Current through Register Vol.. 38, No. 17, April 11, 2022
A. Service description. Supported living
residential service shall take place in a residential setting operated by a
DBHDS-licensed provider of supervised living residential service or supportive
in-home service and consists of skill-building, routine and general supports,
and safety supports that enable an individual to acquire, retain, or improve
the self-help, socialization, and adaptive skills necessary to reside
successfully in home and community-based settings. Supported living residential
service shall be authorized for Medicaid reimbursement in the plan for supports
only when the individual requires this service. This service shall include a
skills development component along with the provision of supports, as needed.
Supported living residential service shall be covered in the FIS and CL
Criteria and allowable
1. Skill-building and routine
supports related to ADLs and IADLs;
2. 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 reimbursed;
3. Supporting the individual in replacing
challenging behaviors with positive, accepted behaviors for home and
Monitoring and supporting the individual's health and physical conditions and
providing supports with medication or other medical needs;
5. Providing routine supports and safety
supports with transportation to and from community locations and
6. Providing general
supports as needed; and
Providing safety supports to ensure the individual's health and
1. The unit of service shall be
one day and billing shall not exceed 344 days per ISP year.
2. Total billing shall not exceed the amount
authorized in the ISP. This service shall be provided on an individual-specific
basis according to the ISP and service setting requirements.
3. Supported living residential service shall
not be provided to any individual who receives personal assistance service or
other residential service under the FIS or CL waiver, such as group home
residential service, shared living service, in-home support service, or
sponsored residential service that provide a comparable level of
4. Room and board shall not
be components of supported residential service.
5. Supported living residential service shall
not be used solely to provide routine or emergency respite care for the
individual's family/caregiver with whom the individual lives.
6. Medicaid reimbursement shall be available
only for supported living residential service when the individual receives
supports from the plan of supports and when an enrolled Medicaid provider is
providing the service.
living residential service shall be a tiered service for reimbursement
purposes. Providers shall only be reimbursed for the individual's assigned
level and tier.
8. Supported living
residential service shall be provided to the individual in the form of
around-the-clock availability of paid provider staff who have the ability to
respond in a timely manner. This service may be provided individually or
simultaneously to more than one individual living in the apartment, depending
on the required supports.
1. The provider shall be licensed by DBHDS as
a provider of supervised residential service or supportive in-home
2. The provider shall also
be currently enrolled with DMAS as a provider. The provider designated on the
provider participation agreement shall render this service and submit claims to
DMAS for reimbursement.
Providers shall ensure that staff providing supported living residential
service meets 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
living residential service shall comply with the HCBS settings requirements
when provided in DBHDS licensed settings per 42 CFR 441.301
. 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 completed, standard,
age-appropriate assessment form as detailed in 12VAC30-122-200
The provider's 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 be provided upon request to DMAS.
3. Provider 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 audits.