Semi-Independent Living Services
(Self-Determination waiver only)
Semi-Independent Living Services (SILS) shall mean services that include training and assistance in managing money, preparing meals, shopping, personal appearance and hygiene, interpersonal and social skills building, and other activities needed to maintain and improve the capacity of an individual with an intellectual disability to live in the community.
The service also includes oversight and assistance in managing self-administered medication and/or medication administration as permitted under Tennessee’s Nurse Practice Act.
This service is appropriate for people who need intermittent or limited support to remain in their own home and do not require staff that lives on-site. However, access to emergency supports as needed from the provider on a 24/7 basis is an essential component of this residential service and is what differentiates it from Personal Assistance services.
The Circle of Support must consider the person's level of independence and safety prior to establishing a semi-independent living arrangement. Safety considerations must be reviewed at least annually (and more often should a change of needs or circumstances warrant). Consideration regarding the use of a Personal Emergency Response System should be given when appropriate. The ISP must reflect the routine supports that will be provided by residential staff.
The person may choose to live with one or two other persons supported and share expenses or to live alone as long as sufficient financial resources are available to do so. No more than 3 persons receiving Semi-Independent Living Services will be permitted to share a residence. The person supported shall have the right to manage personal funds as specified in the Individual Support Plan.
Reimbursement for Semi-Independent Living Services shall not include the cost of maintenance of the dwelling. Residential expenses (e.g., phone, cable TV, food, rent) shall be apportioned between the person(s) supported and other residents in the home (if applicable).
A person who is receiving Semi-Independent Living Services shall not be eligible to receive Personal Assistance, Respite or Transportation as separate services. With the exception of transportation to and from medical services covered through the Medicaid State Plan/TennCare Program, transportation shall be a component of Semi-Independent Living Services and shall be included in the reimbursement rate for such.
The Semi-Independent Living Services provider shall not own the person’s place of residence or be a co-signer of a lease on the person’s place of residence unless the provider signs a written agreement with the person that states that the person will not be required to move if the primary reason is because the person desires to change to a different provider.
The Semi-Independent Living provider shall not own, be owned by, or be affiliated with any entity that leases or rents a place of residence to a person supported if such entity requires, as a condition of renting or leasing, the person to move if the person desires to change to a different provider.
Semi-Independent Living Services shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for individuals with Intellectual Disabilities (ICFs/IID). Semi-Independent Living Services shall not be provided in a home where a person supported lives with family members unless such family members are also persons receiving Semi-Independent Living Services. Family member shall be interpreted to mean the mother, father, grandmother, grandfather, sister, brother, son, daughter, or spouse, whether the relationship is by blood, by marriage, or by adoption.
On a case-by-case basis, the DIDD Commissioner or designee may authorize Semi-Independent Living services for a person supported who resides with his or her spouse and or minor children.
Semi-Independent Living Services shall not be provided out-of-state.
A minimum of two face-to-face direct service visits in the home per week are required for each person receiving Semi-Independent Living Services. However, providers delivering this service are required to implement provisions for availability of provider staff on a 24 hour basis in case emergency supports are needed.
Semi-Independent Living Services providers are required to be licensed as Mental Retardation (i.e., Intellectual Disabilities) Semi-Independent Living Providers.
Additional Facility Specifications for Semi-Independent Living Services:
Environments that can be used as semi-independent living sites shall include apartments or homes that are self-contained and include at least a kitchen, bathroom, living area, and one or more bedrooms.
As long as they have the financial resources to do so, people receiving semi-independent living services can choose to live alone. A person may also choose one or two house mates to share expenses with if they so desire. In no instance will there be more than three (3) service recipients living in one apartment/home. While a provider may facilitate introductions to potential house mates, only the person(s) living in the apartment, along with applicable input from legal guardians and/or conservators, may choose prospective house mate(s).
With support from family members and/or provider staff, people furnish and decorate their own apartment/home. As part of the supports provided, staff may transport people shopping, assist with hanging pictures, assist with financial management or other activities designed to assist the person in setting up their own apartment/home, etc.
