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HomeMy WebLinkAboutIDD-503 Room and Board ProceduresFRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Room and Board Procedures PROCEDURE NUMBER: IDD-503 Effective Date: January 1, 2005 Date Revised: November 20, 2025 Reference: Chapter 6100 Services for Individuals with an Intellectual Disability or Autism §§ 6100.681 – 6100.694, Attached DP 1077 and 1077 LS Room and Board Contract BACKGROUND: In accordance with the Chapter 6100 Services for Individuals with an Intellectual Disability or Autism section 6100.681-6100.694, the Office of Developmental Programs (ODP) has developed a Department approved standard room and board contract form to be used for waiver participants who receive unlicensed or licensed residential habilitation services. Section § 6100.687 (a) states, “the provider shall ensure that a room and board residency agreement, on a form specified by the Department, is completed and signed by the individual annually.” This contract should also be used for base-funded participants when the provider renders residential habilitation services to both waiver and base-funded participants at the same waiver service location. PROCEDURE: ROOM AND BOARD REQUIREMENTS FOR RESIDENTIAL HABILITATION SERVICES § 6100.681. Room and board applicability. ▪ Sections 6100.682—6100.694 apply for the room and board rate charged to the individual in provider owned or leased residential service locations and in life sharing homes that are not owned or leased by the individual. § 6100.682. Assistance to the individual. a) If an individual is not currently receiving Social Security Administration (SSA) benefits, the provider shall provide assistance to the individual to contact the Social Security Office. b) If an individual is denied SSA benefits, the provider shall assist the individual in filing an appeal. c) The provider shall assist the individual to secure information regarding the continued eligibility of SSA for the individual. d) The provider shall keep documentation of the individual's application for SSA benefits, the SSA eligibility determination and, if applicable, the appeal filed under subsection (b). § 6100.683. No delegation permitted. ▪ The provider shall collect the room and board from the individual or the person designated by the individual directly and the provider may not delegate that responsibility. § 6100.684. Actual provider room and board cost. a) The total amount charged for the individual's share of room and board may not exceed the actual documented room and board costs at the individual's residential service location, minus the benefits received as specified in § 6100.685 (relating to benefits). b) The provider shall compute and document actual provider room and board costs each time an individual signs a new room and board residency agreement. c) The provider shall keep documentation of actual provider room and board costs. d) The following items are included as room and board costs: i. Standard toiletries, towels and bedding. ii. One telephone with local telephone service. iii. Internet service. iv. Cleaning products. v. Household furniture. vi. Food choices of the individual, with consideration of the food cost and nutrition, including the individual's preference, culture, religion and beliefs, and an individual's prescribed diet, if the prescribed diet is not covered by the individual's health care plan or another funding source. vii. Laundry of towels, bedding and the individual's clothing. viii. Lawn care, food preparation, maintenance and housekeeping, including staff wages and benefits, to perform these tasks. ix. Meals provided away from the residential service location that are arranged by a staff person in lieu of meals provided in the residential service location. x. Incontinence products, if the incontinence product is not covered by the individual's health care plan or another funding source. xi. Building and equipment repair, renovation and depreciation. xii. Rent, taxes, utilities and property insurance. § 6100.685. Benefits. a) The provider shall assist an individual in applying for energy assistance, rent rebates, food and nutrition assistance and similar benefits. b) If energy assistance, rent rebates, food and nutrition assistance or similar benefits are received, the provider shall deduct the value of these benefits from the documented actual provider room and board cost as specified in § 6100.684 (relating to actual provider room and board cost) before deductions are made to the individual's share of room and board costs. c) An individual's energy assistance, rent rebates, food and nutrition assistance or similar benefits may not be considered as part of an individual's income. d) The provider may not use the value of energy assistance, rent rebates, food and nutrition assistance or similar benefits to increase the individual's share of room and board costs beyond actual room and board costs as specified in § 6100.684. § 6100.686. Room and board rate. a) If the actual provider room and board cost as specified in § 6100.684 (relating to actual provider room and board cost), less any benefits as specified in § 6100.685 (relating to benefits), is more than 72% of the SSI maximum rate plus the Pennsylvania supplement, the following criteria shall be used to establish the room and board rate: 1) An individual's share of room and board may not exceed 72% of the SSI maximum rate plus the Pennsylvania supplement. 