(Revised 04/01/22 ML #3687)
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:
Exception: If authorizing FPC would be detrimental to the household and FHC is preferred, contact Program Administrator for consideration.
Examples for consideration may include: financial complications caused by higher provider reimbursement, etc.
Note: If FHC is preferred, FPC does not need to be sought if:
The cost of FHC services is less than $273 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 the case management, 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
The service tasks/activities within the scope of this service chapter are identified on the Authorization to Provide Services, and only those listed on the SFN 1012, Monthly Rate Worksheet (MRW), can be approved and authorized.
Tasks of laundry, shopping, housekeeping, meal preparation, money management, and communication are allowed only when the service activity benefits the individual.
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:
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. No payment is allowed for individuals out-of-state with the exception of individuals 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 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.
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:
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 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.
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)