complaint·May 15, 2025

The SSI standard rates for Non-Medical Out-of-Home Care (NMOHC) Payment Standard have been $1492.82 for 2023, $1575.07 for 2024, and $1599.07 for 2025. Record review of R1’s admission agreement revealed they were admitted on 11/18/23. R1’s admission agreement was signed by their representative, Visitor #1 (V1). R1’s funding source was listed as both their Social Security and family. R1 was initially charged $1344.82 for basic services with Assisted Living Waiver (ALW) funds covering their cost of care. Since R1 and V1 elected for a private room, the facility charged an additional fee. Review of the Social Security Administration’s Program Operations Manual System (POMS) Chapter SI SF01415.120 California Optional State Supplement indicates “The State provides a breakout of standard charges each year for NMOHC facilities... However, a recipient’s written admission agreement may include additional charges if a resident chooses a private room when a double room is available... The facility should be able to provide the actual charges for room and board as specified in the written agreement”. Interview with Staff #1 (S1) at 10:15 a.m. today revealed a meeting was held in 2024 to discuss R1’s monthly rent rate. In the meeting, S1 and R1’s ALW service coordinator, Visitor #2 (V2) explained to R1's representatives that a private room fee can be established by the facility and documented in the admission agreement. Telephonic interview with V2 at 10:40 a.m. today confirmed that they explained the conditions of private room fees to R1's representatives. Based on interviews and record review, V1 signed R1’s admission agreement which included the private room fee. R1 paid rent each month from their SSI funds in accordance to the applicable payment standards, and the remaining balance was paid from family. The facility did not charge a base fee more than the SSI rate. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Copy of report provided.