Family Home Care 525-05-30-30

(Revised 1/1/19 ML #3543)

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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 client and the qualified family member shall reside in the same residence.
3. The client and the qualified family member shall mutually agree to the arrangement.
4. The qualified family member must be one of the relatives as defined in this chapter and must be the provider performing the care to the client.
5. The need for services must fall within the scope of tasks identified on the SFN 1012, Monthly Rate Worksheet - Live-In Care, and SFN 1699, Authorization to Provider 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 client is responsible for paying the Qualified Service Provider (QSP) directly for room and board IF the client lives in the provider's home.

Service Tasks/Activities - Family Home Care

The service tasks/activities within the scope of this service chapter are identified on the Authorization to Provide Services for SPED/ExSPED, SFN 1699, and only those listed on the SFN 1012, Monthly Rate Worksheet (MRW), can be approved and authorized.

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 client 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.) The child is most likely homebound or bedridden. There must be documentation that application was made for Developmental Disabilities Case Management, and a copy of the denial letter be placed in the client’s file. A letter saying the applicant/child is not receiving DD services is not sufficient.

Out of Home Care

Payment can be made for days the client is receiving the SAME care from the SAME caregiver-QSP although not in the home they otherwise mutually share.  No payment is allowed for clients out-of-state with the exception of clients seeking medical care out of state.

For care out of state, prior approval must be granted from the HCBS Program Administrator.  

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

This provision within the Family Home Care service is appropriate for clients 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 client’s welfare and safety. The client 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 client 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 client’s continued health and safety.

Service Combinations

Family home care is an inclusive 24-hour service. Therefore, only 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 clients 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 a client cannot be safely left alone.
• If informal respite is in place and of benefit to the client, an exception must be obtained from the HCBS Program Administrator.

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 clients who require supervision for cognitive or heath related reasons. Contact the HCBS Program Administrator in writing to obtain approval for the combination of FHC and ERS service.
4. 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.