Family Personal Care 525-05-30-32

(Revised 1/1/19 ML #3543)

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Purpose

The purpose of family personal care (FPC) is to assist individuals to remain with their family members and in their own communities. It provides for the provision of extraordinary care payments to the legal spouse of a recipient for the provision of personal care or similar services.

Service Eligibility, Criteria for

The individual receiving Family Personal Care will meet the following criteria:

1. Must be eligible for the HCBS Medicaid Waiver program.
2. The client and qualified provider (who is the legal spouse and is enrolled as a personal care provider) shall reside in the same residence.
3. Before a legally responsible individual who has decision making authority over a client can be enrolled as a qualified service provider for Family Personal Care, the Case manager must approve the choice of provider. The case manager is responsible to forward a copy of the narrative that explains why the legally responsible person acting as the family personal care provider is in the best interest of the client to the State office. The narrative must be attached to the clients care plan.
4. The client and qualified provider shall mutually agree to the arrangement.
5. The need for services must fall within the scope of tasks identified on the SFN 1012, Monthly Rate Worksheet - Live-In Care (MRW), and Authorization to Provider Waivered Services.

Service Tasks/Activities

The service tasks/activities within the scope of this service chapter are identified on the Authorization to Provide Medicaid Waiver Services form, SFN 410 and only those listed on the SFN 1012, Monthly Rate Worksheet, can be approved and authorized.

Out-of-Home Care

Payment can be made for days the client is receiving the SAME care from the SAME caregiver-QSP although not in the home they otherwise mutually share.  No payment is allowed for clients out-of-state with the exception of clients seeking medical care out of state unless prior approval has been given by an HCBS Program Administrator.

Medical care out of state also requires prior approval from the HCBS Program Administrator.

Provider need not be Present in the Home on a 24-Hour Basis

This provision within the Family Personal Care service is appropriate for clients who can be left alone for routine temporary periods of time (e.g. part-time employment of the qualified family member) without adverse impact to the client’s welfare and safety. The client must agree to be left alone.

• This provision does NOT allow for the qualified family member to hire a provider to provide care for the client during routine absences from the home.

Limitations

Family Personal Care cannot be combined with adult residential care, adult foster care, extended personal care, and transitional living.

Service Combinations

Family Personal Care is an all-inclusive 24-hour service. Therefore, respite care service and Emergency Response System (ERS) along with Family Personal Care is acceptable only as described under the following circumstances:

1. The client meets the eligibility criteria for Respite Care Services or when the spouse provides less than 24-hour per day care on a routine basis, and the client can be left alone safely for brief periods of time, respite care is appropriate only when the qualified family member will be gone for an extended period of time, for example, to attend a wedding.

If clients cannot be safely left alone or supervision is an authorized task on the MRW respite care must be authorized so the spouse can take necessary breaks away from their caregiving responsibilities.

• Respite care must be authorized because FPC providers cannot delegate their care to another individual if a client cannot be safely left alone.
• If informal respite is in place and of benefit to the client, an exception must be obtained from the HCBS Program Administrator.

2. Emergency response is acceptable if a safety risk (i.e. potential fall risk or sudden illness) has been identified during the FPC provider’s short term absence. ERS is not acceptable for clients who require supervision for cognitive or health related reasons. Contact the HCBS Program Administrator in writing to obtain approval for the combination of FPC and ERS service.