2) The proration of board costs shall occur after an individual is on leave from the residence for a consecutive period of 8 days or more. This proration may occur monthly, quarterly or semiannually as long as there is a record of the board costs that were returned to the individual. b) If an individual has earned wages, personal income from inheritance, Social Security or other types of income, the provider may not assess the room and board cost for the individual in excess of 72% of the SSI maximum rate plus the Pennsylvania supplement. c) If available income for an individual is less than the SSI maximum rate, the provider shall charge 72% of the individual's available monthly income as the individual's monthly obligation for room and board. d) An individual shall receive at least the monthly amount as established by the Social Security Administration related to the specific type of residential service location, for the individual's personal needs allowance. § 6100.687. Completing and signing the room and board residency agreement. a) The provider shall ensure that a room and board residency agreement, on a form specified by the Department, is completed and signed by the individual annually. b) If an individual is adjudicated incompetent to handle finances, the individual's court appointed legal guardian shall sign the room and board residency agreement. c) If an individual is 18 years of age or older and has a designated person for the individual's benefits, the designated person shall sign the room and board residency agreement. d) The room and board residency agreement shall be completed and signed in accordance with one of the following: 1) Prior to an individual's admission to residential service. 2) Prior to an individual's transfer from one residential service location or provider to another residential service location or provider. 3) Within 15 days after an emergency residential service placement. § 6100.688. Modifications to the room and board residency agreement. a) If an individual pays rent directly to a landlord and food is supplied through a provider, the room provisions shall be deleted from the room and board residency agreement and the following shall apply: 1) The individual shall pay 32% of the SSI maximum rate plus the Pennsylvania supplement for board. 2) If an individual's income is less than the SSI maximum rate plus the Pennsylvania supplement, 32% of the available income shall be charged to fulfill the individual's monthly obligations for board. b) If an individual pays rent to a provider, but the individual purchases the individual's own food, the board provisions shall be deleted from the room and board residency agreement and the following shall apply: 1) The individual shall pay 40% of the SSI maximum rate plus the Pennsylvania supplement for room. 2) If an individual's income is less than the SSI maximum rate plus the Pennsylvania supplement, 40% of the available income shall be charged to fulfill the individual's monthly obligations for room. § 6100.689. Copy of room and board residency agreement. a) A copy of the completed and signed room and board residency agreement shall be given to the individual, the individual's designated person and the individual's court-appointed legal guardian, if applicable. b) A copy of the completed and signed room and board residency agreement shall be kept in the individual's record. § 6100.690. Respite care. ▪ There may not be a charge for room and board to the individual for respite care. § 6100.691. Hospitalization. ▪ There may not be a charge for room and board to the individual after 30 consecutive days of being in a hospital or rehabilitation facility and the individual is considered in reserved capacity. § 6100.692. Exception. ▪ There may not be a charge for board to the individual if the individual does not take food by mouth. § 6100.693. Delay in an individual's income. ▪ If a portion or all of the individual's income is delayed for one (1) month or longer, the following apply: 1) The provider shall inform the individual, the individual's designated person or the individual's Court-appointed legal guardian in writing that payment is not required or that only a negotiated amount is required. 