Limitations and Non-covered Services 535-05-25

(Revised 1/1/10 ML #3215)

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  1. Personal care services may not include skilled services performed by persons with professional training.
  2. An individual receiving personal care services may not be an inpatient or resident of a hospital, a nursing facility, an intermediate care facility for the mentally retarded, or an institution for mental disease.
  3. Personal care services may not include home delivered meals; services performed primarily as housekeeping tasks; transportation; social activities; or services or tasks not directly related to the needs of the individual such as doing laundry for family members, cleaning of areas not occupied by the individual, or shopping for items not used by the individual.
  4. Laundry, shopping, and housework tasks when provided must be incidental to the provision of other personal care tasks and cannot exceed 30% of the total time authorized for the provision of all personal care tasks.
  5. Services provided by a spouse, parent of a minor child, or legal guardian are not covered.
  6. Care needs of the individual that are outside the scope of personal care services are not covered.
  7. Services provided in excess of the services or hours authorized by the case manager in the individual’s approved service plan are not covered.
  8. Authorized personal care services may not exceed 120 hours (480 units) per month for Level A Personal Care Services or 240 hours (960 units) per month for Level B Personal Care Services, and 300 hours (1200 units) per month for Level C Personal Care Services.
  9. Personal care services may only be provided when the needs of the eligible individual exceed the abilities of a spouse or parent(s) of a minor child to provide such services. Personal care services may not be substituted when a spouse or parent(s) of a minor child refuses or chooses not to perform the service. Personal care services may be provided during periods when a spouse or parent(s) of a minor child is gainfully employed if such services cannot be delayed until the spouse or parent(s) is able to perform them.
  10. Personal care services may not be provided for tasks that are otherwise  age appropriate or generally needed by an individual within the normal stages of development.
  11. The combination of personal care services and hospice service requires prior approval from the Department.