Supported Living Services (SLS) include training and assistance in maintaining a home of one’s own, or a home shared with other freely chosen housemates, in the community, not owned or controlled by any waiver service provider. SLS includes supports for maintaining home tenancy or ownership, managing money, preparing meals, shopping, maintaining positive relationships with neighbors, opportunities for participation in and contribution to the local community, supports to maintain personal appearance and hygiene, supports for interpersonal and social skills building through experience with family, friends and members of the broader community, and other activities needed to maintain and improve the capacity of an individual with an intellectual disability to live in the community.
SLS Description
The services shall support and maximize the person’s independence through the use of teaching, training, technology, and facilitation of natural supports. The service shall support the individual’s full integration into the community, ensure the person’s choice and rights, and comport fully with standards applicable to HCBS settings delivered under Section 1915(c) of the Social Security Act, including the provision of opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources. Further, supports shall be provided in a manner that ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint; and which optimizes individual initiative, autonomy, and independence in making life choices. Any modification to one or more of these HCBS setting standards must be supported by the individual’s specific assessed need and fully documented in the person-centered Individual Support Plan (ISP), along with a plan to reduce or eliminate the modification as soon as prudent, as required by federal regulation. The service also includes oversight and assistance in managing self-administered medication and/or medication administration as permitted under Alabama’s Nurse Practice Act and performance of other non-complex health maintenance tasks, as permitted by State law. The SLS provider shall monitor the health care needs of the person supported and support the person to attend to their own health care needs and/or work with natural supports to ensure the person’s health care needs are addressed. This service is appropriate for people who need intermittent staff support to remain in their own homes and do not require 24/7 staffing. However, access to emergency supports as needed from the provider on a 24/7 basis is an essential component of this residential service and is what differentiates it from Personal Assistance services. The provider must also ensure each SLS participant has an emergency preparedness plan in place at all times, that is shared with the support coordinator, and the individual is supported to learn and practice this plan at regular intervals. Individuals receiving SLS may choose to receive services in a shared living arrangement. Other persons in the shared living arrangement may need different levels of support, differing types of waiver services, or may participate in different HCBS programs, as permitted in-state licensure law and regulation, as long as there is a willing, qualified provider who can safely and appropriately meet the needs of each individual in the home. No more than 3 persons receiving services will be permitted per residence. All individual goals and objectives for SLS, along with a description of needed SLS supports to achieve these goals and objectives, shall be established through the person-centered planning process and documented in the person-centered ISP. The Circle of Support must consider the person's level of independence, availability of natural supports, ability to utilize technology, ability to rely on housemates, neighbors, etc. in establishing a Supported Living arrangement and the service delivery schedule. The Supported Living service plan must be reviewed at least annually (and more often should a change of needs or circumstances warrant). Consideration should be given to the use of a Personal Emergency Response System and/ or other technology to increase independence, when appropriate. The ISP must reflect the routine supports that will be provided by Supported Living staff while recognizing flexibility may be needed and desired by the person supported. The person may choose to live with one or two other persons supported and share living expenses or choose to live alone as long as sufficient financial resources are available to support the chosen arrangement. Payment to providers is based on a monthly fee and service delivery that must be appropriate to meet the individual needs and goals. Transportation may be necessary for some individuals and is included in the rate paid to the provider.
Reimbursement
Reimbursement for SLS shall not include the cost of maintenance of the dwelling. Residential expenses (e.g., phone, cable TV, food, rent, mortgage, home/renters insurance, etc.) shall be paid by the person(s) supported and other residents in the home (if applicable), through mutual agreement reached by the persons sharing the dwelling. A person who is receiving SLS shall not be eligible to receive Personal Care, Respite or Transportation as separate services, except for Supported Employment Transportation and Personal Care at the Worksite. With these exceptions and the additional exception of transportation to and from medical services covered through the Medicaid State Plan, transportation shall be a component of SLS and shall be included in the reimbursement rate for the service. The SLS provider shall not own the person’s place of residence under any circumstances. The provider shall not be a co-signer of a lease on the person’s place of residence unless this is necessary for person to obtain lease and , the provider signs a written agreement with the person that states that the person will not be required to move if the primary reason is because the person desires to change to a different provider. The SLS provider shall not own, be owned by, or be affiliated with any entity that leases or rents a place of residence to a person supported if such entity requires, as a condition of renting or leasing, the person to move if the person desires to change to a different SLS provider. SLS shall not be provided in any setting defined as an institutional setting under the federal Medicaid HCBS Settings Rule including inpatient hospitals, nursing facilities, and Intermediate Care Facilities for individuals with Intellectual Disabilities (ICFs/IID). Certain family member(s) of the person supported cannot be reimbursed to provide SLS i.e. spouse to spouse, parent to child, child to parent or either appointed as legal guardian and/or living with the person. Other family member(s) may be reimbursed to provide SLS if they otherwise meet the provider qualifications and hiring requirements for this service or are employed by an approved provider of SLS services. SLS shall not be provided in a home where a person supported lives with family members unless such family members are also persons receiving waiver services. Family member shall be interpreted to mean the mother, father, grandmother, grandfather, sister, brother, son, daughter, or spouse, whether the relationship is by blood, by marriage, or by adoption. Provision of personal care and companion services may be subject to EVVMS for service delivery SLS shall not be provided out-of-state. A minimum of two face-to-face direct service visits lasting at least one hour in the home per week are required for each person receiving SLS, along with 24/7 availability of provider staff in case emergency supports are needed.
