Hartwood currently operates 18 group residences supporting nearly 100 persons within the community where they receive the support and encouragement they need to build their skills and reach their highest potential. In addition, Hartwood owns and operates a state-of-the art group home-based respite/emergency program serving up to eight individuals at a time and in-home (and drop-in) supports programs in Fairfax County, Virginia serving children and adults. Finally, Hartwood administers Fairfax county’s Respite Subsidy Program which gives nearly two hundred local families a break on the cost of private respite services for their loved one with special needs. See details below.
Note: Unless otherwise noted all programs are for adults. Fees are charged based on the ability to pay and pursuant to contractual agreements with Community Services Boards. HUD supported programs require Section 8 eligibility and payment of fees.
Group Home Services and Supports:
Provides safe, comfortable and adaptive (as may be needed) housing and comprehensive residential support services 24 hours/day
Supported Residential Services:
Provides safe, comfortable housing and (less than 24 hour/day care) residential support and general supervision
Emergency Respite Services:
Traditional Group Home-Based Respite Services:
Hartwood’s respite program may be used by any person who meets the target population requirements, the admission criteria, and pays the necessary fees.
A maximum of 8 individuals who meet the target population and admissions criteria may simultaneously use the respite facility. Up to four beds may be in “routine” use, the remaining beds are reserved for emergency use (3 – Fairfax – Falls Church CSB and 1- Arlington CSB)
The main focus of the respite program will be to provide short term, periodic care for the residents in the absence of their families or other care providers. The respite facility is typically used for traditional respite purposes, i.e. giving families a break or respite from caring for the family member with an intellectual disability; however, it may be used for short-term emergency placement also.
“Routine” Respite Services for any individual at Hartwood Foundation’s respite facility may not exceed 21 consecutive days and may not exceed 60 days in any 1-year period.
The individual, individual’s family, or CSB support coordinator will be responsible for arranging transportation to and from the respite facility, the individual’s day placement, recreational events not arranged and staffed by Hartwood Foundation staff, and any medical appointments that happen to fall during an individual’s “private respite” stay at the facility. Hartwood Foundation staff will not be available to accompany an individual to a medical appointment. Should a medical emergency occur, 911 will be contacted to request an ambulance. The individual’s parents and/or emergency contacts will be contacted/ notified as soon as possible to meet the individual at the hospital.
In-Home Support Services:
With funding through the Virginia Intellectual Disability Waivered Services Program support can be provided in the family home on a limited basis. Both children and adults are eligible for services.
Drop-In Support Services:
With funding through the Fairfax-Falls Church Community Services Board, adults living in the community alone or with housemate(s) may receive support in all facets of home and community living.
Respite Subsidy Program:
With funding through the Fairfax-Falls Church Community Services Board, families may be eligible to receive cash subsidies to assist with the costs of hiring specially skilled “sitters/companions” to care for a family member with intellectual disabilities during short absences of caregivers. Both children and adults are eligible for services.
Once a Hartwood Services Application is completed and either mailed or emailed to the Hartwood main office, Hartwood staff will confirm the individual’s/family’s eligibility to participate in the Respite Subsidy Program with the Community Services Board. Once eligibility is confirmed, the Respite Subsidy Coordinator will contact the family to schedule a home visit/intake to assess the individual’s support intensity level and review forms and procedures for seeking (subsidy) reimbursement for Respite fees paid by the family directly to the private provider of their choosing.
Respite Subsidy Reimbursement Procedures
To streamline the process of Reimbursement for Respite Subsidy Program expenses, the Hartwood Foundation, Inc business office will be directly involved in the Reimbursement Process.
The new pre-authorization and reimbursement procedures are as follows:
STEP 1: Organize information as follows:
STEP 2: Call the voicemail of Respite Authorization Line at the Hartwood Main Office @ (703) 273 – 0939 ext. 26 or email @ firstname.lastname@example.org
STEP 3: State the date you are calling.
STEP 4: State the Respite Recipient’s Name
STEP 5: State the Level of Service
STEP 6: State the Expected/Planned Date(s) of Service
STEP 7: State the number of hours you expect to use on each date
STEP 8: State the Parent/Guardian Name
STEP 9: Leave a contact phone number of the Parent/Guardian
STEP 10: Insert date of your call/email in numerical form (see example below) as the “Authorization Date” in the appropriate space on your Respite Reimbursement Request.
