12VAC30-120-1028
In-home support service description. In-home support services means residential services that take place in the individual's home, family home, or community settings that typically supplement the primary care provided by the individual, family, or other unpaid caregiver and are designed to ensure the health, safety and welfare of the individual. This service shall consist of skill-building and routine supports, 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. In-home support services require the presence of a skills development (formerly called training) component, along with the provision of supports. In-home support services is not a tiered service but shall be reimbursed according to the number of individuals served.
Units and limits. The unit shall be one hour. These services shall not typically be provided 24 hours per day but may be authorized for brief periods up to 24 hours a day when medically necessary. This service shall not be covered for the individual simultaneously with the coverage of group home residential, supported living residential, or sponsored residential services. Individuals may have in-home supports, personal assistance, and respite services in their ISP but shall not receive these Medicaid-reimbursed services simultaneously.
D. Allowable activities include:
1. Skill-building and providing routine supports and safety supports related to personal care activities (ADLs);
2. Skill-building and providing routine supports and safety supports related to the use of community resources (transportation, shopping, dining at restaurants, and participating in social and recreational activities);
3. Supporting the individual in replacing challenging behaviors with positive, accepted behaviors for home and community environments;
4. Monitoring the individual's health and physical condition and providing general supports and safety supports with medication or other medical needs;
5. Providing supports with ADLs and IADLs and using community resources;
6. Providing supports with transportation to and from training sites and community resources; or
7. Providing safety supports to ensure the individual's health and safety.
Note the above and then think through the issue/process:
The basis of any plan is the person – what is important to and what is important for; if there is an individual living in an apartment who receives in-home services to support “important to and important for” at hours/days when they are not engaged in other activities such as supported employment, competitive work, other day support services, visits with friends or family, church, etc. These supports are not routinely provided during nighttime hours.
Heretofore, a schedule was proposed and hours needed for supports such as accompanying the individual to a doctor’s appointment, providing safety supports if the individual is ill and not participating in other scheduled activities, providing assistance in using community resources on days when the individual is not working because it is a holiday, etc., have been requested through the authorization system as “periodic support.”
“Periodic supports” are no longer allowed for this service, BUT the service plan developed as per the above is still valid unless there has been a significant change in the circumstances (in which case a new team meeting should be held). And in order to continue to support the individual in the residential option of their choice and NOT force a move to a far more expensive and less desirable (in their opinion) group home setting, the In-Home hours requested within the regulatory parameters above can meet the needs. The plan might include a semi regular “schedule” of hours and a more flexible schedule to meet the episodic needs described above.