2) Room and board shall be charged to make up the accumulated difference between room and board paid and room and board charged according to the room and board residency agreement. ATTACHMENT: Room and Board Contract - DP 1077 and DP 1077 LS Services for Individuals with an Intellectual Disability or AutismRoom and Board Residency Agreement § 6100.687 55 Pa. Code Chapter 6100 THIS AGREEMENT, made on between , hereinafter referred to as individual, and at hereinafter referred to as provider agency. This agreement may only be effective for a maximum of 12 months from the effective date of the agreement. Whereas, the individual is participating in a residential program administered by the provider agency; and room and board is furnished by the provider agency at: TERMINATION OF THE AGREEMENT: The provider agency must notify the individual in writing if the provider agency is no longer willing to provide residential services to the individual at the address of residence. The provider agency must give this notice to the individual at least 45 days prior to the date of the proposed change in provider or address of residence as described in 6100.301-307. EFFECTIVE DATE OF AGREEMENT NAME OF INDIVIDUAL PROVIDER AGENCY ADMINISTERING PROGRAM ADDRESS OF ADMINISTERING PROVIDER AGENCY ADDRESS OF RESIDENCE SIGNED: ________________________________________________________________ _______________ PROVIDER AGENCY DATE ________________________________________________________________ _______________ WITNESS DATE ________________________________________________________________ _______________ INDIVIDUAL OR OTHER DESIGNATED PERSON SIGNING ON INDIVIDUAL’S BEHALF (INCLUDE RELATIONSHIP TO INDIVIDUAL) DATE ________________________________________________________________ _______________ REPRESENTATIVE PAYEE, IF OTHER THAN PROVIDER AGENCY OR INDIVIDUAL DATE ________________________________________________________________ _______________ COURT APPOINTED LEGAL GUARDIAN, IF APPLICABLE DATE DP 1077 5/24 I. INDIVIDUAL’S RESPONSIBILITIES: 1.Individual agrees to pay provider agency a total of $ __________ for room and/or board. This amount is based on the following (oneapplicable box must be checked below): p No more than 72 percent of the SSI maximum rate plus the Pennsylvania Supplement. (This should be checked if provider agency provides both room and board to individual.) p No more than 32 percent of the SSI maximum rate plus Pennsylvania Supplement for board. (This should be checked if individual pays their own rent directly to a landlord, but food is supplied through provider agency.) p No more than 40 percent of the SSI maximum rate plus Pennsylvania Supplement for room. (This should be checked if the individual pays rent to provider agency, but individual purchases their own food.) 2.If individual’s available income is less than the SSI maximum rate plus Pennsylvania Supplement, provider agency shall charge 72 percent of individual’s available monthly income as individual’s monthly obligation for room and board; 32 percent for board if food issupplied through provider agency; or 40 percent for room if individual purchases their own food. The individual shall receive at least themonthly amount as established by the Social Security Administration related to the specific type of setting, for the individual’s personal needs allowance. 3.In addition to the room and board amount listed in this agreement, the individual also agrees to pay the provider agency any moneyreceived through Pennsylvania’s Rent Rebate Program. The provider agency will deduct the value of the rent rebate from the actualdocumented room and board costs of individual’s residence. 4.The total amount charged for the individual’s share of room and board may not exceed the actual documented room and board costs of the individual’s residence minus the benefits received. 5.Payment shall be made on a monthly basis and shall be due and payable the first day of each month. Payments for periods of lessthan a month shall be due and payable prior to leaving the residence. 6.Monies for room and board shall be paid to the person designated by the provider agency. Such person shall issue a receipt showingamount of payment and period covered. II. PROVIDER AGENCY’S RESPONSIBILITIES: 1.The provider agency agrees to comply with §§ 6100.681-694 relating to Room and Board. 2.The provider agency agrees to comply with 55 Pa. Code Chapter 6400 (relating to Community Homes for Individuals with an IntellectualDisability or Autism) or 55 Pa. Code 6500 (relating to Life Sharing Homes), if licensing requirements apply to the residence. 3.The provider agency may temporarily relocate the individual to another location that is not the address of residence due to emergencycircumstances. When this occurs, the requirements in this Room and Board agreement continue to apply. The provider is not requiredto give written notice as described in 6100.301-307. III. IV. V. VI. The provider must use the DP 1077 and may not alter the form. COMPLAINTS: 1.The individual has the right to file an oral or written complaint with the provider agency if they disagree with the termination of this agreement. 