EXAMPLE: IF YOU CALL ON January 2, 2014 (01/02/14, YOUR AUTHORIZATION NUMBER WOULD BE 010214.
STEP 1: Complete Respite Reimbursement Request as directed in instructions and submit to the Hartwood Main Office at the address/fax number listed above.
STEP 2: Please keep track of the hours used as they relate to your quarterly budget. If necessary, you can call the HFI Main Office to check your budget hours status.
For PROGRAM INFORMATION and REIMBURSEMENT INFORMATION, please contact Severina Henderson (703) 273 – 0939 ext. 22.
A copy of the processed Respite Reimbursement form will be returned to parents/guardians, along with the approved subsidy and a new form for future request.
Please do not detach carbon copies of the request form. All three sheets must be submitted to Hartwood Foundation, Inc. (HFI) for processing.
INDIVIDUAL LEVEL: The individual level should be consistent with the service level determined at the time of program. Medically Fragile: Only those family members who received skilled nursing services for an individual with significant medical needs should check the Professional Nursing Service box.
SPECIAL ASSISTANCE: This section is to be completed by individuals who have already been determined to be eligible for financial assistance.
The Advance Request box should be checked by family members who opt to use this form to request a subsidy advance by mail. In order to receive a subsidy advance, families are required to complete the individual and parent/guardian information at the top of the form. Next, the Respite Delivery information at the top of the form should be completed. Finally, respite service delivery information on the respite care chart (provider, dates, times, location and rate), and the Provider Information section on the bottom of the form should be completed.
Once an advance request is received and authorization by the Respite Subsidy Coordinator, the request form will be returned along with the approved subsidy.
The follow-up Receipt for Advance Payment box should be checked by families after services that were pre-paid by HFI have been provided. The reimbursement form, once completed and signed by the provider and family, will serve as the follow-up receipt for the HFI advance. The form should be completed as specified below.
AUTHORIZATION #: This number will be the numerical date you call/email for Authorization.
EXAMPLE: If you call/email on January 2, 2014 (01/02/14), your Authorization # will be 010214.
AUTHORIZATION DATE: This is the same as the Authorization # in the above section (the date that you call for authorization) in the form of a date.
EXAMPLE: If your Authorization # is 010214, your authorization date will be January 2, 2014 (01/02/14).
AUTHORIZED BY: If you pre-authorized by email, please check the email box. If you pre-authorized by phone, please check the phone box.
INDIVIDUAL NAME: The individual who require respite care.
PARENT/GUARDIAN: Parent/guardian is the individual who is requesting reimbursement services.
FULL MAILING ADDRESS: Full mailing address is the address where the approved
TELEPHONE #: Best contact number to be reached.
INFORMATION TO BE PROVIDED WITHIN THE CHART:
PROVIDER NAME: The provider is the individual who provides respite services.
DATES/TIME: Dates, times, and location of respite service provision should be concise.
FAMILY HOME/PROVIDER HOME Check the appropriate box for location where services provided
ACTUAL AMOUNT PAID The rate of pay per hour/day should indicate the full rate of
TO THE PROVIDER: pay per hour/day that the provider receives.
DATE PAID: The actual date the family pays the provider should be indicated.
PROVIDER SIGNATURE/PARENT/GUARDIAN SIGNATURE:
Both the provider and the family must sign the form where indicated within the chart. These signatures will certify that the provider has been paid for services as specified on the form: (Note: Signatures are required from the family and provider on each line that denotes a separate period of service delivery.)
PROVIDER INFORMATION: This information must be provided from HFI records. Please be informed, however, that HFI does not file reimbursement information regarding program participants with the Internal Revenue Service. Families and providers are responsible for filing appropriate information with the IRS for tax purposes, as required by law.
Once the Respite Reimbursement form is complete, please mail/fax it to the address at the top of the form for processing. Reimbursement will be processed by HFI after receipt of the Reimbursement Request, provided the form is complete as required.
NOTE: INCOMPLETE FORMS WILL NOT BE PROCESSED FOR REIMBURSEMENT.
Hartwood has developed and maintained private funding for special purposes that can be used with any Hartwood operated program.
Hartwood is an approved and enrolled provider of residential and respite services under the Mental Retardation Medicaid Waivered Services Program since its inception in 1991. Program operations are licensed through the Virginia Department of Behavioral Health and Developmental Services – Office of Licensure.
Group Home / Center Based Respite
Respite Subsidy Programs