Appendix K Amendment Office Hours Shared Living and

Appendix K Amendment: Office Hours Shared Living and Waiver Members Receiving Services from Relatives, Friends and Guardians Sections 18, 20, 21, and 29 June 12, 2020

Panel • Office of Maine. Care Services – Heather Bingelis – Tom Leet – Tammy Usher • Office of Aging and Disability Services – Derek Fales – Betsy Hopkins – Kristen Fortier Maine Department of Health and Human Services 2

Agenda 1. Shared Living - Review of Scope and Structure Changes to Availability, Setting Size, and Reimbursement Rates 2. Waiver Members Receiving Services from Family - Service Options Examples of Transitions to Family Providing Services Person-Centered Planning Team Considerations 3. Questions? Maine Department of Health and Human Services 3

Shared Living: Review • Scope of service – Direct support: personal care, protective oversight and supervision, and supportive services. – An increased level of support is available for waiver members with high medical or behavioral health needs, providing at times for 2: 1 support delivered by the Shared Living Provider and another DSP. • Structure – An agency recruits and enters into a contract with a Shared Living Provider. The agency bills Maine. Care for the service, pays the Shared Living Provider a negotiated stipend, and provides oversight and support to the Shared Living Provider. – A Direct Support Professional shares a home with a waiver member and provides individualized support. – For Shared Living settings with multiple waiver members, the members must have a pre-existing relationship (friendship, familial, romantic, etc). Maine Department of Health and Human Services 4

Shared Living: Changes • Availability – Previously, Shared Living was only in Sections 21 and 29. – The Appendix K adds Shared Living to Section 20. • Setting Size – Previously, Shared Living settings in Section 21 and 29 could serve one or two waiver members. – The Appendix K allows for Shared Living settings of up to three waiver members in Section 21 and 29, and up to two waiver members in Section 20. – Please note, waiver members from different programs may certainly choose to reside together. Maine Department of Health and Human Services 5

Shared Living: Changes, continued • Reimbursement Rates – Due to increase, agencies should amend existing contracts to increase stipend paid to Shared Living Providers. – Please note the different rates for each date range: • 3/1/2020 -5/31/2020 • 6/1/2020 - 30 days following the end of the emergency, as declared by Governor Mills, or 2/28/2021, whichever comes sooner. Maine Department of Health and Human Services 6

Waiver Members Receiving Services from Family • Service Options – Waiver members can receive Shared Living from a person in their family; this was allowed previously, and it has not changed. – The Appendix K also allows for family members to deliver other direct support services, either those in place prior to the COVID 19 emergency or services that are newly needed. – Shared Living, Home Support- Quarter Hour, and Community Support are common examples of services that waiver members have received from family through the Appendix K. – A waiver member cannot directly hire their family. The family member must be an employee or contractor of a provider agency. Maine Department of Health and Human Services 7

Waiver Members Receiving Services from Family • Examples of Transitions to Family Providing Services – Same location, service, and agency • Previously, a member living alone received Home Support- Quarter Hour from a DSP employed by Agency A. The member’s sister lives nearby; now, she is employed by Agency A and provides Home Support- Quarter Hour to make sure that the member has as few contacts as possible. – Same location, new service, and new agency • Previously, a member living with his family had received Community Support from Agency B. This was a center-based program, and it closed temporarily. The member’s uncle was hired by Agency C, and he is providing Community Support to the member. – New location, service, and agency • Previously, a member living in a group home received Home Support. Agency from Agency D. The member moved back to their family home on March 20 th because they were concerned about the risks of a congregate setting. The member’s father became a contractor of Agency E, and the member elected to receive Shared Living. Maine Department of Health and Human Services 8

Waiver Members Receiving Services from Family • Person-Centered Planning: – An update to the Care Plan/ PCP is needed to reflect a member’s decision to receive services from Family/ Relatives/ Friends/ Guardian • The service provider will update the Plan of Care/ PCP Service Description and Planning Narrative to reflect: – The need for the change (including changes to the member’s health and safety) – When the change occurred/will occur; – Description of the scope of the change; – Temporary address, (if applicable); and – Criteria for adjustment back to authorized services/ locations before the emergency began (e. g. “when the COVID-19 emergency ends”) Maine Department of Health and Human Services 9

Waiver Members Receiving Services from Family • Planning Team Considerations – Services by Family/ Relatives/ Friends/ Guardian can be retroactively authorized; however, the start date of services can be no more than sixty (60) days from the date the Plan of Care/PCP was updated. • For example: If the Plan of Care/ PCP update (aka “re-version”) date is May 15, 2020 then the service start date cannot be before March 16, 2020. – Appendix K will end within 30 days after the end of the COVID-19 State of Emergency, or by February 28, 2021, whichever comes sooner. • Are changes short or long-term? If this is not currently known, when will it be re-evaluated? What are the factors influencing this decision? Planning Teams will need to conduct a post COVID-19 assessment of needs and desires of the member/guardian. Maine Department of Health and Human Services 10

Questions? OADS@Maine. gov – subject line: Appendix K Question Maine Department of Health and Human Services * 11