Provider Requirements
The Supported living provider must meet the general requirements for the In-Home Residential specifications outlined from previous waivers. An applicant wishing to provide SLS does not need to provide evidence of compliance with fire and health standards because the service will be provided in the individual's home, but not in the home with the family for SLS. Instead, a new applicant shall submit to the Division a written plan in the form of a proposal, together with an application for programmatic certification, describing how the programmatic standards referenced above will be met. Certification surveys will follow the standards for Hourly Service Providers and may include visits to the homes of individuals being served. When the application, supporting data, and site visit, if applicable, prove the program or service is in full compliance with certification requirements, a certificate will be issued by the Division of Developmental Disabilities. Subsequent site inspections shall be scheduled in accordance with the policy and procedures of the Office of Certification. Programmatic re-surveys are conducted at one or two-year intervals depending on the previous survey outcome. Programs delivering SLS shall have a written mission statement for dissemination to prospective clients and their families. This mission statement shall address: Program philosophy and purpose; Geographical area served; Range of services provided; and Population served, including criteria for service eligibility, program admission, and program discharge. SLS services will be delivered/supervised by a QIDP in coordination with the individual's plan of care. Providers must have documented records of having completed training prior to providing services. Providers of service must maintain a service log that documents specific dates on which services were delivered, consistent with the consumer's person-centered plan. The Department of Mental Health, Division of Developmental Disabilities requires certification of programs delivering Supported Living as an in-home residential type service. Site inspections and/or Life Safety inspections shall be scheduled in accordance with policy and procedures of the ADMH/DDD only when there are documented concerns regarding the individual(s) health, safety, and/or welfare. Programmatic re-surveys are conducted at one or two-year intervals depending on the previous survey outcome. Each SLS program must develop and maintain appropriate, up-to-date staffing to provide adequate services as outlined in the PCP and POC. Program staff ratios and staff work schedules shall be maintained to meet the needs of individuals. An emergency, on-call staff person, in addition to those normally required to maintain appropriate staffing patterns, shall be available on a 24/7 basis for each individual. Staff scheduling and workplace assignments shall be so arranged as to provide services to meet individual needs. Since this service provides supported living, the staffing pattern shall be appropriate to the type and scope of programmed services and shall include staff members who meet qualifications set forth in the approved job descriptions. Supported Living services will be supervised by a QIDP in coordination with the individual's person-centered plan. The role of the QIDP is to ensure services are delivered as outlined in the PCP, POC and are based on individual needs. Qualifications:
- All providers shall be at least 18 years of age.
- Staff who have direct contact with or direct responsibility for the service recipient shall be able to effectively read, write, and communicate verbally in English and shall be able to read and understand instructions, perform record-keeping, and write reports.
- Any waiver service provider who is responsible for transporting a service recipient shall ensure that the driver has a valid driver's license and automobile liability insurance.
- Staff who have direct contact with or direct responsibility for the service recipient shall pass a criminal background check performed in accordance with AMA and ADMH Policies/Procedures
- Waiver service providers shall not have been excluded from participation in the Medicare or Medicaid programs.
- All providers must comply with ADMH/DD policies, procedures, and rules for waiver service providers, including quality monitoring requirements.
- Must have an annual TB Skin test. Documentation: Providers must have documented records of having completed training prior to providing services. Providers of service must maintain a service log that documents specific dates on which services were delivered, consistent with the consumer's plan of care. All service visits should be signed by the individual being served at each visit. Each visit signature must be original. Copied signatures will not be accepted. An applicant wishing to provide Supported Living Services under this waiver does not need to provide evidence of compliance with fire and health standards because the service will be provided in the individual's home. Instead, a new applicant shall submit to the Division a written plan in the form of a proposal, together with an application for programmatic certification, describing how the programmatic standards referenced above will be met. Certification surveys will follow the standards for Hourly Service Providers and may include visits to the homes of individuals being served. When the application, supporting data, and site visit, if applicable, prove the program or service is in full compliance with certification requirements, a certificate will be issued by the Division of Developmental Disabilities. Subsequent site inspections shall be scheduled in accordance with the policy and procedures of the ADMH/DD Division. Programmatic re-surveys are conducted at one or two-year intervals depending on the previous survey outcome.