Adult Foster Care 525-05-30-15

(Revised 2/1/17 ML #3490)

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Purpose

The purpose of Adult Foster Care is to offer a choice within a continuum of care to adults who could benefit from living in a family environment, as well as to promote independent functioning to the limit of a person's ability and provide for a safe and secure environment.

Service Eligibility, Criteria for

The individual receiving Adult Foster Care will meet the following criteria:

1. Must be eligible for the programs of Medicaid Waiver for Home and Community Based Services, SPED, or ExSPED;
2. Be at least eighteen years of age or older;
3. Not be eligible for or receiving foster care for children;
4. Have needs or a disability that makes a family home environment an appropriate care setting;
5. A licensed Adult Foster Care home is available;
6. Not be related by blood or marriage to the licensed provider;
7. The care required by the recipient of Adult Foster Care does not exceed the documented skill in personal care of the available licensed provider; and
8. The care is provided by a licensed Adult Foster Care home provider.

Service Payment Procedures

1. If public funds are used for payment, the following criteria applies:

1. A rate of no more than the current maximum room and board rate per month shall be paid to the licensed provider by the recipient for board and room costs.

• The first source for the board and room cost is from the recipient’s income.
• Another potential source of funds could be county general assistance funds.
• SPED funds, Ex-SPED funds, and Medicaid Waiver funds cannot be used for room and board. Room and Board is the responsibility of the recipient and is not included in the provider's daily rate.

2. The service payment for Adult Foster Care is determined using the Monthly Rate Worksheet, SFN 1012, and is in addition to the amount for board and room.
3. The maximum service payment that may be allowed to a recipient of adult foster care is listed in the funding source manuals, Section 05-35.
4. Under the SPED program, other funding (i.e. private pay, county funds) may augment the Adult Foster Care Service payment.  

2.  If the funding source is self-pay, the following applies:

1. The service payment is the amount negotiated between the recipient or their representative, and the licensed Adult Foster Care provider.
2. Case Management is not a required service.

Service Tasks

The service tasks/activities within the scope of this service chapter are identified on the Authorization to Provide Service SFN 1699 or Authorized for Waivered Services SFN 404, and the Monthly Rate Worksheet, SFN 1012.  Only tasks indicated as needed on the SFN 1012 can be authorized on the SFN 1699 or Authorized for Waivered Services.

To avoid duplication homemaker, chore, emergency response system, residential care, transitional care, attendant care, environmental modification, and non-medical transportation are not allowable service combinations for individuals receiving AFC. Non- medical transportation is a component of AFC and is included in the rate.

Prohibited Activities effective 12/31/2016

The provision of adult foster care services funder under the waiver, SPED or Ex-SPED must ensure an individual’s right of privacy, dignity, and respect. Coercion, seclusion, or restraint of waiver recipients is expressly prohibited in all adult foster care settings.

Critical Incident Reporting

Unauthorized restraints are required to be reported as suspected abuse, neglect, or exploitation per NDCC 50-25.2.

Arranging for Adult Foster Care Service

When arranging for placement, the HCBS Case Manager must consider the following:

1. Care needs of the individual must not be in excess of the capacity of the provider;
2. The physical structure of the home must allow for the needs of the individual (i.e. individuals who are not independently mobile); and
3. Any physical or mental condition that may deem Adult Foster Care inappropriate.

Service Combinations

Adult Foster Care is an inclusive 24-hour service. Therefore, Respite Care and Extended Personal Care are the only allowable service(s) that can be authorized with the Adult Foster Care Service.

NOTE: There must be more than one QSP identified on the care plan (i.e. there may be two or more licensed providers in the home) as it is not reasonable to allow one provider to be responsible for 24 hours of care per day. If there is only one licensed AFFC provider in the home, respite must be authorized so that the provider can take necessary breaks away from their caregiving responsibilities.

A client who is a resident of an Adult Foster Care home may choose their respite provider and is not required to use a relative of the Adult Foster Care provider for respite.

When the client in an Adult Foster Care home receives overnight care in another adult foster care home, the care rate is the same as the adult foster care rate and the procedure code used by the substitute Adult Foster Care provider will be the Adult Foster Care procedure code.

Client Out of Home with Foster Care Provider

A provider may claim payment for care of the client when the client vacations with the foster care provider if the client has continuously lived with the foster family for a substantial period of time and the client made an independent choice to vacation with the family. The provider must report the following to the county social service agency prior to departure:

1. The dates the client will be vacationing with the foster family;  
2. The telephone number(s) where they can be reached;
3. The names and addresses of individuals they will be visiting, if applicable; and
4. A travel itinerary, if applicable.

The client must remain in the care of the foster care provider. Care of the client cannot be transferred to other family, friends, or anyone else during that time.

Employment Outside of the Home

Adult foster care is an inclusive 24-hour service. Therefore, employment outside of the home is generally not allowable. An adult foster care provider may be employed outside the home if the license to provide adult foster care was issued to more than one individual and at least one of the licensed individuals remains in the home to provide the care.

If an AFC client is enrolled in a day-program (documented in the client’s plan of care) and is out of the home, outside employment by the AFC provider may be considered during the hours the client is away. However, client care cannot be compromised.

Employing individuals other than those who meet the definition of a respite provider or substitute caregiver is not permitted. Employing respite care providers or substitute caregivers to assist in the daily operation of the adult foster care home is also prohibited. Respite care and substitute caregivers may provide care only in the absence of the provider.

The HCBS Case Manager must be informed of outside employment to evaluate whether client care would be negatively impacted.