4100, Adult Foster Care | Texas Health and Human Services

4110 Adult Foster Care Introduction

Revision 19-13; Effective November 5, 2019

Adult foster care (AFC) provides 24-hour living arrangements and personal care services (PCS) and supports for persons who, because of physical or behavioral conditions, are unable to live independently. Services and supports may include assistance and/or supervision with daily living, including meal preparation, housekeeping, companion services, personal care, nursing tasks and the provision of, or arrangement for, transportation. The STAR+PLUS Home and Community Based Services (HCBS) program applicant or member who chooses AFC must reside with a contracted STAR+PLUS HCBS program AFC home provider that meets the minimum standards and licensure requirements found in Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers.

AFC home providers must be contracted either directly with the member’s managed care organization (MCO) or with an AFC provider agency contracted with the member’s MCO. The individual qualified to provide AFC (AFC home provider) must be the primary caregiver. AFC home providers must live in the household and share a common living area with the member. Detached living quarters do not constitute a common living area. AFC home providers may serve up to three adult residents in a qualified AFC home without being licensed as a personal care home or assisted living facility (ALF), and may be the AFC home provider’s home or the STAR+PLUS HCBS program member’s home. AFC home providers with four or more residents, which are also contracted with the Texas Health and Human Services Commission (HHSC), are required to have a Type C Personal Care Home license. AFC homes with four to eight AFC residents must be licensed as an ALF, with limitations on the number of residents at each level who may reside in the home. The three levels of eligibility for AFC are explained in Section 4133, Adult Foster Care Classification Levels. ALF licensure requirements are found in Title 26 Texas Administrative Code (TAC) Chapter 553, §553.41.

Any reference to “resident” includes members receiving services in the STAR+PLUS HCBS program AFC or private pay individuals. AFC home providers may serve a combination of STAR+PLUS HCBS program members and private pay individuals in a qualified or licensed AFC home as long as the AFC home provider continues to meet the minimum standards specified in Appendix XXIV, and additional other standards may be specified by the MCO.

When the AFC home provider moves in with the STAR+PLUS HCBS program member receiving AFC in the member’s home, the AFC home enrollment requirements indicated with an asterisk in Appendix XXIV may be waived at the discretion of the MCO or the MCO-contracted AFC provider agency, as appropriate. Other minimum standards, excluding home safety requirements, may be waived at the discretion of the MCO, or upon the recommendation by the MCO-contracted AFC provider agency if the MCO-contracted AFC provider agency has completed a home assessment and concluded the member’s needs can be appropriately met through the STAR+PLUS HCBS program and AFC specific services. Such conclusions must be documented by the MCO-contracted AFC provider agency and approved by the MCO.

The MCO is responsible for ensuring the AFC member receives all necessary AFC services, including the authorization of other needed services and nursing tasks.

STAR+PLUS HCBS program AFC members are required to pay for their own room and board (R&B) charges and, if able, contribute to the cost of AFC services through a copayment to the AFC home provider. The only time the R&B charge is not required is when the AFC home provider moves in with the member and the member's home becomes the AFC home. R&B arrangements must be documented in the member’s case file by the MCO or by the MCO-contracted AFC provider agency.

If an AFC home is contracted with HHSC to provide services to a member receiving AFC through HHSC, the MCO or the MCO-contracted provider agency may request a copy of the AFC home and AFC home provider qualification documents from HHSC, if applicable. These documents contain HHSC findings regarding the qualifications of the AFC home and AFC home provider.

4111 Adult Foster Care Purpose

Revision 19-13; Effective November 5, 2019

The purpose of the STAR+PLUS Home and Community Based Services (HCBS) program adult foster care (AFC) is to promote the availability of appropriate services in a home-like environment for members who are aging and who have disabilities to enhance the dignity, independence, individuality, privacy, choice and decision-making ability of a member.

The STAR+PLUS HCBS program requires each AFC member to have enough living space to guarantee his or her privacy, dignity and independence.

4112 Reserved for Future Use

Revision 24-1; Effective Feb. 22, 2024

4113 Adult Foster Care Services

Revision 19-13; Effective November 5, 2019

The adult foster care (AFC) home provider must provide services, supports and supervision, as needed, around the clock in an AFC home that has either been qualified based on the minimum standards or licensed by the Texas Health and Human Services Commission (HHSC) (for homes serving four or more residents). Services may include personal assistance services (PAS).

