Attendant Care Service 525-05-30-18

(Revised 6/1/08 ML #3144)

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Purpose

Attendant Care Services (ACS) is hands on care, of both a supportive and medical nature, specific to a client who is ventilator dependent for a minimum of 20 hours per day and includes nursing activities that have been delegated by the nurse manager to the ACS provider. ACS is an all-inclusive service that provides direct care to ventilator-dependent individuals to meet their care needs.

Service Eligibility, Criteria for

The individual receiving ACS must be:

1. Eligible for the Technology Dependent Medicaid Waiver
2. Dependent upon a ventilator for a minimum of 20 hours per day
3. Medically stable, as documented by their primary care physician on an annual basis (at a minimum) or as requested by the Case Manager
4. Competent, as documented by the primary care physician on an annual basis (at a minimum) or as requested by the Case Manager

The individual receiving ACS must:

5. Have an informal caregiver support system to provide contingency (back-up) care in case of absence of ACS providers
6. Actively participate in the development and monitoring of their individual care plan

Authorization for Service

1. The initial Request for Attendant Care Services, SFN 944, 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.
2. 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.
3. The ICP, SFN 1467, Authorization to Provide Services, SFN 1699, instructions for incident reporting, and NPOC must be completed and reviewed on an annual basis 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

ACS and Nurse Management are provided in accordance with the nursing plan of care (NPOC), developed by the client, the HCBS Case Manager and the Nurse Manager, 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 ACS client is required to identify and oversee their ACS providers. The client with the assistance of the Case Manager must develop a contingency plan to assure health, welfare, and safety in the event clients care needs change or providers are not available.

Incidents

The Nurse Manager provides written documentation to the Department that shows he or she has provided instructions to the ACS Provider that outlines the types of situations that are considered reportable incidents. ACS providers must report incidents that result in client injury or require medical care to the Nurse Manager and the Home and Community Based Services (HCBS) Case Manager. If the HCBS Case Manager and Nurse Manager 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.

Limits

1. Payment to ACS providers can be made for time performing authorized services even if performed outside of the client’s home, and as approved by the Case Manager and delegated by the Nurse Manager. The authorized hours remain the same regardless of where the services are delivered.  

Note:  When care will be delivered outside the client’s home for a period in excess of 7 calendar days, the client must provide the Case Manager and the Nurse Manager with contact information and an itinerary. The comprehensive assessment must identify and the POC must outline the care required during the absence from the client’s home.

2. When there is an appearance of potential ineligibility (change in medical or mental status), the Case Manager, Nurse Manager or HCBS Program Administrators can request a re-evaluation of eligibility determination.
3. For consumers receiving Attendant Care Service, the cost is limited to the highest monthly rate allowed to a nursing facility within the rate setting structure of the Department of Human Services. This cap may be increased as determined by legislative action. If the client’s needs cannot be met within the allowed rate, case management would explore other service options with the participant including nursing home placement. The case manager should make participants aware of the service cap.
4. Due to the complexity of the care provided to individuals receiving attendant 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

1. The service tasks/activities within the scope of this service chapter are identified on the Authorization to Provide Service, SFN 1699.
2. Community Integration, Social Appropriateness, shopping & Transportation, are tasks which cannot be authorized.
3. Documentation outlining the tasks the nurse has trained/delegated to the Attendant Care Service Provider are maintained by the Nurse and a copy sent to the Case Manager. The Case Manager notes on the SFN 1699 in Section II “Other," that the nurse has trained/delegated tasks to the ACS Provider.