Residential habilitation means individually tailored supports that assist with the acquisition, retention, or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living, community inclusion, transportation, adult educational supports, social and leisure skill development, that assist the participant to reside in the most integrated setting appropriate to his/her needs. Residential habilitation also includes personal care and protective oversight and supervision. Payment is not be made for the cost of room and board, including the cost of building maintenance, upkeep and improvement. The method by which the costs of room and board are excluded from payment for residential habilitation is specified in Appendix I-5. Payment is not made, directly or indirectly, to members of the individual's immediate family, except as provided in Appendix C-2. Instructions • Supplement or modify the core definition as appropriate to encompass the specific service elements/activities furnished as residential habilitation. • Residential habilitation may be furnished in the following living arrangements: participant’s own home, the home of a relative, a semi-independent or supported apartment or living arrangement, or a group home. Supplement the core definition by specifying the types of settings where residential habilitation is furnished. Guidance • Residential habilitation services may be provided in the participant’s living arrangement or in the surrounding community, provided that such services do not duplicate services furnished to a participant as other types of habilitation. • Provider owned or leased facilities where residential habilitation services are furnished must be compliant with the Americans with Disabilities Act. • Home accessibility modifications when covered as a distinct service under the waiver may not be furnished to individuals who receive residential habilitation services except when such services are furnished in the participant’s own home. Compensation for the costs of life safety code modifications and other necessary accessibility modifications that a provider makes may be included in provider rate (as amortized costs) so long as they are necessary to meet the needs of residents and are not basic housing costs Instructions: Version 3.5 HCBS Waiver Application 147 Appendix C: Participant Services • Residential habilitation services may include the provision of medical and health care services that are integral to meeting the daily needs of residents (e.g., routine administration of medications by nurses or tending to the needs of residents who are ill or require attention to their medical needs on an ongoing basis). The provision of such routine health services and the inclusion of the payment for such services in the payment for residential habilitation services is not considered to violate the requirement that a waiver may not cover services that are available through the State plan. Medical and health care services such as physician services that are not routinely provided to meet the daily needs of residents may not be included. • Personal care/assistance or other similar services may be a component part of residential habilitation services but may not comprise the entirety of the service. When personal care or another similar service is covered as a distinct waiver service but also is furnished as a component of residential habilitation, there must be mechanisms that prevent the duplicative billing of the provision of personal care services. • If transportation between the participant's place of residence and other service sites or places in the community is provided as a component of residential habilitation services and the cost of this transportation is included in the rate paid to providers of residential habilitation services, include a statement to that effect in the service definition. • Respite care may be made available to persons who receive residential habilitation or other types of residential services under the waiver (e.g., adult foster care) for the relief of a primary caregiver, provided that there is no duplication of payment. When respite is furnished for the relief of a foster care provider, foster care services may not be billed during the period that respite is furnished. Respite care may not be furnished for the purpose of compensating relief or substitute staff for a waiver residential service. The costs of such staff are met from payments for the waiver residential service. • When residential habilitation services are furnished in living arrangements subject to §1616(e) of the Social Security Act (the Keys Amendment), the standards for such services must address the topics specified in Appendix C-2 (item C-2-c-ii), including assuring that the living arrangement is homelike rather than institutional in character. • Retainer payments may be made to providers of residential habilitation while the waiver participant is hospitalized or absent from his/her home for a period of no more than 30-days. See Olmstead Update #3 (July 25, 2000) in Attachment D for additional information. If the state elects to make such payments, describe the circumstances under which such payments are authorized and applicable limits on their duration.