DMHAS: MRO-Group Homes

Community Services Division
GROUP HOMES

By Federal Law, a state’s Medicaid program must offer medical assistance for certain basic services such as inpatient hospital, outpatient hospital, laboratory and x-ray, physicians’ and dentists services, home health services and pregnancy related services. The state and the federal government share the cost of these mandatory services.  

States may also receive Federal matching funds to provide certain optional services thereby relieving some of the financial burden on the state.  Rehabilitative services in community settings are an example of such an optional service.  These federal funds are paid on a fee-for-service basis directly to providers as well as matching funds to the State of Connecticut.  All optional services must be deemed "medically Necessary" for living successfully in the community.

Medical Necessity- Federal Definition

“Any medical or remedial service (provided in facility, home or other settings) recommended by a physician or other licensed practitioner of the healing arts (LPHA), within the scope of their practice under state law, for the maximum reduction of physical or mental disability and restoration of the individual to the best possible functional level.”      

The Local Mental Health Authority (LMHA) has the responsibility for determining medical necessity* and developing the Master Treatment Plan for all people who receive Medicaid Rehab Option services.  All clients must be voluntary, active participants.

*  note

Medical Necessity for the purpose of the Medicaid Rehab Option in group homes means health care/services provided to correct or diminish the adverse effects of mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnosis a mental illness or medical condition related to a mental illness; or to prevent a condition, i.e., debilitating psychiatric symptoms, from occurring.


Group Home Mental Health Rehabilitation – CT State Plan Amendment

Medicaid Rehab Option services are delivered in Private Non-Medical Institutions (PNMI) such as private non-profit mental health residential group homes of 16 beds or less.  These facilities must be designed to assist individuals with a serious and persistent mental illness to achieve their highest degree of independent functioning and recovery.   

Access to mental health group home rehabilitative services is provided to those recipients on or eligible for Medicaid whose mental illness is so serious and disabling as to require care in a group home setting.  The clients will be sufficiently stable that they can function outside of a 24-hour medically managed setting and participate in community-based treatment services.  However, these clients will have functional disabilities secondary to serious and persistent mental illness and these disabilities will be so great as to require that these clients reside in a non-medical twenty four hour, seven day per week, supervised community–based residential setting with rehabilitative services and supports.  Necessary rehabilitative services are provided by group home staff to individuals who have significant skill deficits in the areas of self-care and independent living as a result of their psychiatric disability


Mental Health Group Home Provider Qualifications

Participating facilities must be licensed by the Department of Public Health to provide residential services for individuals with a serious and persistent mental illness and must be certified by the Department of Mental Health and Addiction Services or its agent.  The Department of Mental Health and Addiction Services’ facility certification will assure that the facility provides the necessary level of supervision and oversight of the non-licensed mental health counselor staff responsible for the provision of direct rehabilitative services.   

The facility director will hold a bachelors degree in a human service discipline and a minimum of three years of experience in a mental health services related position.  The facility director (or other manager) will be accessible after-hours by telephone or pager to staff on duty.  Direct service staff will hold either a bachelor’s degree in a behavioral health related specialty or have two years experience in the provision of mental health services.  All group home staff will be certified in First Aid and CPR.   

As a condition of certification, all facilities will be required to provide an initial orientation, training and periodic supervision to direct service staff related to the provision of rehabilitative services.  A licensed clinician will provide the staff supervision and oversee the formulation of client service plans as evidenced by the clinician's signature on the plan. The clinician will be employed or contracted by the facility provider.   


Residential Rehabilitation Services

Services contained in a written plan of care must be based on the assessment of the medical necessity for services as recommended by a physician or other licensed practitioner of the healing arts (LPHA) and ‘ordered’/contained in the Master Treatment Plan.  These rehabilitative services are provided in a structured recovery environment, with on-site staffing twenty-four hours a day, seven days a week.  Each Medicaid client must receive a minimum of 40 hours of residential rehabilitation services each month. 

Rehabilitative services include the following:

  • Behavior management training and intervention;

  • Supportive counseling directed at solving daily problems related to community living and interpersonal relationships;

  • Psycho-educational groups pertaining to the alleviation and management of psychiatric disorders;

  • Teaching, coaching and assisting with daily living and self-care skills such as the use of transportation, meal planning and preparation, personal grooming, management of financial resources, shopping, use of leisure time, interpersonal communication and problem-solving;

  • Assistance in developing skills necessary to support a full and independent life in the community;

  • Support with connecting individuals to natural community supports; orientation to and assistance with accessing self help and advocacy resources; development of self-advocacy skills;

  • Health education; teaching of recovery skills in order to prevent relapse; and

  • Other rehabilitative supports necessary to develop or maintain social relationships, to provide for independent participation in social, interpersonal or community activities, and to achieve full community reintegration. 

In addition, the facility provider shall conduct on-going assessment and service planning, and supervise and monitor self-administration of medications.  Restraint and seclusion are not provided within these facilities. 


Exclusions to Residential Rehabilitation Services

  • Services and programs that are solely recreational
  • Social events
  • Academic education
  • Job training and vocational services
  • Case management
  • Case coordination
  • Habilitative services
  • Transportation (teaching the use of transportation systems may be part of covered, skill building rehabilitation services)

None of the excluded services are Medicaid Rehab Option reimbursable.


Training Handouts

Consultants from the National Council of Consulting Services have been working closely with the Department of Mental Health and Addiction Services (DMHAS) to assure that the transition to the Medicaid Rehab Option is successful for group home providers.  The following handouts were used at the various training sessions conducted by these consultants.  They contain excellent useful information about the implementation of the Rehab Option in identified group homes.


 Sample Forms

The consultants from the National Council of Consulting Services have provided templates/samples of various forms for use in documenting planning and services to required by group homes for Medicaid Rehab Option.  These samples can be downloaded and adapted for use.


 MRO Time Study Materials


 Resources


Group Home Contacts

Sue Graham, Medicaid Rehab Option,
(860) 418-6918  sue.graham@po.state.ct.us

Lauren Siembab, Director, Community Services Division,
(860) 418-6897  lauren.siembab@po.state.ct.us

Wayne Starkey, Regional Manager, Community Services Division, Region 1 and 2,
(860) 418-6835 (OOC Hartford)  Wayne.starkey@po.state.ct.us

Rhonda Kincaid, Regional Manager, Community Services Division, Region 3 and 5,
(860) 418-6886  rhonda.kincaid@po.state.ct.us

Liz Downing, Value Options
(877) 552-8247 x301127  liz.downing@valueoptions.com  

Paul Piccione, Ph.D., Department of Social Services
(860) 424-5160  paul.piccione@po.state.ct.us 


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Content Last Modified on 11/15/2013 12:48:12 PM