2.The provider agency must document and manage all complaints in accordance with 6100.51. This includes providing any assistanceneeded by the individual to file a complaint and assuring that there is no retaliation (punishment) or intimidation (frightening or threatening a person so that they will do what they want) relating to the filing or investigation of a complaint. TERMINATION OF THE AGREEMENT: The provider agency must notify the individual in writing if the provider agency is no longer willing to provide Life Sharing services to the individual at the address of the home. The provider agency must give this notice to the individual at least 45 days prior to the date of the proposed change in provider or address of the home as described in 6100.301-307. IV. Life Sharing Services for Individuals with an Intellectual Disability or AutismRoom and Board Residency Agreement § 6100.68755 Pa. Code Chapter 6100 THIS AGREEMENT, made on _________________________ between ___________________________________________________ , hereinafter referred to as individual, and ___________________________________________________________________________ at ____________________________________________________________________________ hereinafter referred to as the host home. This agreement may only be effective for a maximum of 12 months from the effective date of the agreement. Whereas, the individual is participating in a residential program administered by the Life Sharing provider agency; and room and board is furnished by the host home. EFFECTIVE DATE OF AGREEMENT NAME OF INDIVIDUAL LIFE SHARING HOST HOME ADDRESS OF THE LIFE SHARING HOST HOME DP 1077 LS 10/24 I. INDIVIDUAL’S RESPONSIBILITIES: 1. Individual agrees to pay the host home a total of $ __________ for room and/or board. This amount is based on the following (one applicable box must be checked below): p No more than 72 percent of the SSI maximum rate plus the Pennsylvania Supplement. (This should be checked if the host home provides both room and board to individual.) p No more than 32 percent of the SSI maximum rate plus Pennsylvania Supplement for board. (This should be checked if individual pays their own rent directly to a landlord, but food is supplied through host home.) p No more than 40 percent of the SSI maximum rate plus Pennsylvania Supplement for room. (This should be checked if the individual pays rent to the host home, but individual purchases their own food.) 2. If individual’s available income is less than the SSI maximum rate plus Pennsylvania Supplement, host home shall charge 72 percent of individual’s available monthly income as individual’s monthly obligation for room and board; 32 percent for board if food is supplied through host home; or 40 percent for room if individual purchases their own food. Individual shall receive at least the monthly amount as established by the Social Security Administration related to the specific type of setting, for the individual’s personal needs allowance. 3. In addition to the room and board amount listed in this agreement, the individual also agrees to pay the host home any money received through Pennsylvania’s Rent Rebate Program. The host home will deduct the value of the rent rebate from the actual documented room and board costs for the individual’s home. 4. The total amount charged for individual’s share of room and board may not exceed the actual documented room and board costs of individual’s residence minus the benefits received. 5. Payment shall be made on a monthly basis and shall be due and payable the first day of each month. Payments for periods of less than a month shall be due and payable prior to leaving the home. 6. Monies for room and board shall be paid to the host home. II. HOST HOME’S AND PROVIDER AGENCY’S RESPONSIBILITIES: 1. The host home and the provider agency agree to comply with §§ 6100.681-694 relating to Room and Board. 2. The provider agency and host home agree to comply with 55 Pa. Code 6500 (relating to Life Sharing Homes), if licensing requirements apply to the home. 3. The host home must provide a copy of this agreement to the provider agency. 4. The provider agency may temporarily relocate the individual to another location that is not the address of Life Sharing home due to emergency circumstances. When this occurs, the requirements in this Room and Board agreement continue to apply. The provider is not required to give written notice as described in 6100.301-307. III. COMPLAINTS: 1. The individual has the right to file an oral or written complaint with the provider agency if they disagree with the termination of this agreement. 2. The provider agency must document and manage all complaints in accordance with 6100.51. This includes providing any assistance needed by the individual to file a complaint and assuring that there is no retaliation (punishment) or intimidation (frightening or threatening a person so that they will do what they want) relating to the filing or investigation of a complaint. V. SIGNED: ________________________________________________________________ _______________PROVIDER AGENCY DATE ________________________________________________________________ _______________LIFE SHARING HOST HOME DATE ________________________________________________________________ _______________INDIVIDUAL OR OTHER DESIGNATED PERSON SIGNING ON INDIVIDUAL’S BEHALF (INCLUDE RELATIONSHIP TO INDIVIDUAL) DATE ________________________________________________________________ _______________REPRESENTATIVE PAYEE, IF OTHER THAN PROVIDER AGENCY OR INDIVIDUAL DATE ________________________________________________________________ _______________COURT APPOINTED LEGAL GUARDIAN, IF APPLICABLE DATE VI. The host home must use the DP 1077 and may not alter the form.