A STAR+PLUS Home and Community Based Services (HCBS) program adult foster care (AFC) member may not receive STAR+PLUS HCBS program PAS while the member is a resident in a STAR+PLUS HCBS program AFC home. Form H6516, Community First Choice Assessment or Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, and any addendums to Form H2060, are completed by the managed care organization (MCO) to determine the needed tasks for completion by the AFC home provider. The MCO must provide a copy of the required PAS tasks to the AFC home provider and to the MCO-contracted AFC provider agency, if applicable:

transportation;
supervision;
meal preparation; and
housekeeping.

AFC services, except for 24-hour supervision that is provided to all STAR+PLUS HCBS program AFC members, are provided on an "as needed" basis, with the flexibility to meet the member's needs in the least restrictive way possible. For example, STAR+PLUS HCBS program AFC members may not need assistance with medication or help with transportation, but the services are available to all STAR+PLUS HCBS program members in AFC homes. PAS tasks must be provided, as identified on Form H6516, Form H2060 and any addendums to Form H2060. The AFC home provider may provide more services for the member than are authorized, as the changing needs of the member may warrant, but may not reduce or discontinue services without prior consultation with the MCO.

STAR+PLUS HCBS program members, as recipients of Medicaid, are entitled to medical transportation services. Transportation is provided to Medicaid-covered medical appointments. Access to non-emergency medical transportation is available to members through the Medical Transportation Program (MTP).

4120 Minimum Standards for All AFC Homes and Providers

Revision 19-13; Effective November 5, 2019

All adult foster care (AFC) homes and AFC home providers must be qualified initially and annually thereafter in accordance with the minimum standards outlined in Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers.

4121 AFC Homes with Four or More Residents and Members

Revision 19-13; Effective November 5, 2019

An adult foster care (AFC) home provider must obtain an assisted living (AL) license if the AFC home provider wants to serve four or more private pay residents and/or members. The AFC home provider may apply for an AL license from the Texas Health and Human Services Commission (HHSC) Regulatory Services Division. The license must be renewed annually and requires an annual fee. Licensing standards for various types of AL facilities are found in Title 26 Texas Administrative Code (TAC) Chapter 553, §553.41.

The AFC home provider must submit a copy of the AL license to the managed care organization (MCO) or MCO-contracted AFC provider agency before being credentialed and upon renewal. The AFC home provider must report to the MCO or MCO-contracted AFC provider agency any problem(s) identified by the HHSC Regulatory Services Division. AFC home providers must meet all applicable requirements in the minimum standards for AFC. AFC home providers with an AL license must serve no more than a total of eight adult residents in a small group home.

AFC homes of four or more residents, without an HHSC contract, are also subject to the following two sets of regulations:

Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers; and
Licensing Standards for Assisted Living Facilities, found in Title 26 TAC, Chapter 553, §553.41.

The stricter requirements apply when requirements of the two sets of regulations conflict. For example, an AFC home licensed as a small group home must comply with the requirement that an attendant be present at all times when residents are in the facility. This requirement applies regardless of the number of members currently residing in the facility.

If the MCO uses a contracted AFC provider agency, the contracted AFC provider agency must provide copies of any licenses for AFC homes of four or more residents when the MCO requests them.

4122 Small Homes for One to Three Residents and Members

Revision 19-13; Effective November 5, 2019

An adult foster care (AFC) home provider who serves up to three residents, including STAR+PLUS Home and Community Based Services (HCBS) program members, may be a member's relative, excluding the spouse. While these small homes do not require licensure, AFC homes and AFC home providers must meet the standards found in Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers. As outlined in Section 4110, Adult Foster Care Introduction, if the AFC home provider moves into the AFC member's home, AFC home requirements in Appendix XXIV may be waived at the discretion of the managed care organization (MCO) or MCO-contracted AFC provider agency.

4123 MCO Responsibilities

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) responsibilities include:

providing information to interested applicants about potential adult foster care (AFC) homes and coordinating visits to the homes;
developing an individual service plan (ISP);
acting as coordinator of the interdisciplinary team (IDT);
authorizing AFC services;
evaluating and coordinating services for the member;
notifying the member, AFC home provider and AFC provider agency, if applicable, of room and board (R&B) charges and copayment amounts, as outlined in Section 3236, Copayment and Room and Board;
processing changes and conducting annual reassessments for the member;
completing an assessment to ensure the potential or existing member’s needs can be met in a particular home;
recruiting, contracting and credentialing AFC homes and home providers;
processing AFC home and home provider applications;
orienting and training AFC home providers;
approving private pay residents;
ensuring initial and ongoing compliance with AFC minimum standards;
conducting annual requalification reviews of the AFC home and home provider;
conducting administrative reviews; and
processing AFC provider payments.

