Section 21 Home Support- Agency Per Diem: Authorizations in Two-Person Homes Requirements Reminder

With the end of the COVID-19 public health emergency and Appendix K flexibilities, Section 21 Home Support- Agency Per Diem providers must follow service requirements outlined in the MaineCare Benefits Manual (MBM) regarding the number of members served. MBM Ch. II, Section 21.10-6 states "As of December 24, 2012, Home Support- Agency Per Diem placements will only be approved at provider-controlled homes where a minimum of two (2) Members reside.”

As a general rule, providers should always identify two members in their requests submitted in Atrezzo for rate determination. To clarify, two members should also be identified in Atrezzo requests when a home is entirely vacant; it is not permissible to request authorization for one member to move in while the provider works to fill the vacancy. The Department will only issue authorizations for a setting with one member when there is:

• a relevant approved Americans with Disabilities Act (ADA) modification; or
• a recent housemate departure, as outlined at MBM Ch. II, Section 21.10-6, Residential Vacancies in Two-Person Homes.

In the event of recent housemate departure, the provider must fill the vacancy or provide written notice of ending services to the member remaining at the setting. Case Managers may be asked for support to:

• submit an ADA request due to individual needs found on the ADA/Civil Rights Compliance webpage; or
• assist a member to consider their options for new services, service locations, and/or providers.

For questions, please contact Emily Kalafarski at [email protected].