Family Members as Paid Providers

In some situations, family members may be paid to provide certain services.  Immediate relatives permitted to provide service include the following:

  1. Natural Child
  2. Natural Sibling
  3. Adoptive Child
  4. Adoptive Sibling
  5. Stepchild or Step-sibling
  6. Father-in-Law, Mother-in-Law, Son-in-Law, Daughter-in-Law, Sister-in-Law, Brother-in-Law
  7. Grandparent or Grandchild
  8. Spouse of Grandparent or Grandchild

Immediate relatives not permitted to provide services for children under age 18 include:

  1. Natural Parent
  2. Adoptive Parent
  3. Step Parent

Certain requirements are specific to family members who may be paid to provide supports to their family member with a developmental disability.

They include:

  1. Parent/Step Parents may only be paid for an adult child (over age 18). Other family members of an adult or minor who meet certification requirements may be paid to provide services.
  2. A spouse of a person with a developmental disability may not be paid to provide services to their spouse. (See Attendant Care section for exception.)
  3. The Planning Team must determine the type and amount of services the person needs within their home environment. This determination is based on assessed need as well as the availability of natural and community resources.
  4. Family members cannot be paid for skilled care during the provision of services such as Attendant Care or habilitation (skilled care includes but is not limited to: G-tube insertion and feedings, catheter replacement, respiratory treatment such as Small Volume Nebulizers or suctioning tracheostomy care. (See Appendix D – Skilled Nursing Matrix.).
  5. A single family member who is an individual independent provider may not be paid to provide more than 40 hours of any combination of service per week. This maximum of 40 hours per week does not limit another family member from providing services. For example, an adoptive sibling may provide 38 hours of services and the grandparent may provide another 12 hours of service.
  6. Family members must comply with all requirements in their contract in addition to all policies, procedures, laws and rules.
  7. Primary caregivers/parents may not be paid to provide Respite.
  8. Services shall not replace care provided by the person’s natural support system.
  9. Family members shall participate in and cooperate with ongoing monitoring requirements by the Division.
  10. Qualified family members may become certified home and community based services providers by meeting the certification requirements, as applicable.
  11. When a family member requests to become the provider for a member over the age of 18, the Support Coordinator/designee will conduct a personal interview with the member.

Attendant Care


This service provides assistance for a member to remain in their home and participate in community activities by attaining or maintaining personal cleanliness, activities of daily living, and safe and sanitary living conditions.

Barring exclusions noted in this section, Attendant Care may include the following as determined by the member’s assessed needs:

  1. Meal preparation and clean up (e.g., meal planning, preparing foods, special diets, clean-up, and storing foods).
  2. Eating and assistance with eating.
  3. Bathing (e.g., washing, drying, transferring, adjusting water and setting up equipment).
  4. Dressing and grooming (e.g., selecting clothes, taking off and putting on clothes, fastening braces and splints, oral hygiene, nail care, shaving and hairstyling).
  5. Toileting (e.g., reminders, taking off and putting on clothes and/or undergarments, cleaning of catheter or ostomy bag).
  6. Mobility (e.g., physical guidance or assisting with the use of wheelchair).
  7. Transferring.
  8. Cleaning.
  9. Laundry (e.g., putting clothes in washer or dryer, folding clothes, putting away clothes).
  10. Shopping (e.g., grocery shopping and picking up medications).
  11. Attending to certified service animal needs.
  12. General supervision for a member who cannot be safely left alone. (See Appendix A, B and C.)


Responsible Person’s Participation (Attendant Care)

The member/family is responsible to provide:

  1. Needed supplies (e.g., cleaning supplies) or money for supplies. Money must be provided in advance when the Attendant Care provider is expected to shop for food, household supplies, or medications.
  2. Documentation required for the approval of this service.