An MCO may also choose to contract with an AFC provider agency to facilitate AFC home and home provider management on behalf of the MCO. When this occurs, the contracted AFC provider agency is responsible for provisions stipulated in its contract with the MCO. However, the MCO retains overall responsibility for all requirements related to AFC service delivery and oversight of the MCO contracted AFC provider agency and the member.

4130 Adult Foster Care Eligibility

Revision 19-13; Effective November 5, 2019

To be eligible for adult foster care (AFC), applicants and members must meet basic eligibility requirements for STAR+PLUS Home and Community Based Services (HCBS) program services as well as specific requirements related to AFC. Basic eligibility requirements for the STAR+PLUS HCBS program can be found in 3230 , Financial Eligibility, and 3240 , STAR+PLUS HCBS Program Requirements. AFC applicants or members are identified for STAR+PLUS HCBS program AFC based on their assessed needs for care. Refer to 4133 , Adult Foster Care Classification Levels, for additional information.

4131 AFC Intake, Assessment and Response to Request for Services

Revision 25-1; Effective Feb. 19, 2025

Adult foster care (AFC) is appropriate for individuals who, because of physical, mental or behavioral conditions, cannot live independently and who need and desire the support and security of family living. AFC may be appropriate for individuals who are:

seeking alternatives to facility-based care; or
interested in leaving institutional care but are unable to resume independent living.

The managed care organization (MCO) or MCO-contracted AFC provider must explain the room and board (R&B) requirements and ensure the applicant or member understands that he or she must pay a portion of the monthly income for R&B when discussing AFC as a living arrangement option. Payment for R&B charges does not apply if the AFC home provider moves into the member’s home. The MCO must also explain that some members living in an AFC home are also required to contribute to the cost of their AFC services by paying a copayment, regardless of if the AFC home is the member’s home. Refer to 3236, Room and Board and Copayment Requirements, for additional information.

4132 Reserved for Future Use

Revision 22-3; Effective Sept. 27, 2022

4133 Adult Foster Care Classification Levels

Revision 19-13; Effective November 5, 2019

Classification (payment levels) for adult foster care (AFC) members are used for identification of potential AFC applicant or member appropriateness and are based on the member’s assessed needs for care, as determined through the required face-to-face assessments for STAR+PLUS Home and Community Based Services (HCBS) program services and the individual service plan (ISP) completed by the managed care organization (MCO) service coordinator. Determine and document whether an applicant or member is appropriate for AFC based on the applicant’s or member’s condition and behavior. Develop an ISP appropriate to the applicant’s or member’s needs and specific to a given AFC home provider, taking into consideration the AFC home provider’s capabilities. The MCO-contracted AFC provider agency, if applicable, would be involved in a determination of AFC home provider capabilities.

4133.1 Levels of Adult Foster Care Members

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) will use the Medical Necessity and Level of Care (MN/LOC) Assessment, Form H6516, Community First Choice Assessment, or Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, and addendums. The MCO service coordinator determines a member’s classification level for adult foster care (AFC) services. MCOs must consider a need for limited or greater assistance with the performance of activities of daily living (ADLs) (transferring, walking, dressing, eating, toileting, bathing), and behaviors that occur at least once a week in the assessment and determination, as well as other identified needs of the member.

Below are the classification levels of a member’s daily assistance or supervision requirements.

Level I AFC Member

A member who needs assistance with identified needs including a minimum of:

one ADL and behavior(s) that occur at least once a week; or
two ADLs.

Level II AFC Member

A member who needs assistance with identified needs including a minimum of:

two ADLs and behavior(s) that occur at least once a week; or
three ADLs.

Level III AFC Members

A member who needs assistance with identified needs including a minimum of:

three ADLs and behavior(s) that occur at least once a week; or
four ADLs.

