Family Home Care 525-05-30-30

(Revised 02/01/2025 ML #3899)

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Purpose

The purpose of family home care is to assist individuals to remain with their family members and in their own communities. It provides an option for an individual who is experiencing functional impairments which contribute to his/her inability to accomplish activities of daily living.

Service Eligibility, Criteria for

The individual receiving Family Home Care will meet the following criteria:

1. Must be eligible for the SPED or ExSPED program.
2. The individual and the family member must reside in the same residence.
3. The individual and the family member must mutually agree to the arrangement.
4. QUALIFIED SERVICE PROVIDER (QSP) SERVICE AGREEMENT -LIVE IN PAID CAREGIVERS, SFN 1654, is required for all Family Home Care providers.
5. The family member must be one of the relatives as defined in Family Home Care N.D.C.C 50-06.2-02(4), and must be the provider performing the care to the individual. Family Home Care can be provided by the "spouse or by one of the following relatives, or the current or former spouse of one of the following relatives, of the elderly or disabled person: parent, grandparent, adult child, adult sibling, adult grandchild, adult niece, or adult nephew."
6. The need for services must fall within the scope of tasks that includes bathing, communication, dressing/undressing, eye care, feeding/eating, hair care/shaving, housework, incontinence, laundry, meal preparation, medication assistance, mobility, money management, fingernail care, shopping, skin care, teeth/mouth care, toileting, transferring/turning/positioning, supervision, exercises, hoyer lift/mechanized bath chairs, indwelling catheter, medical gases, prosthesis/orthotics, suppository/bowel program, TED socks, temp/bp/pulse/respiration rate, apnea monitor, jobst stockings, ostomy care, postural/bronchial drainage, and RIK bed care. The identified tasks for the individual are listed on the service authorization.

   1. The FHC provider is not required to have global endorsements or client specific endorsements.

   2. The FHC provider may be authorized for medication administration even if the individual is not able to self-direct their medications.

7. The individual must have a daily personal care and/or supervision need that is provided by the FHC provider.
8. The provider for FHC must provide a minimum total of one (1) hour of care to the eligible individual per day. The one hour per day includes the daily personal care or supervision need and any other allowable task under FHC.

   a. The one hour of care per day may include homemaker tasks within the limits allowable under SPED.

9. The number of reimbursable hours of care for this service cannot exceed 10 hours per day.
10. The individual does not qualify for Family Personal Care (FPC). If an individual receives or would be eligible for Medicaid and meets level of care screening, FPC must be sought as opposed to Family Home Care (FHC).

Exception: If authorizing FPC would be detrimental to the household and FHC is preferred, contact Program Administrator for consideration.

Note: A provider who is on Medicaid is not allowed to request a lower rate than what is calculated based on the service recipient’s needs. Per Medicaid guidelines: if a provider is on Medicaid, all income available to that provider must be considered and counted.

• If a provider on Medicaid has questions about how payment will affect their eligibility, they should refer to their eligibility worker.

• If a provider receiving other financial assistance such as TANF, SNAP, housing assistance, SSI, etc. has questions about how payment with affect their eligibility, they should refer to the authorizing entity.

Note: If FHC is preferred, FPC does not need to be sought if:

The cost of FHC services is less than $233 a month.

Note: If FHC is preferred, FPC does not need to be sought if:

The individual’s Medicaid was closed due to not meeting recipient liability, or it is clear they would not meet recipient liability (after summing the medical expenses, plus Medicaid waiver services).

A flat rate of no more than the current maximum room and board rate per month has been established for room and board. The individual is responsible for paying the Qualified Service Provider (QSP) directly for room and board IF the individual lives in the provider's home.

Service Tasks/Activities - Family Home Care

Tasks of laundry, shopping, housekeeping, meal preparation, money management, and communication are allowed only when the service activity benefits the individual. The service of family home care is not intended to be used primarily for environmental tasks. The individual must have a daily personal care and/or supervision need to qualify for this service.

The department may pay a provider for homemaker tasks that would otherwise be considered the individual’s share of the responsibility to complete the task. An example of this would be authorizing housekeeping for the individual’s personal private space OR their shared responsibility of cleaning the common living space.

Family Home Care Limitation, Under 18 Years of Age

In addition to the eligibility criteria set forth above, the following conditions must be met by the under 18 year old potential recipient of family home care AND caregiver/qualified service provider. If the conditions cannot be met, the individual under 18 years of age is NOT eligible for Family Home Care:

1. The provider must be either the parent or spouse of the individual who is under the age of 18.
2. The caregiver/qualified service provider provides continuous care to the child. That is, the individual's/child's disability prohibits his/her participation in programs and/or activities outside the home; the child is unable to regularly attend school OR is severely limited in the amount of time at school. (The relationship to school attendance applies even when school is not in session; would the child be able to attend school and to what extent if it were in session.) If it appears that the child may be eligible for DD services, an application must be made to the DD Division to make this determination prior to consideration of SPED. There must be documentation that application was made for DD services, and a copy of the denial letter be placed in the individual’s file. A letter saying the applicant/child is not receiving DD services is not sufficient.

