LRI Requirements
LEGALLY RESPONSIBLE INDIVIDUALS
UPDATED 2/29/24
Rules Effective TBD as an extension past March 1st has been granted to individuals by DMAS.
UPDATED 2/29/24
Rules Effective TBD as an extension past March 1st has been granted to individuals by DMAS.
Legally Responsible Individual: Parent, Stepparent, Legal Guardian, Spouse
EOR: Employer of Record
- The temporary federal flexibility allowed by an Appendix K waiver amendment and described in the Medicaid Memo dated April 22, 2020 will be replaced by the new program rules.
- Changes apply to personal care services provided through the Commonwealth Coordinate Care Plus (CCC+), Community Living and the Family and Individual Supports Waivers (DD). Please note, respite and companion services as well as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) are not included in this change.
What does this mean for you?
- If you are a LRI (Legally Responsible Individual) AND an attendant to a child UNDER 18 years of age and need to remain an attendant for your loved one (as there is no one else to care for them), then you have some work to do!
- “No one else is available/able to provide services to the member.” This means all avenues have been explored, and the LRI providing the service/care is the last resort. How can you prove this? The most effective way is for the EOR to advertise for an outside attendant. Please be advised the EOR is responsible for the hiring and management of all attendants providing care for the member, therefore, they are the ones that must advertise for an attendant.
Some ways to begin that process:
- The EOR can post an advertisement on local bulletin boards, such as your local church bulletin board or the public library.
- The EOR can post an advertisement on social media.
- The EOR can use Care.com.
- The EOR can place an ad in the local newspaper. You WILL NEED a copy of the ad and proof that the advertisement has been posted publicly (a picture of the ad in its posting place/location should suffice). YOU MUST complete the ad posting AT LEAST in TWO different locations. For your convenience, you can upload a copy of your advertisement using the link on the FORMS page. It should show that it was posted by the EOR as well as their contact information.
You will need to complete the forms below and submit them for approval.
- Extraordinary Care Form: HERE
The DMAS 487 form will need to be completed daily. This form must be available for review by SF’s and DMAS/MCO’s as requested. You can find a downloadable copy of this form HERE
Once these are completed, upload in your portal in GRACE so that the completed documents will go straight to your Service Facilitator for processing.
RULES to know & remember:
- Current authorization/authorized weekly total. The 40-hour-per-week limit is inclusive of caring for multiple children on the waiver.
- A member may be authorized for more or fewer than 40 hours of personal care per week, depending on their documented needs in the Plan of Care. However, the 40-hour limit applies specifically to the number of hours a Legally Responsible Individual (LRI) may be reimbursed each week. If your authorization allows for additional hours beyond the 40 used by the LRI, a different attendant (who is not an LRI) may be hired in a part-time or fill-in capacity to provide services during those remaining hours.
- Respite services are NOT available when the LRI is the paid caregiver (whether AD or CD; respite auth must end).
- The EPSDT program does not permit a LRI to serve as a paid attendant and has never allowed this under its guidelines.
- LRI’s may receive reimbursement for “extraordinary care.” This means LRI’s will continue to be responsible for meeting the typical care needs of a member younger than 18 years old. This includes the need for assistance for completion of ADL (bathing, dressing, toileting, transferring, eating), typically required for children at various stages of growth and development. Instrumental activities of daily living (such as cooking, cleaning, laundry, etc.) are not included in extraordinary care.
- Anyone over age 18: Do not need to complete any of the above as this does not apply to them.
- The EOR must complete an Enhanced EOR Agreement with the Fiscal-Employer Agent.
- These EOR requirements do not apply to an adult member who hires a spouse to be the paid attendant.
- The LRI must Document tasks daily on the Consumer Directed Legally Responsible Attendant form (DMAS 487 LRI). This form must be available for review by SF’s and DMAS/MCO’s upon request.
Employer of Record / Parent or Guardian
Detailed demonstration of why no one else is available.
Was an employment ad attached (2 placements within past six months)?
Was it posted long enough to receive responses? Where was it posted?
Did the ad encourage responses? Were appropriate terms used (terms such as “babysitter” are incorrect).
Did the ad list tasks that are consistent with personal care services? (Activities of daily living and instrumental activities of daily living.)
Is the LRI relationship with the member listed on the form?
Tasks completed by the Service Faciliator
- Has the LRI Plan of Care been submitted?
- Instrumental Activities of Daily Living (IADLs)—such as meal preparation, housekeeping, laundry, attending medical appointments, and participating in social activities—are not included in the Plan of Care or identified as tasks to be performed by the LRI.
- Are there any skilled tasks listed on the Extraordinary Care (EC) form that the LRI is performing? If so, have these tasks been properly delegated by a Registered Nurse (RN)?
- Does the LRI Plan of Care include supervision as a provided service?
Self-referral
Does the EC form indicate any of the following? (If so, it could indicate self-referral.)
- No other care options have been sought out.
- The family/member indicates they do not want anyone else in their home.
- Care has only been provided by an LRI and the family/member states that no one else can sufficiently provide care without showing evidence.
- Communication needs indicate that the member is “nonverbal” or uses a communication device that would be difficult to train an attendant to use.
Behavioral Needs
Are behavioral needs listed as the reason for being unable to find care?
- Are behavioral needs documented in the member’s record and identified by an evaluation or assessment?
- Is there evidence that the behavioral needs are so great that only the LRI can safely support them at this time?
- Have resources been offered to assist the member in overcoming the barrier behaviors?