4133.2 AFC Homes Corresponding to AFC Member Levels

Revision 19-13; Effective November 5, 2019

The adult foster care (AFC) home provider must be able to meet the member’s needs in the AFC setting in conjunction with the STAR+PLUS Home and Community Based Services (HCBS) program and other available supports. If the member’s needs for care exceed the capability of the AFC home provider, the managed care organization (MCO) service coordinator must reassess the member and offer alternate care options.

The AFC home provider who is a licensed registered nurse (RN) and the AFC home provider RN substitute must provide proof of current licensure to the MCO or contracted provider agency (if applicable) initially and annually thereafter.

The MCO RN service coordinator will complete the Medical Necessity and Level of Care (MN/LOC) Assessment, both initially and annually. AFC home providers with STAR+PLUS HCBS program members may not care for more than one totally dependent AFC resident. The MCO RN service coordinator must respond to a request for a change in services within the individual service plan (ISP) year.

Health maintenance activities (HMAs) are tasks which may be exempt from RN delegation based on the MCO RN assessment. HMAs may enable the member to remain in an independent living environment and go beyond activities of daily living (ADLs) because of the higher skill level required to perform them (as found in the Texas Board of Nursing (BON) rules in Title 22 Texas Administrative Code (TAC) §225.4(8)).

For members residing in Level I, Level II and Level III AFC homes not operated by an RN, the skilled nursing needs must be:

identified by the MCO service coordinator as HMAs;
purchased as nursing services on the ISP;
provided by Medicare, Medicaid home health or other resource;
met by a nurse at a Day Activity and Health Services (DAHS) facility; or
a combination of the above options.

For members residing in Level I, Level II and Level III AFC homes operated by an RN, the skilled nursing needs must be:

identified by the MCO service coordinator as HMAs;
met by the AFC home provider nurse or nurse substitute;
provided by Medicare, Medicaid home health or other resource; or
a combination of the above options.

AFC members receiving nursing services and residing with an RN who is the AFC home provider are not eligible to receive DAHS.

4134 Adult Protective Services and Adult Foster Care

Revision 19-13; Effective November 5, 2019

This section provides details regarding when Adult Protective Services (APS) staff request adult foster care (AFC) as a resource for individuals who may benefit from AFC.

4134.1 Placement of APS Clients in AFC

Revision 19-13; Effective November 5, 2019

Adult Protective Services (APS) may want to move an adult foster care (AFC) individual into an AFC home where a STAR+PLUS Home and Community Based Services (HCBS) program member resides. The managed care organization (MCO) must approve and ensure the APS individual is appropriate and document this in the MCO case record. This includes determining the:

APS individual's medical and behavioral health needs are met;
capacity of the AFC home provider to meet the APS individual's needs; and
compatibility of service delivery to the APS individual with the delivery of services to existing AFC members who may reside in the AFC home.

If the MCO determines the APS individual's placement is not appropriate, the APS individual may not move into the AFC home and the APS worker must make other living arrangements.

4134.2 APS Investigations of AFC Providers

Revision 19-13; Effective November 5, 2019

Any time managed care organization (MCO) staff of an MCO-contracted adult foster care (AFC) provider agency suspect abuse, neglect or exploitation (ANE) of an AFC member in an unlicensed AFC home, the staff must report it immediately to Adult Protective Services (APS). Reports of ANE in a licensed AFC home must be made to the Texas Health and Human Services Commission (HHSC) Regulatory Services Division. The MCO-contracted AFC provider agency must also notify the MCO.

If reports of ANE taking place in an unlicensed AFC home are made to APS by other parties, the MCO or MCO-contracted AFC provider agency staff may not be notified of member allegations against an AFC provider until after the allegations have been validated. However, APS staff may ask the MCO or MCO-contracted provider agency to assist with the delivery of alternative services during the investigation if the alleged mistreatment poses an immediate threat to the safety of the member or other AFC residents.

The MCO handles disenrollment and corrective actions against the AFC home provider, as appropriate. HHSC takes necessary licensure actions for licensed AFC homes. If HHSC terminates the licensure of an AFC home and the MCO is unable to find a suitable alternative residence for the member, the member is referred to APS for assistance in moving from the AFC home.

A member in an unlicensed AFC home who has the capacity to consent may decide not to move from the AFC home, even though the allegation has been validated. In this instance, the member's AFC services will be denied, payments to the home will terminate and an MCO-contracted provider agency will withdraw from supporting ongoing management of the home. However, the member may continue to reside in the unlicensed AFC home by making private pay arrangements at that home.

