Important information regarding legally responsible individuals and related responsibilities for respite care

We are writing to you to highlight the crucial role and responsibilities you hold within the legally responsible individuals (LRI) process.

As you know, an LRI, or legally responsible individual, should not provide more than 40 hours of service per week. Furthermore, members who use an LRI are not eligible to receive any respite hours.

If an LRI is employed by your organization, it is your responsibility to inform the health plan. This notification enables us to make the necessary adjustments and discontinue respite authorizations accordingly.

Care providers should ensure that they make note of the paid and unpaid caregiver(s) in the Support System section of the DMAS 99. Care providers should also make note if there is an LRI on the coversheet or DMAS 98R form of their authorization requests.

We want to emphasize the significant consequences faced by care providers who fail to comply with these requirements. Any care provider who falsifies information concerning LRI engagement or delays reporting such information places themselves at risk of payment recoupment. Additionally, such actions may be considered as a breach of their participation agreement.

Our aim is to ensure the appropriate provision of services and maintain the highest level of integrity. We appreciate your dedication to these objectives and your continued commitment to the communities we serve together.

Should you have any uncertainties or require further clarification on LRI processes and responsibilities, please do not hesitate to reach out to the member’s assigned care coordinator or contact the Long-Term Services and Supports (LTSS) Provider Services team at valtsspr@anthem.com