Extended Personal Care Service 525-05-30-27
(Revised
1/1/14 ML #3399)
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Purpose
The purpose of Extended Personal Care Services (EPCS) is to complete
tasks that are medical in nature and specific to the needs of an eligible
individual. Approval to complete these tasks is provided by the Nurse
Educator who has provided training to the EPCS Provider and is enrolled
with the Department to provide Nurse Education. Or, if a necessary medical task is too complex to be taught to an unlicensed provider the nurse may provide the service directly to the client. Services provided by a licensed nurse include but are not limited to nurse assessments, care planning, training, medication set up and periodic review of client care needs or the provision of direct care that is too complicated to delegate to an extended personal care provider.
This service may include nursing care to the extent permitted by state
law that will maintain the health and well-being of the individual and
allow the individual to remain in the community. EPCS are services that
an individual without a functional disability would customarily and personally
perform without the assistance of a licensed health care provider, such
as catheter irrigation, administration of medications, or wound care.
Activities of daily living and instrumental activities daily living are
not part of this service.
Service
Eligibility, Criteria for
The individual receiving EPCS must be:
- Eligible for the Medicaid
Waiver
for Home and Community Based Services or Service Payments to the Elderly & Disabled.
- Competent to participate
in the education of the Extended Personal Care Service Provider by the
Nurse Educator or have a legally responsible representative directly participate
in the process.
- The need for EPCS is limited
to individuals who have a cognitive or physical impairment that prevents
them from performing extended personal care service activities.
- Have an informal caregiver
support system to provide contingency (back-up) care in case of absence
of EPCS providers
- Be competent to actively
participate in the development and monitoring of their individual care
plan or have a legally responsible party available to participate.
Authorization
for Service
- The initial Request for
Extended Personal Care Services (written request by Case Manager), ICP,
SFN 1467, Authorization to Provide Services, SFN 1699, and NPOC (including documentation of education
provided for tasks, monitoring plan, and instructions for incident reporting)
must be pre-approved by the Assistant Medicaid Director of the Long Term
Care Continuum, Medical Services Division. The case manager is responsible
to send the completed documents to Medical Services/HCBS.
- The ICP, SFN
1467, Authorization to Provide Services, SFN 1699, and NPOC must be
updated and reviewed at the six month level by the Assistant Medicaid
Director of the Long Term Care Continuum, Medical Services Division. The
case manager is responsible to send the completed documents to Medical
Services/HCBS.
- The ICP, SFN 1467, Authorization
to Provide Services, SFN 1699, and NPOC must be completed and reviewed
every six months by the Assistant Medicaid Director of the Long Term
Care Continuum, Medical Services Division. The case manager is responsible
to send the completed documents to Medical Services/HCBS.
Service
Delivery
EPCS and Nurse Education are provided in accordance with the nursing
plan of care (NPOC), developed by the client and
the Nurse Educator, to meet the identified needs of the client. The Case
Manager is responsible to complete an Individual Plan of Care, SFN 1467,
and Authorization to Provide Services, SFN 1699,
taking into consideration the needs identified in the NPOC.
The EPCS client or their legally responsible person is required to identify
and oversee their EPCS providers. The client, with the assistance of the
Case Manager must develop a contingency plan to assure health, welfare,
and safety in the event the client’s care needs change or providers are
not available.
Incidents
The Nurse Educator provides written documentation to the Department
that shows he or she has provided instructions to the EPCS Provider that
outlines the types of situations that are considered reportable incidents,
and instructions on who should be contacted, and this may include contacting
the client’s primary health care provider for
instruction and then contacting the HCBS Case Manager. If the HCBS Case
Manager and Nurse Educator determine that the incident is indicative of
abuse, neglect, or exploitation, the HCBS Case Manager must immediately
report the incident to the Department. The Case Manager must also follow
the policy found in HCBS Case Management 525-05-30-05,
Monitoring for Abuse, Neglect, or Exploitation. The incident plan needs to be updated on an annual basis and a copy provided to the Assistant Medical Director.
Limits
- Assistance with activities
of daily living and instrumental activities daily living are not part
of this service.
- Due to the complexity of
the care provided to individuals receiving Extended Personal Care Services,
contingency plans are required as a prerequisite to receive this service
to assure that health welfare and safety are maintained in the event that
a provider is unavailable to provide the service.
Service
Activities, Authorized and Limits
- Documentation outlining
the tasks the nurse has trained the
Extended Personal Care Service Provider on are maintained by the Nurse
and a copy is sent to the Case Manager. The Case Manager notes on the
SFN 1699 in Section II “Other," the tasks the nurse has trained the
Extended Personal Care Service Provider to complete.
- If a necessary medical task is too complex to be taught to an unlicensed provider the nurse may be paid to provide the service directly to the client. Services provided by a licensed nurse include but are not limited to nurse assessments, care planning, training, medication set up and periodic review of client care needs or the provision of direct care that is too complicated to delegate to an extended personal care provider.
- The nurse educator will provide at a minimum, a review of the client’s needs every six months to determine if additional training and or tasks are required.