If a member residing in an unlicensed AFC home, who does not appear to have the capacity to consent, refuses to move from an unlicensed AFC home in which an individual identified as the perpetrator in a case of validated ANE lives and is in a state of ANE, the MCO must make a referral to APS. The MCO-contracted AFC provider agency staff must send a referral to the MCO and APS if the agency staff identify this situation.

If the substantiated allegation of ANE is in a licensed AFC home, the perpetrator must be removed from the AFC home and the license holder must submit to HHSC a plan for the protection of the health and safety of all residents. The resident will not be required to move.

4135 Private Pay Individuals in AFC

Revision 19-13; Effective November 5, 2019

Some adult foster care (AFC) home providers may wish to take private pay individuals. The AFC home provider must contact the managed care organization (MCO) when considering the admission of a private pay individual before he or she is accepted in the AFC home. The purpose of the approval is to determine the:

appropriateness of AFC for the private pay individual based on the individual’s condition and behavior;
capacity of the AFC home to meet the private pay individual’s needs; and
compatibility of service delivery to the private pay individual and the delivery of services to AFC members.

If the MCO determines placement in an AFC home is inappropriate, the AFC home provider cannot accept the private pay individual. Any issues regarding placements must be resolved by the MCO.

4140 AFC MCO Procedures

Revision 19-13; Effective November 5, 2019

This section provides details for a managed care organization (MCO) when determining an applicant's eligibility for adult foster care (AFC) and for developing the applicant’s or member’s individual service plan (ISP).

4141 Eligibility Determination

Revision 19-13; Effective November 5, 2019

To determine eligibility for Adult Foster Care (AFC), the managed care organization (MCO) must determine the applicant or member meets all criteria for the STAR+PLUS Home and Community Based Services (HCBS) program and completes an assessment to determine the applicant’s or member’s classification level. If the AFC placement is with an individual AFC home provider contracted with the MCO, the MCO must also ensure the applicant or member has an agreement with an enrolled AFC home provider, and the applicant or member and AFC home or home provider are appropriately matched per the classification and needs of the applicant or member before the MCO pays for AFC services. If an MCO contracts with an AFC provider agency to perform AFC management services, the MCO-contracted provider agency may perform activities related to the qualification of the home and the home provider before the MCO pays for AFC services. Refer to Section 4133, Adult Foster Care Classification Levels, for additional information.

4142 Service Planning

Revision 19-13; Effective November 5, 2019

The member’s plan of care (POC) must address functional, medical, social and emotional needs and how the needs will be met by the adult foster care (AFC) home provider. The managed care organization (MCO) must assess whether other resources in the community should be used to meet specialized needs of the member. Use of those resources must be documented in the member’s POC.

The MCO must complete Form H6516, Community First Choice Assessment or Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, Part A, Functional Needs Assessment, to document the specific personal assistance tasks with which the AFC home provider must assist the member. The AFC home provider may provide more services for the member than are identified on Form H2060 as the changing needs of the member may warrant but may not reduce or discontinue services without consultation with the MCO or MCO-contracted AFC provider agency.

Upon approval for AFC, the MCO determines if the member has any special needs that require additional monitoring in the AFC home. The MCO must document any special needs or interventions in the case record on Form 2327, Individual/Member and Provider Agreement. Use the "Other Special Arrangements" space under the "Miscellaneous Arrangements" section.

The MCO or MCO-contracted AFC provider agency contacts the member and the AFC home provider to arrange for the initial visit and a negotiated move-in date for the member or AFC home provider. If there are health concerns regarding the member, the MCO nurse may be consulted and a recommendation may be made for the member to have a physical or medical exam before moving into the AFC home. The MCO coordinates with the interdisciplinary team (IDT) and the MCO-contracted AFC home provider, if applicable, regarding the AFC member’s care.

4150 Finalizing the Member’s Plan of Care

Revision 19-13; Effective November 5, 2019

On or before the date the member begins to receive adult foster care (AFC) services, a face-to-face meeting with the member and the AFC home provider is required to discuss the member's plan of care (POC) and to complete Form 2327, Individual/Member and Provider Agreement. The interdisciplinary team (IDT), including the staff of the managed care organization (MCO)-contracted AFC provider, as applicable, and the member's family, authorized representative (AR) or guardian may be included in the meeting. The meeting should preferably take place in the AFC home.

