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Respite

Respite shall mean services provided to a person when unpaid caregivers are absent or incapacitated due to death, hospitalization, illness, or injury, or when unpaid caregivers need relief from routine caregiving responsibilities.  Respite may be provided in the person's place of residence, in a Family Model Residential Support home, in a Medicaid-certified ICF/IID, in a home operated by a licensed residential provider, in a licensed respite care facility, or in the home of an approved respite provider.  The Respite provider may also accompany the person on short outings for exercise, recreation, shopping or other purposes while providing respite care.

Reimbursement for Respite shall not include payment for Respite provided by the spouse of a person or family member or relative (whether by birth or marriage) who resides with the person in the home. The Respite provider and provider staff shall not be the parent or custodial grandparent of a person under age 18 years, whether the relationship is by blood, by marriage, or by adoption; and reimbursement shall not include payment for Respite provided by such individuals.  Reimbursement for Respite shall not include payment for Respite provided by any other individual who has been appointed as the conservator for the person unless so permitted in the Order for Conservatorship.  Family members who provide Respite must meet the same standards as providers who are unrelated to the person, including implementing services as specified in the individual support plan (ISP). 

When less than 8 hours of respite services is needed in a day, the unit of reimbursement shall be per 15 minutes. When 8 hours or more of respite services are needed in a day, the unit of reimbursement shall be per day.

Level 1 per day reimbursement shall be for persons requiring at least 8 hours, but less than 16 hours of respite services in a day.  Level 2 per day reimbursement shall be for persons requiring 24 hour respite services, but no awake overnight direct support staff.  Level 3 per day reimbursement shall be for persons requiring 24 hour respite services with awake overnight direct support staff. Respite shall be limited to a maximum of 30 days per person per year.

Family members are required to implement services as specified in the individual support plan (ISP). Reimbursement to family members shall be limited to forty hours per week per family member for self-directed services as well as those delivered by contracted provider agencies. The person’s Circle of Support is responsible for determining if the use of family members to deliver paid care is the best choice for the person-supported and shall ensure that paid services do not supplant natural supports that would otherwise be provided at no cost to the Medicaid program.

Providers who receive the per diem reimbursement rate for Respite shall be responsible for the cost of any Day Services needed while the person is receiving Respite services.

Respite Services shall not be provided during the same time period that the person is receiving Personal Assistance Services, Day Services, or services under a 504 Plan or Individual Education Program (IEP), is being homeschooled, or any combination thereof.

Respite Services shall not be used to replace or supplant personal assistance services.

Applicable limits, if any, on the amount, frequency, or duration of this service: Maximum of 30 days per person per year.

 

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