Support staff will be available to assist people with food stamp applications, grocery shopping etc. and will be expected to ensure people have adequate food supplies. People will have unrestricted access to their kitchen/food supplies. They will decide how they want to spend their time and what activities they wish to participate in. Staff will support them to participate in activities of their choosing as they desire.
The apartment/home is under the control of the person(s) who live there and there are no restrictions on visitors of their choosing. Should issues arise, the person and their circle of support would work to resolve them on an individualized basis.
Service recipients’ privacy will be ensured with lockable entrance doors. With guidance from their circle of support, service recipients will choose whether to share keys with support staff. Should the provider own the residence, as the landlord they would retain a key to the premises for emergency purposes as any landlord would.
Prior to an initial move into a semi-independent living apartment/home, if the person has mobility issues, a therapeutic site assessment may be completed to determine home modifications that might be needed. Minor modifications may be completed in accordance with waiver protocols within the individual’s Waiver budget. The owner of the property may choose to make adaptations as appropriate.
There must be a legally enforceable lease agreement between the person supported and the landlord. Such an agreement must be in compliance with landlord/tenant laws of the state applicable for any tenant under a lease agreement.
Lease Requirements Applicable to Semi-Independent Living Services:
The following requirements are applicable regarding lease arrangements for persons receiving semi-independent living services:
- The preferred lease option is for the home lease to be signed by the person supported or legal representative.
- A provider may co-sign a lease with a person supported in order to increase the selection of housing options available to the person, but may not be the sole lease holder. A provider would not be expected to co-sign the lease with the person supported if the provider owns the home.
- If a provider does co-sign a lease with a person supported, the provider must also sign a written agreement with the person supported stating that the person will not be required to move or pay an increased lease payment due to a change of semi-independent living providers.
- If a provider owns a semi-independent living home leased to a person supported, the provider shall not require as a condition of the lease agreement that the person move if a different semi-independent living provider is chosen. The lease agreement shall specify that the service recipient will not be forced to move should the person choose to be supported by a different provider agency.
- A provider may not be affiliated with the owner of a semi-independent living home leased to a person supported if the entity owning the home requires that the person move as a condition of the lease if a different semi-independent living provider is chosen.
- A change in provider shall not require the person to change residences. Should the person supported wish to change provider agencies, such transition shall proceed in accordance with person-centered transition planning processes set forth in the Community Transition Policy. This process requires that the wishes and desires of the person supported be considered by the circle of support (COS) and incorporated into the planning process. The person and legal representative, if applicable, in conjunction with the COS shall determine if the proposed transition is in the person’s best interests. Logistics of the transition, including disposition of co-signed leases, will be worked out during the transition process.
- The owner of a semi-independent living home may not be an employee or board member employed or appointed by the semi-independent living provider.
- The lease must provide for a sixty (60) day notice to the person supported prior to termination of the lease agreement or increase in the rent or lease amount.
- The rental payment or lease amounts shall not exceed fair market value for similar property in the same general location.
- The term of the rental or lease agreement shall not exceed one (1) year unless specified in the ISP and in the best interests of the person supported for purposes of obtaining a home with accessibility modifications.
- In the event that a multi-year agreement is desired and meets the aforementioned standards, an annual increase of no more than 3% of the annual lease value may be contained within the lease agreement.
- No more than one month’s rent may be charged as a security deposit.
- All notices related to termination of or changes in the lease agreement must be provided to the person supported, and/or legal representative or other person designated by the person.
Availability of Mortgage/Lease Documentation:
Individual leases and mortgage documentation must be accessible to auditors and surveyors representing CMS, TennCare, DIDD and other state and federal agencies responsible for regulation and oversight of DIDD programs. Lease/mortgage payment information must also be available for review if the provider is involved with assisting the person supported in managing financial resources.
Applicable limits, if any, on the amount, frequency, or duration of this service: None
Governor Bill Haslam