The MCO must discuss the member's POC with the member and family, AR or guardian and reach understanding with them about how the AFC home provider will meet the member’s needs. This discussion should ensure the member and family, AR or guardian that the AFC home provider is adequately prepared to provide services to the member and that adjustments occur smoothly. The MCO must document the POC and any special needs of the member or special agreements between the member and AFC home provider on Form 2327.

If the applicant or member is already residing in the AFC home, Form 2327 must be completed by the MCO service coordinator face-to-face with the applicant or member and AFC home provider or provider agency, if applicable, before the MCO pays for AFC services initially and upon annual reassessment.

4151 Member and AFC Home Provider Agreement

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) documents the service arrangements and the agreement of the room and board payment (R&B) charge on Form 2327, Individual/Member and Provider Agreement.

The MCO or the MCO-contracted adult foster care (AFC) provider agency reviews all of the information on the agreement with the member, family, authorized representative (AR) or guardian and the AFC home provider. All conditions of the agreement and the following topics must be covered in the discussion:

A full description of the care needs of the member and frequency of services needed.
The need for, and frequency of, supervision.
The beginning and ending date on Form 2327.
A detailed description of the rights and responsibilities of the member and the AFC home provider.
An explanation of the member's and AFC home provider's right to privacy and confidentiality.
The monthly dollar amount the member agrees to pay the AFC home provider for R&B, as documented on Form 2327.
The arrangements for a trust fund if the STAR+PLUS Home and Community Based Services (HCBS) program member requests such service from the AFC home provider.
An inventory of the AFC member’s personal belongings.
The names, addresses and telephone numbers of the persons to be notified in an emergency, including the member's physician, family members and/or AR or guardian.
Any special habits and needs of the member and any special arrangements or agreements between the member and the AFC home provider.
Any additional training needs of the AFC home provider and methods to obtain that training.
The rights and responsibilities of both the member and the AFC home provider for notifying the MCO, MCO-contracted AFC provider agency, as applicable, of problems such as illnesses, adverse medication reactions, hospitalizations, acts of violence, accidents or complaints about abuse, neglect or exploitation (ANE). The Texas Health and Human Services Commission (HHSC) Managed Care Compliance and Operations (MCCO) Unit staff must be notified if the member, MCO-contracted provider agency or AFC home provider have a complaint or issue regarding the health and safety of the member.
Other conditions that reflect changes in the member's condition that might affect the appropriateness of AFC services.

The MCO or MCO-contracted provider agency must fully discuss with the AFC home provider the potential for transition issues arising after the member moves into the AFC home or when the AFC home provider moves into the member’s home. The discussion should include notification procedures and suitable actions to be taken to address issues and resolve problems, and the impact of a new living situation on family and other residents in the home.

The member and the AFC home provider must sign Form 2327 after all of the above issues are discussed and both parties are in agreement. Form 2327 must be completed and signed before authorizing and reauthorizing AFC. Any significant changes to the terms of the agreement must be reported by the AFC home provider within five business days. Any incidents, as referenced in Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers, must be reported by the AFC home provider to the MCO service coordinator assigned to the member, and the MCO-contracted AFC provider agency, as applicable, within 24 hours of the occurrence.

4152 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

4153 Trust Funds

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) must offer money management assistance by the adult foster care (AFC) home provider to the member and document when the member either accepted or refused the assistance. If the member expresses an interest in money management, the MCO documents the expressed interest on Form H2067-MC, Managed Care Programs Communication, and sends the form to the AFC home provider. The requirement for money management services may also be documented on Form 2327, Individual/Member and Provider Agreement.

The AFC home provider must maintain trust fund records. The AFC home provider must:

