Relative as Direct Support Employee

Per the N.C. Innovations Technical Amendment (waiver), the draft version of the Clinical Coverage Policy 8-P and the policies and procedures of Vaya Health, the Relative as Direct Support Employee (RaDSE) policy, will incorporate the following changes effective November, 1, 2016.

Community Living and Supports (CLS) will replace Personal Care, In-Home Skill-Building and In-Home Intensive Supports with each annual review. As members transition to CLS, CLS will be the ONLY waiver service that may be provided by a relative who resides in the home of an adult waiver member (ages 18 and older).

  • A relative is defined as an individual related by blood or marriage to the waiver member. The following relatives remain excluded from providing services as a RaDSE: biological or adoptive parents of a minor child, stepparents of a minor child and the spouse of a waiver member.
  • For waiver members receiving Residential Supports, this policy does not apply.

The provider must continue to ensure that he or she and the RaDSE are in compliance with N.C. Session Law 2013-258 (House Bill 543): Guardianship Roles of MHDDSA Providers.

It is recommended that a relative residing in the home of the member provide no more than 40 hours per week of service to the individual.

Additional Guidelines

  • If the RaDSE provides 40 hours per week of service or less, refer to the Vaya Health guidelines on the approval process, qualification criteria other important information.
  • If the RaDSE requests more than 40 hours per week of service, refer to the Vaya Health guidelines on prior approval for such requests, qualification criteria, service restrictions and other important information.

Submit the RaDSE request form online

Vaya Health has created an electronic prior-approval procedure. The Innovations provider must initiate this process and complete the form. The RaDSE form is available through DocuSign.

The form requires detailed information to provide the Vaya Health with all information necessary to approve or deny the request. Completion of the form will generate a prior-approval request. The form will be reviewed for complete information, and a decision then rendered within 14 calendar days.

Questions?

Call Vaya at 1-800-893-6246, ext. 1179, or email RaDSE@vayahealth.com.

Call 1-800-849-6127 toll free 24/7 to access mental health, substance use and intellectual and/or developmental disability services. Members can request materials in Spanish or English.

Llamar al número gratuito 1-800-849-6127 24/7 para obtener servicios y apoyo a la salud mental, discapacidades de desarrollo y abuso de sustancias. Los miembros pueden solicitar materiales en español o Inglés.