RetiredCareSourcePolicy N/A

Supportive Living Services-AR PASSE-MM-1566, MEDICAL POLICY STATEMENT

Defines eligibility, levels of support, documentation, coverage conditions, exclusions, and review processes for Supportive Living Services provided to Arkansas PASSE Medicaid members with intellectual and developmental disabilities (IDD). Applies to home and community-based SLS as an alternative to institutional care.

Policy Summary

PayerCareSource

PolicySupportive Living Services-AR PASSE-MM-1566, MEDICAL POLICY STATEMENT

Policy CodePolicy N/A

Change TypeArchived (12/31/2025)revisions and annual review

Effective Date02/01/2025

Next Review Date

Key ActionCompleted Prior Authorization Form for Supportive Living Services is required; services must be authorized and be part of the member's PCSP.

SourceLink

POLICY UPDATE CHANGES

Policy archived effective 12/31/2025.

10/23/2024 annual review; added V.A. and updated references.

Policy established to define criteria for service provision (issued 11/08/2023; merged from archived AD-1174).

4Levels of Support Defined

14Max consecutive inpatient SLS duration

6Temporary needs resolution threshold (months)

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Coverage Summary

Overview: Supportive Living Services (SLS) under Arkansas Medicaid PASSE provide home- and community-based care as an alternative to institutionalization for eligible members with intellectual and developmental disabilities (IDD) who would otherwise require intermediate care facility (ICF) level of care. Policy status: RETIRED / Archived (policy established 11/08/2023; approved at committee; effective 02/01/2025; archived 12/31/2025).

Subject and scope: Defines eligibility, the four levels of support, documentation required, coverage conditions, exclusions, and review processes for SLS provided to Arkansas PASSE members with IDD. Headline stats: 4 levels of support defined; SLS provided in inpatient settings are limited to 14 consecutive days when performed for supportive care during hospitalization; temporary needs expected to resolve in 6 months or less are considered for time-limited increased support.

Quick Facts and Thresholds

Levels of Support Defined4

Maximum inpatient SLS duration14 consecutive days

Temporary needs resolution timeframe6 months

Billing codes specified0

Supportive Living Services - Eligibility and Levels of Support

Coverage While Inpatient

Case-by-case review for continued services provided in inpatient settings; services must be authorized and part of member's PCSP

ALL of the following

Each inpatient admission must be reviewed
Services must be authorized and part of the member's PCSP
If health maintenance activities are performed in a hospital setting for supportive care while receiving medical care, SLS cannot exceed 14 consecutive days nor the approved prior authorized rate in place prior to hospitalization14 days

Exclusions (Not Covered)

Denial Risk

Exclusion-Based Denial Risk

Claims may be denied or not reimbursed when SLS are provided concurrently with other services (eg, private duty nursing), paid to non-hired caregivers, for room and board, or for activities not directly related to active treatment goals.

Concurrent services (e.g., private duty nursing, personal care)
Payment to non‑hired caregivers
Room and board, home maintenance, upkeep, or improvements
Activities not directly related to active treatment goals or that serve as respite/babysitting

Provider Requirements and Authorization

Prior Authorization

Prior Authorization Required

Completed Prior Authorization Form for Supportive Living Services is required; services must be authorized and be part of the member's PCSP. Each inpatient admission and requests for continued inpatient services must be reviewed and authorized on a case-by-case basis.

Prior Authorization Form for Supportive Living Services is required
Services must be authorized and included in the member's PCSP
Each inpatient admission and requests for continued inpatient services require review/authorization

Documentation Required

Documentation Submission

Providers must maintain and submit required documentation depending on support level (psychological testing with adaptive functioning, Waiver Area of Needs, provider service plan with goals and schedule, PCSP, nursing assessment with ADLs, existing natural/paid supports, and a completed Prior Authorization Form). Exceptional and Enhanced levels require additional documentation such as treating practitioner medical documentation, Positive Behavior Support Plan, medication list, psychiatric assessment and medication management notes, detailed narratives for 1:1 overnight staffing, and known incident reports/summaries. See the Documentation Requirements criteria group for details.

Coding

No specific billing codes listed in policymixed

No codes listed

Background

Background: Arkansas Medicaid PASSE offers home- and community-based Supportive Living Services (SLS) as an alternative to institutionalization for eligible members with a developmental disability who would otherwise require ICF level of care. SLS are individually tailored services and activities provided in an integrated community setting to enable members to reside successfully in the home, with families, or in alternative living settings.

Relation to PCSP and goals: SLS assist members in acquiring, retaining, and improving self-help, socialization, and adaptive skills and must directly relate to individualized goals and objectives in the member's Person Centered Service Plan (PCSP). Services are provided at four levels of support based on functional needs and required supports.

Definitions

ADLsFundamental skills required to independently care for oneself; includes basic (ambulation, feeding, dressing, hygiene, continence, toileting) and instrumental (transportation, shopping, finance, meal prep, home maintenance, communication, medication management).

IDDIntellectual Developmental Disability: substantial, long-term disability beginning from birth through age 21 expected to last a lifetime, with impairment of intellectual functioning or adaptive behavior requiring support services.

PCSPPerson Centered Service Plan: the total plan of care in accordance with 1915(c) waiver and 1915(i) state plan services requirements.

Revision History

11/08/2023added

Policy established to define criteria for service provision (merged from archived AD-1174); Approved at Committee.

10/23/2024revised

10/23/2024 annual review; added V.A. and updated references; Approved at Committee.

02/01/2025effective

Policy effective date for the Medical Policy Statement (02/01/2025).