have written permission from the member, his or her guardian, power of attorney or applicable individual to handle the member’s personal financial affairs;
keep member trust accounts separate from the AFC home provider's operating accounts. The separate account must be identified "Trustee (name of the STAR+PLUS Home and Community Based Services (HCBS) program AFC home provider), Member's Trust Fund Account." If the AFC home provider maintains a trust fund, the AFC home provider must:
- deposit the member's monthly income into the account; and
- write a check for the room and board (R&B) charge and copayment amount out of the trust fund account into the AFC home provider's operating account. Staff must not deposit the member's monthly income into the operating account and then deposit the personal needs and R&B allowance into the trust fund account;
make the member trust fund records available for review by the MCO or AFC home provider agency during work hours without prior notice;
not charge the member for services the AFC home provider is expected to provide for the member;
not charge the member for banking service costs if the member’s trust fund is in a pooled account;
obtain and maintain current written individual records of all financial transactions involving the member's personal funds that the AFC home provider is handling. The AFC home provider must include at least the following in the records:
- member's name;
- identification of member's representative payee or responsible party;
- admission date;
- member's earned interest; and
- transactions – the AFC home provider may choose one of the following options:
  - maintain records of the date and amount of each deposit and withdrawal, the name of the person who accepted the withdrawn funds and the balance after each transaction. The member must sign each withdrawal. If the member is unable to sign when funds are being withdrawn from his or her trust funds, the transactions or receipt must be signed by a witness other than the AFC home provider or employee or contractor of the provider; or
  - maintain signed receipts indicating the purpose for which any withdrawn funds were spent, the date of expenditure and the amount spent. The receipt must be signed by the person responsible for the funds and the member. If the member is unable to sign his or her name, a witness other than the AFC home provider or employee or contractor of the provider must sign the transaction or receipt; and
distribute the interest earned on any pooled interest banking account in one of the following options:
- prorated to each member on an actual interest earned basis; or
- prorated to each member based on his or her end-of-quarter balance.

The following information must be included on the receipt for all money that is received or deposited in the member’s trust fund:

member's name;
date the money was received;
source of the money;
amount received; and
amount returned to the member, if any.

All records pertaining to the member's trust fund must be kept in the manner designated above, and available for monitoring without notice.

4154 Hospital Leave

Revision 19-13; Effective November 5, 2019

If a member is receiving adult foster care (AFC) services in an AFC home which is not the member’s home, the member may be required to reserve his or her space during hospital stays by paying the daily bedhold charge, if the provider requires such a charge, which is the negotiated daily rate the managed care organization (MCO) pays the AFC home provider or MCO-contracted provider agency. The AFC home provider does not bill the MCO for the days the STAR+PLUS Home and Community Based Services (HCBS) program AFC member is hospitalized. The AFC member's bedhold charge constitutes the entire payment to the AFC home provider or MCO-contracted AFC provider agency when an AFC member is hospitalized.

During the initial home visit, the MCO or MCO-contracted AFC provider agency review the information regarding the AFC member's responsibility to pay a bedhold charge when away from the home and document this on Form 2327, Individual/Member and Provider Agreement. Hospital leave does not apply when the AFC home provider moves into the member’s home.

4160 Monitoring Quality of Care

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) service coordinator will monitor the quality of care and services provided to meet the needs of the STAR+PLUS Home and Community Based Services (HCBS) program members receiving adult foster care (AFC) services. The MCO service coordinator will appropriately address any issues identified to protect the health and safety of the member.

During regular monitoring visits, the MCO service coordinator must contact the MCO management and MCO-contracted AFC provider agency, if applicable, if the AFC home provider is not meeting the member's needs or the home provider requires additional support or training to meet the member’s needs. The AFC member's physical and medical condition must be carefully monitored to determine whether initial problems are resolved and/or whether new problems are arising due to decreased functional capacity or illness.

Form 2327, Individual/Member and Provider Agreement (see No. 1 under Miscellaneous Arrangements), is used to document special monitoring schedules and other resources used in the plan of care (POC). When the AFC home provider moves in with the AFC member, it is the MCO's responsibility to ensure the AFC member's needs are being met, and there are no health and safety concerns. If concerns are reported or identified, the AFC member's rights must be protected and adjustments to the POC made accordingly.

4170 Reserved for Future Use

Revision 24-1; Effective Feb. 22, 2023

4180 Annual Reassessment of the AFC Member

Revision 19-13; Effective November 5, 2019

In addition to the regular reassessment for the STAR+PLUS Home and Community Based Services (HCBS) program, which includes the managed care organization (MCO) service coordinator completing the Medical Necessity and Level of Care (MN/LOC) Assessment, Form H6516, Community First Choice Assessment, or Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, and addendums, and the individual service plan (ISP) documents, the MCO or MCO-contracted adult foster care (AFC) provider agency must also continue to meet all eligibility requirements and complete Form 2327, Individual/Member and Provider Agreement.