Considerations (Attendant Care)

When assessing the need for this service, the following factors will be considered:

  1. Due to advancing age, a temporary or permanent documented physical or cognitive/intellectual disability or documentation of other limitation, the parent or guardian cannot meet a child’s basic care needs.
  2. Due to the child’s intensive medical, physical, or behavioral challenges, which are a result of the disability, the parent or guardian cannot meet the child’s care needs.
  3. The child, due to a medical condition or procedure related to the disability, is unable to attend their school/work/day program, and natural support(s) is/are unavailable to provide care.
  4. The adult member is unable to meet specific, basic personal care needs.
  5. The adult member lives alone and is temporarily unable to meet basic personal care needs due to a medical condition or illness.
  6. The member’s needs are not currently met due to unavailability of service. Attendant Care may be used as an alternative service.
  7. The member has medical or physical needs, was living in a Developmental Home, Group Home, Intermediate Care Facility (ICF), Nursing Facility, or other out of home placement, and with Attendant Care, the member will be able to return home.
  8. When a spouse provides Attendant care, the total hours of Attendant care may not exceed 40, regardless of who provides the care. In addition, the member may not receive any similar or like service (i.e., Homemaker). (Habilitation services are not a similar or like service.)
  9. Attendant care services are subject to monitoring and supervision as outlined in Arizona Health Care Cost Containment System policy.
  10. When a family member requests to become the Attendant care provider for a member over the age of 18, the Support Coordinator/designee will conduct a personal interview with the member.

Settings (Attendant Care)

Attendant Care Services may only be provided:

  1. In the member’s home (unlicensed).
  2. In an Independent Developmental Home when there is a specific issue, problem, or concern that is believed to be temporary or short term and the service is approved by the Assistant Director/designee.
  3. In the community:
  4. While accompanying the member; or,
  5. While shopping or picking up medications.

Exclusions (Attendant Care)

Exclusions to the authorization of Attendant Care Service are indicated below. Exceptions shall be approved by the District Manager.

  1. The Attendant Care Service:
  2. Shall not substitute for private pay day care or a school program for children.
  3. Shall not cover before and after school care needs, days when there is no school, half school days, holidays, or summer and winter breaks or for ‘babysitting’ unless a child meets the criteria for supervision.
  4. Shall not be provided for acute illnesses that prevent the child from attending private daycare or school.
  5. Shall not be provided while the member is hospitalized.
  6. Shall not substitute for Work, Day Program, Transportation, or Habilitation unless those services are not available to the member.
  7. When used as a substitute, Attendant Care shall be used only until an appropriate service is available.
  8. When the appropriate service has been refused, Attendant Care cannot be used as a substitute.
  9. Shall not substitute for Respite.
  10. Shall not be received during the provision of a Division funded Employment or Day Program.
  11. Shall not be used to avoid residential licensing requirements.
  12. Shall not be used to take the place of care provided by the natural support system for children.
  13. The tasks below are not included as part of the Attendant Care Service:
  14. Cleaning up after parties (e.g., family celebrations and holidays).
  15. Cleaning up several days of accumulated dishes.
  16. Preparing meals for family members.
  17. Routine lawn care.
  18. Extensive carpet cleaning.
  19. Caring for household pets.
  20. Cleaning areas of the home not used by the member (e.g., parents’ bedroom or sibling’s bathroom).
  21. Skilled medical tasks. (See Appendix D – Skilled Nursing Matrix.)
  22. Shopping for a child living in the family home.
  23. The Division will not authorize Attendant Care when the only tasks identified are cleaning, shopping and laundry. (See Homemaker section in this chapter.)


Description (Habilitation)

This service provides learning opportunities designed to help a member develop skills and independence.

Barring exclusions noted in this section, based on member and family priorities Habilitation may be provided to:

  1. Increase or maintain independence and socialization skills.
  2. Increase or maintain safety and community skills.
  3. Increase or maintain the member’s health and safety.
  4. Provide training in:
  5. Essential activities required to meet personal and physical needs.
  6. Alternative and/or adaptive communication skills.
  7. Self-help/living skills.
  8. Develop the member’s support system to reduce the need for paid services.
  9. Help family members learn how to teach the member a new skill.
  10. When this service is authorized in conjunction with a Habilitation Behavioral Masters/Bachelors program, the Habilitation Hourly provider will follow the plan developed by the Habilitation Behavioral Masters/Bachelors provider.

