INFORMATION FOR CASE MANAGERS SHARED LIVING SERVICES

WHAT IS SHARED LIVING Shared Living provides a home and supports for an adult with intellectual disabilities in the home of a qualified contracted provider. The home should be a cooperative sharing of space and supports between adults. The individual becomes part of the fabric of the Shared Living Home Provider’s life, the provider’s family, home, and community. In MaineCare it’s called Adult Foster Care

WHO IS SHARED LIVING FOR? Shared Living is for any individual with intellectual disabilities who prefers to live in a family-type home Who is eligible for MaineCare services under Section 21 Home and Community-Based Waiver Whose Person-Centered Planning team has determined this to be an appropriate living option.

A HOME PROVIDER IS A DSP A Shared Living Home Provider provides a supportive home environment, inclusion in the community and the appropriate level of support. The Shared Living Home Provider is responsible for the day to day activities that accomplish the desired outcomes as identified by the individual’s Annual Plan.

SHARED LIVING HOME PROVIDER QUALIFICATIONS Successfully pass background checks as required by MaineCare. Successfully pass team interviews and home visits. Successfully complete the training required by DHHS- OADS and MaineCare. Once all these requirements are met, the Shared Living Home Provider must contract with an Administering Agency and comply with all DHHS-OADS and MaineCare requirements.

WHAT DOES THE AGENCY DO? Recruit and match the individual’s needs with an appropriate home on behalf of DHHS-OADS. Bill MaineCare and disburse of MaineCare dollars for all services provided to the individual. Assess the qualifications as stated in DHHS-OADS guidelines and Medicaid Benefits Manual (Maine Care Section 21). Provide Quality Assurance

WHAT DO CASE MANAGERS DO? Develop and write the Person-Centered Plan with input from the individual’s team and oversee the coordination of the meetings. Play a key role in quality assurance, particularly in assessing the quality of life experienced by the individual living in a Shared Living home.

SHARED LIVING HOME PROVIDER Is self-employed and provides the Shared Living service (Home Supports) as an independent contractor of an Administering Agency. Works independently in his/her own home and community with minimal oversight and control. Has the right to contract with the agency of his/her choice for purposes of providing Share Living Home services. (The Member/Guardian chooses the Admin. Agency.) Must maintain his/her qualified status by adhering to DHHS-OADS policy, MaineCare rules, and other pertinent State laws and regulations.

SHARED LIVING HOME PROVIDER (2) Supplies, at his/her own expense: all housing, food, transportation, equipment, tools, materials, supplies, and care giving activities to perform the provisions of the Shared Living service (Home Supports). Is not paid wages for the services he/she provides. He/she receives a stipend at a rate set by the Administering Agency and funded by MaineCare. This payment is classified by the Internal Revenue Service as a “Difficulty of Care” payment.

CONTRACTOR VS. EMPLOYEE Employee Takes direction from Agency Can be disciplined per Agency Policy Is scheduled for each shift by Agency Contractor Is responsible for items identified in the contract Directs the “work” Owns the expenses of being independent from employment.

DEPARTMENT OF LABOR (DOL) A individual has to meet the DOL definition of contractor. If not, the employer is responsible for: Unemployment Wage & Hour Workman’s Compensation

IN A PROVIDER’S HOME The FLSA applies to employees, not independent contractors. A home care provider could be an employee of a consumer and/or of a third party. Only if neither is her employer is she an independent contractor. In most shared living arrangements that occur in the provider’s home, the provider will be an independent contractor.

IN A PROVIDER’S HOME When is a provider an employee? If the third party is more involved in the provider’s relationship with the consumer. For example: If a case manager instructs the provider on how to perform tasks. If the third party finds and rents the residence in which the shared living arrangement occurs. If the third party negotiates the terms of the provider’s employment, such as wages and benefits.

ROOM & BOARD IN SHARED LIVING Rep Payee negotiates Room & Board payments with the Home Provider. Negotiations should be documented and all items that are included in this payment should be included in the contract. The Agency does not control the home. The Home Provider provides the Room & Board service not the Agency in Shared Living.

PARENTS AS HOME PROVIDERS Initial qualification for Section 21 What reason was given for the health & safety need? What was the initial service requested in the application. Ongoing Shared Living by parents What do you need to know? Where does it go right/wrong? Maine Care Service Providers!

IN A CLIENT’S HOME: NOT SHARED LIVING In most shared living arrangements that occur in the consumer’s home, the provider will be an employee of the consumer or agency. The consumer or agency controls the residence, sets the schedule, etc. Therefore, the FLSA applies if: 1)there is coverage and 2)no exemption applies.

WHAT IS INCREASED LEVEL OF SUPPORT? At times, a member may require increased levels of staff support due to more intensive needs while living in a Shared Living arrangement or a Family Centered-Support model. Section 21 provides for such staffing through the increased level of support (described in full at Section (Appendix I) in Chapter II of the MaineCare Benefits Manual). The Department of Health and Human Services must review and approve each initial request for increased level of supports prior to provision, to determine whether the request satisfies the eligibility criteria and is medically necessary. Ongoing eligibility for the increased level of support must be reviewed annually by the central review team, coinciding with the annual certification/planning process.

HOME VISIT TOOL: SHARED LIVING This document is located on the Maine.gov website. The Home Visit Tool should be completed annually, signed and shared with all team members. Is required for significant changes in programming as well as annually.

SO…HOW WILL WE MANAGE THIS SERVICE MODEL TOGETHER? How do we keep the Home Provider and agency in compliance with all the ambiguity? What if there’s a problem? With provider? With agency? With case manager? What if provider or Member or guardian wants to “change agencies?” What if guardian wants to be provider?

QUESTIONS/SITUATIONS NOT identifiable situations/concerns? Questions? Comments? Suggestions?