Service Location

Services will be administered in the most integrated setting consistent with the Person Centered Plan of Care, including (checked if allowable):

ü The individual's home

ü Workplace

ü Other community service settings

Out of Home Care

Payment can be made for days the individual is receiving the SAME care from the SAME caregiver-QSP although not in the home they otherwise mutually share.  For care out of state, prior approval must be granted by the HCBS Program Administrator. No payment is allowed for care provided outside of the country.

Provider Need Not be Present in the Home on a 24-Hour Basis

This provision within the Family Home Care service is appropriate for individuals who can be left alone for routine temporary periods of time (e.g. part-time employment of the qualified family member) without adverse impact to the individual’s welfare and safety. The individual must agree to be left alone.

• This provision does NOT allow for the qualified family member to hire a provider to provide care for the individual during routine absences from the home.
• This provision does not allow a provider to work full time unless the arrangement has been approved by an HCBS Program Administrator and assures the individual’s continued health and safety.

Service Combinations

Family home care is an inclusive 24-hour service. Therefore, respite care service along with family home care is acceptable as described under the following circumstances:

1. There is full-time family home care service provided by a qualified family member. When the family member provides less than 24-hour per day care on a routine basis, respite care is only appropriate when the qualified family member's absence occurs outside the routine scheduled absences, for example, to attend a wedding.
2. If individuals cannot be safely left alone so that the provider can take necessary breaks away from their caregiving responsibilities respite must be authorized.

If supervision is an authorized task on the MRW, respite care must be an authorized service, as it is not reasonable to allow one provider to be responsible for 24 hours of care per day.

• Respite care must be authorized because FHC providers cannot delegate their care to another individual if the individual cannot be safely left alone.
• If informal respite is in place and of benefit to the individual and the family home care provider, the case manager must document that formal respite care was offered and declined.

3. Emergency response is acceptable if a safety risk (i.e. potential fall risk or sudden illness) has been identified during the FHC provider’s short term absence. ERS is not acceptable for individuals who require supervision for cognitive or heath related reasons.
4. For some situations, it may be appropriate for two Family Home Care providers to be authorized to provide care to one individual if both providers meet the Family Home Care definition. However, both Family Home Care Providers cannot bill for the service on the same day. Pre-approval is required for services authorized in this manner. See Paid Family or Household Members/Qualified Service Provider (QSP) Service Agreement - Live in Paid Caregivers 525-05-45-50 for instructions on how the QSP Service Agreements are completed for these instances.
5. See Paid Family or Household Members/Qualified Service Provider (QSP) Service Agreement - Live in Paid Caregivers 525-05-45-50 for instructions on how the QSP Service Agreements are completed if one Family Home Care provider has been approved to provide daily live-in care to more than one individual.
6. Under unusual or unique circumstances other HCBS service combinations may be appropriate. In such cases, contact the HCBS Program Administrator in writing to obtain approval.

Authorization

When an individual’s live-in provider changes from a unit rate service to daily rate service, the case manager ends the unit-rate service the last day of the month and authorizes the daily rate service the first day of the next month.

• Example: an individual’s provider is authorized for SPED T1019 and the living situation changes to where the individual and provider reside together and are eligible for Family Home Care. The case manager ends T1019 the last day of the month and starts Family Home Care the first day of the next month.

When an individual’s live-in provider changes from one daily rate service to another daily rate service, the case manager ends the first service the last day of the month and authorizes the new service the first day of the next month.

• Example: An individual’s provider is authorized for Family Home Care but becomes approved for Family Personal Care. The case manager ends Family Home Care the last day of the month and starts Family Personal Care the first day of the next month.

Providers

Family Home Care may be provided by the following individuals (checked if allowable):

ü Guardian

ü Legally Responsible Person - Legal spouse or parent of a minor child.

ü Relative within the definition of Family Home Care under subsection 4 of N.D.C.C. 50-06.2-02. (Required)

Limits

If the provider is a live-in provider and meets the criteria for FHC, the individual is not eligible for SPED PC Daily Rate.

The number of reimbursable hours of care for FHC cannot exceed 10 hours per day.

1. The provider may provide more care than 10 hours, but the State is not obligated to pay because that care is being provided because of their close personal relationship and that they share a household with the eligible individual.