SI PHI00815.050 Adult Services Program Payments
See SI 00815.050
This supplement describes and summarizes the Adult Services Program in the State of West Virginia. Each SSI individual residing in an Adult Family Care Home or Personal Care Home under the Adult Services Program may receive a service payment, made on his behalf to a provider of care, when the State determines that a service need exists and must be met.
This State payment meets the criteria of SI 00815.050 and is therefore, excluded from income under the SSI program.
B. Specifics of State Program
The State of West Virginia supervised the placement of SSI individual in need of residential services in a network of family care and personal care homes throughout the State. Placement is made in two types of facilities:
a. Adult Family Care Home
Provides for placement of 1-3 adults in a family home usually comprised of a husband, wife and possible children. The purpose is to provide care and services in a family setting, with all of the advantages and personal satisfaction accruing from such an arrangement.
b. Personal Care Home
Provides for placement in facilities housing from 6-100 individuals. The State advises that all such homes are privately sponsored and operated. These homes provide care to individuals for whom group care is more appropriate than individualized care in a family atmosphere.
2. Eligibility for Provision of Adult Services Program Payments
Individuals in receipt of monthly SSI payments, with or without other income, comprise one group eligible for payments from the Adult Services Program. These payments are made by the State on behalf of the SSI individual to the provider of care, and are only made when local Department of Human Services Offices identify a service need of the SSI individual residing in the care facility. The types of services budgeted for include: supervision of self-administered medications, diet services, feeding assistance in ambulation for daily activities, bathing, dressing, communication problems, and teaching and supervising activities of daily living.
Individuals residing in these facilities are required to enter into a placement agreement with the State and the provider of care which specifies that the individual is expected to pay for both his support and maintenance and personal needs from his own funds. The State's service payment does not include any support and maintenance monies. See Exhibit for example of agreement.
C. District Office Considerations
Since the State payment under the Adult Services Program are for services only, such payment are not income to the placed individual for purposes of SSI. If receipt of this payment is alleged by an SSI individual who was placed under the Adult Services Program, exclude the payments from income without verification.
If an SSI applicant/recipient alleges receipt of this payment as a provider of adult services, contact the Assistance programs Branch of the regional office.
An SS-8045-43 should be established for all Personal Care Homes, and a list of Adult Family Care Homes (noninstitutional care) should be maintained for the service area of each field office in West Virginia in order to standardize the treatment of SSI individuals who reside there.
The State identifies individuals in need of placement and services payments. However, SSA offices should be knowledgeable about the Adult Services Program so that appropriate referrals to local Human Services Offices can be made when an individual requests information about the program.
WEST VIRGINIA DEPARTMENT OF HUMAN SERVICES
ADULT FAMILY CARE/PERSONAL CARE HOMES
___(Client)_______, Social Security Number _____________________ has been approved for Adult Family Care/Personal Care in _(Name of Home)__ at _(Provider's Address)_ effective ______________. The monthly rate a payment is established at $___________ monthly or $__________ per day. The client receives will keep $_____ from ________________.
The client will keep $____________ for his personal expense allowance and will pay the provider $____________ monthly toward the cost of his care. The Department of Human Services will make a monthly vendor payment of $__________ to the provider for the client's remaining cost of care.
The client agrees to pay the provider at the rate listed per month, or per day for a partial month, for board, room and personal services for such time as the Client remains in the provider's home or until such time as the situation may change requiring a new agreement in accord with the policies of the Department of Human Services.
The provider agrees to provide board, room, personal care and supervision to the client at the rate given above.
It is the understanding of al parties that the contract may be terminated by the client of the provider of by the Department of Human Services in accord with the agency's policies.
Complete 4 copies
Original filed in Agency Record
Copy given to Sponsor/Operator
Copy given to Client
Copy given to Financial Clerk
SS-AS-16- (Rev. 1-82)