La. Admin. Code tit. 50 § XXI-16303

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXI-16303 - Community Living Supports

A. Community living supports (CLS) are provided to a beneficiary in his/her own home and in the community to achieve and/or to maintain the outcomes of increased independence, productivity, and enhanced family functioning, to provide relief of the caregiver, and to provide for inclusion in the community. Community living supports may be a self-directed service.

B. Community living supports focus on the achievement of one or more goals as indicated in the beneficiary's approved plan of care by incorporating teaching and support strategies. Supports provided are related to the acquisition, improvement, and maintenance of independence, autonomy and adaptive skills. These skills include:

1. self-help skills;

2. socialization skills;

3. cognitive and communication skills; and

4. development of appropriate, positive behaviors.

a. - b. Repealed.

C. Place of Service. CLS services are furnished to adults and children who live in a home that is leased or owned by the beneficiary or his/her family. Services may be provided in the home or community, with the place of residence as the primary setting.

D. Community living supports may be shared by up to three beneficiaries who may or may not live together, and who have a common direct service provider agency. In order for CLS services to be shared, the following conditions must be met.

1. An agreement must be reached among all of the involved beneficiaries, or their legal guardians, regarding the provisions of shared CLS services. If the person has a legal guardian, their approval must also be obtained. In addition, CLS direct support staff may be shared across the Children's Choice or New Opportunities Waiver at the same time.

2. The health and welfare must be assured for each beneficiary.

3. Each beneficiary's plan of care must reflect shared services and include the shared rate for the service indicated.

4. A shared rate must be billed.

5. The cost of transportation is built in to the community living services rate and must be provided when integral to community living services.

E. Service Exclusions

1. Community living supports staff are not allowed to sleep during billable hours of community living supports.

2. Payment does not include room and board or the maintenance, upkeep, and improvement of the provider's or family's residence.

3. Community living supports may not be provided in a licensed respite care facility.

4. Community living supports services are not available to beneficiaries receiving any of the following services:

a. shared living;

b. host home; or

c. companion care.

5. Community living supports may not be billed at the same time on the same day as:

a. day habitation;

b. prevocational services;

c. supported employment;

d. respite care services-out of home;

e. transportation-community access;

f. monitored in-home caregiving (MIHC); or

g. adult day health care.

6. Community living supports may not be provided in a licensed respite care facility.

7. Community living supports services are not available to participants receiving any of the following services:

a. shared living;

b. host home;

c. companion care; or

d. monitored in-home caregiving (MIHC).

8. Community living supports may not be billed at the same time on the same day as:

a. day habilitation;

b. prevocational services;

c. supported employment;

d. respite care services-out of home;

e. transportation-community access;

f. monitored in-home caregiving (MIHC); or

g. adult day health care.

9. Payment will not be made for services provided by a relative who is:

a. parent(s) of a minor child;

b. legal guardian of an adult or child with developmental disabilities;

c. spouse of or legally responsible adult for the participant; or

d. power of attorney, curator, or authorized responsible representative for the waiver participant.

F. Provider Qualifications. CLS providers must be licensed by the Department of Health as a home and community-based services provider and meet the module requirements for personal care attendant in LAC 48:I. Chapter 50.

1. Family members who provide CLS services must meet the same standards as providers who are unrelated to the beneficiary. Service hours shall be capped at 40 hours per week, Sunday to Saturday, for services delivered by family members living in the home.

2. Legally responsible individuals (such as a parent or spouse) and legal guardians may provide community living supports services for a beneficiary provided that the care is extraordinary in comparison to that of a beneficiary of the same age without a disability and the care is in the best interest of the beneficiary.

La. Admin. Code tit. 50, § XXI-16303

Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2443 (November 2007), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 422157 (10/1/2015), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 451765 (12/1/2019), Amended LR 471510 (10/1/2021), Amended LR 481561 (6/1/2022).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.