Personal Care Service 525-05-30-45
(Revised
12/1/10 ML #3252)
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Purpose
The philosophy of the Department is that personal
care should be provided so as to assist the eligible client with as many
activities of daily living and instrumental activities of daily living
as needed and as permitted in order to maintain independence and self
reliance to the greatest degree possible. Care, if appropriate, should
be provided when, and as long as, the client needs it, up to 24-hour care
if necessary. The client or legally responsible person, must
direct the care provided and should be involved in training and monitoring
the personal care QSP as much as possible and when appropriate.
The informal network, especially family members,
should be explored as potential informal providers of care before formal
care is provided under the provisions of this chapter. Care provided by
the informal network should not be replaced by formal/paid care unless
it is necessary
for the client to receive such care.
- Personal care provided
up to 24 hours per day, differs from adult family (foster) care in that
personal care is provided in the client's home, and adult family (foster)
care is provided in the service provider's home. If a non-relative is
caring for the client on a 24-hr live in basis in the provider’s home,
the service must be Adult Family Foster Care. It cannot be Personal Care
service.
- Live-in personal cares
(daily care) is all inclusive with the exception of Respite Care.
- Personal
care differs from respite care in that respite care is provided to relieve
the primary, live-in caregiver, whereas the primary purpose of personal
care is to provide the care a client needs and not to relieve the caregiver.
Service
Eligibility, Criteria for
The individual receiving Personal Care service
will meet the following criteria:
- Must be eligible for the
SPED program and not eligible to receive Personal Cares under the Medicaid
State Plan, or Family Home Care;
- Be at least age 18;
- The care needs of the client
must fall within the scope of personal care service as described in this
service chapter. The care needs may include a combination of Activities
of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
Either the client must have the ADLs and IADLs needs performed for him/her
OR a cognitively impaired client may be able to complete the activity
ONLY with supervision, guidance, or prompting.
- Daily Personal Cares live-in
must be authorized if the provider and the client live in the same residence.
- Daily Personal Care is
an all inclusive service and can only be combined with Respite Care. For
unusual or unique circumstances, prior approval from the HCBS Program
Administrator must be obtained.
- Who lives alone or is alone
due to the employment of the primary caregiver as the incapacity of other
household members.
Provider
Need Not be Present in the Home on a 24-Hour Basis
The provision of Daily Personal Cares live-in is appropriate ONLY for
clients who can be left alone for routine temporary periods of time (e.g.
part-time employment) without adverse impact to the client’s welfare and
safety. The client must agree to be left alone.
Cognitively
Impaired Clients, Services to
For cognitively impaired clients, the care
plan shall identify how the daily care needs are met. During those periods
of time when personal care service is not being provided, cooperative
and coordinated efforts of meeting the needs of the client by the family,
other informal providers, and agency providers are to be identified. The
care plan must reflect the ongoing need for supervision, guidance, or
prompting and must identify how the informal network entity(s) is involved
to meet this primary need with the formal service network filling gaps.
Limits:
- Clients whose providers
do NOT meet the definition of Family Home Care may qualify for Personal
Care Service. SPED Personal Care Service is not an option for clients
when the live-in care provider is a family member. See
N.D.C.C. 50-06.2-02(4) for the definition of family
member.
- Under Personal Care Service,
payment can be made for time performing authorized personal care tasks
even if performed outside the client's home as long as the cares are provided
in the local trade area. The hours remain based on the care necessary
in the client's home. The care provided outside the home must be within
the defined scope (allowable tasks as authorized) of the service.
- Exception: When
the client is required to seek essential services outside of the local
trade area, contact the HCBS Program Administrator for prior approval.
Assisted
Living Facility
A Monthly Rate Worksheet, SFN
1012, is completed for an individual to receive daily (SPED) personal
care services in an assisted living facility when the client lives in
a licensed assisted living facility and the provider has been approved
to use the assisted living billing code.
The following criteria have been established
for recipients in an "assisted living facility":
- Clients meeting one of
the following criteria may have a self-employed QSP as a live-in-attendant.
- The provider is a family
member as defined in State law for Family Home Care.
- The intensity of care needs
cannot be met under "assisted living" (e.g. need for continuous
on-site care).
- The assisted living personal
care provider is not identified in the tenant’s rental agreement.
- For those clients unable
to do their own meal preparation, it will be included in the "assisted
living" provider's daily rate. The
provider may prepare the meal in the recipient's individual apartment
or offer congregate dining. The
recipient is responsible for payment of food costs.
The Monthly Rate Worksheet, SFN
1012, for Assisted Living Facilities is used in setting the daily
rate for providers of "assisted living." The HCBS Case Manager
must determine what services are being provided by the Assisted Living
facility as a component of their base rate which includes room and board.
For those services included within the base rate, the tasks would not
be recorded and calculated in the Monthly Rate Worksheet. The monthly
rate worksheet applies to all clients who receive assisted living personal
care services.
Service
Activities, Authorized and Limits
- The service tasks/activities
within the scope of this service chapter are identified on the Authorization
to Provide Service, SFN 1699.
- For Personal Care unit
rate, housework, laundry, communication, money management, shopping, and
meal preparation are considered homemaker tasks and cannot be authorized
as a personal care tasks.
- For Personal Care unit
rate, Community Integration, Social Appropriateness, and Transportation
are tasks which cannot be authorized under the SPED personal care service.
- Live-in personal care services
are limited to those tasks identified on the SFN 1012,
Monthly Rate Worksheet.
