Shared Living – 24-Hour Supports

(A) Conditions of Payment. (1) Shared living – 24-hour supports is a residential service that provides 24-hour, seven- days-per-week supportive services. (2) Shared living – 24-hour supports integrates the participant into the usual activities of the caregiver’s family life. In addition, there will be opportunities for learning, developing, and maintaining skills including in such areas as ADLs, IADLs, social and recreational activities, and personal enrichment. (3) The caregiver lives with the participant at the residence of the caregiver or the participant. Shared living agencies recruit caregivers, assess their abilities, coordinate placement of participant or caregiver, train and provide guidance, supervision and oversight for caregivers and provide oversight of participants’ living situations. The caregiver may not be a legally responsible family member. (4) The shared living – 24-hour supports provider must provide regular and ongoing oversight and supervision of the caregiver. (5) Shared living – 24-hour supports may be provided to no more than two participants in a home. (6) In the event the shared living caregiver is temporarily unavailable or unable to provide care, the shared living agency may bill for short-term alternative shared living—24-hour support days in accordance with all applicable guidance issued by the MassHealth agency or its designee, during which time the staff qualifications and site requirements remain the same. (B) Nonpayable Services. (1) Shared living – 24-hour supports is not available to individuals who live with their immediate family unless the immediate family member (grandparent, parent, sibling or spouse) is also eligible for shared living – 24-hour supports and had received prior authorization, as applicable, for shared living – 24-hour supports. (2) The following waiver services are not available to participants receiving shared living – 24-hour supports: assisted living and residential habilitation. (3) Payment is not made for the cost of room and board, including the cost of building maintenance, upkeep, and improvement. (4) Payment is not made for short-term alternative shared living – 24-hour support days not billed in accordance with all applicable guidance issued by the MassHealth agency or its designee. (5) Shared living – 24-hour supports may not be billed on the same day as short-term alternative shared living – 24-hour support days (C) Payer for Shared Living – 24-Hour Supports. DDS is responsible for payment to providers for shared living – 24-hour supports.