supporting documentation shall be subject
to recovery by DMAS or its designee as a result of utilization reviews or