Considerations (Habilitation) 

The following will be considered when assessing the need for this service:

  1. Existing community support systems have been exhausted and no other service is more appropriate.
  2. The member’s documented needs cannot be met by the member’s support system, employment program or a day program.
  3. Habilitation can support therapy home program strategies.

Settings (Habilitation)

Habilitation Services may be provided:

  1. Hourly or daily in the member’s own home.
  2. Hourly in the home the member shares with the family.
  3. Daily in a group home.
  4. Hourly in a Child Protective Services licensed foster home.
  5. Daily in a developmental home.
  6. Hourly in other community settings (e.g. a Habilitation provider can assist a child in participating in a private pay day care/after school program).

Exclusions (Habilitation)

Exclusions to the authorization of Habilitation Services include, but are not limited to:

  1. Habilitation shall not substitute for Respite or day care.
  2. Habilitation shall not be used in place of regular educational programs as provided under Public Law 108-446 IDEA Part B.
  3. Habilitation shall not substitute for funded or private pay day programs.
  4. Habilitation shall not be used when another service is more appropriate.
  5. Hourly Habilitation shall not be authorized when Daily Habilitation is authorized.
  6. Habilitation shall not be provided in private or public schools during school hours or in transit to schools.
  7. Habilitation shall not be provided in a provider’s residence unless the residence is also the home of the member receiving the service.
  8. Hourly Habilitation shall not be provided in a Qualified Vendor owned or leased service site.
  9. Hourly habilitation shall not be offered in vendor supported Child Development Foster Homes or Adult Developmental Homes unless the following are met:
  10. There is a specific issue, problem or concern that is believed to be temporary or short term.
  11. The Planning Document must outline specific, time limited goals/outcomes regarding the service to be provided.
  12. Monthly progress reports validate continuing the service.


Service Description and Goals (Respite)

This service provides short-term care to relieve caregivers.  Members who are cared for by Respite providers must be eligible for supports and services through the Division.  Respite providers may be required to be available on a 24-hour basis.  Respite services are intended to temporarily relieve unpaid caregivers.  Respite services are not intended as a permanent solution for placement or care.  The number of hours authorized for Respite services must be used for Respite services and cannot be transferred to another service.

Service Settings (Respite)

Respite may be provided in the following settings:

  1. The member’s home.
  2. A Medicare/Medicaid certified Nursing Facility.
  3. A group home foster home or adult developmental home certified by the Division.
  4. A certified Intermediate Care Facility for Individuals with an Intellectual Disability (ICF/IID).
  5. A provider’s home that complies with the requirements of the Department of Health Services or the Division.

Service Requirements (Respite)

Before Respite can be authorized, the following requirements must be met:

  1. Prior to initiating service, the provider shall meet with the primary caregiver to obtain necessary information regarding the member.
  2. The provider shall:
  3. Supervise the member and meet their social, emotional and physical needs.
  4. Ensure the member receives all prescribed medications in the ordered dose and time.
  5. Administer First Aid and give appropriate attention to injury or illness.
  6. Supply food to meet daily nutritional needs including any prescribed therapeutic diets.
  7. Furnish transportation as needed to day programs and appointments.
  8. Carry out any programs as requested by the Planning Team.
  9. Report any unusual incidents to the Division in accordance with policies and procedures.
  10. Ensure appropriate consideration of member needs, compatibility and safety when caring for unrelated members.

Exclusions (Respite)

Exclusions to the provision of Respite services may include the following:

  1. Respite shall not substitute for routine transportation, day care or another specific service.
  2. Respite shall not substitute for a residential placement.
  3. Respite providers shall not serve more than three people at one time.
  4. Foster care (child developmental homes) and adult developmental home providers shall not give services to more members than would exceed their Division license.
  5. Foster care (child developmental homes) and adult developmental home Respite providers shall not give services to children and adults simultaneously. This is only allowed if stated on the license. Additionally, the provider shall not offer services to adults if the license is for children and vice versa.
  6. Respite is not available for members living in group homes or an ICF/IID.
  7. Assisted Living Centers, non-state operated ICF/IID, skilled nursing facilities; Level I or Level II behavioral health facilities and members living independently are not approved for Respite.