(NEW 7/1/07 ML #3088)
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To qualify for coverage of personal care services an individual must meet at least ONE of the following criteria:
Must have applied for and been found eligible for Medicaid benefits
Be Impaired in at least one of the following ADLs:
Bathing
Dressing
Eating
Toileting
Continence
Transferring
Mobility
Or be impaired in at least THREE of the following IADLs:
Meal Preparation
Housework
Laundry
Taking medications
An individual meeting the above criteria, qualifies for Level A personal care services. An individual who meets the above criteria may qualify for Level B personal care services if the individual also meets the nursing facility level of care criteria set forth at NDAC 75-02-02-09 or meets ICF/MR level of care criteria.
After completing a comprehensive needs assessment the individual’s case manager shall complete Section II of Personal Care Services Plan, SFN 662, to determine if the individual qualifies for personal care services. Section II allows the case manager to determine the level of impairment an individual is experiencing, based on specific medical, emotional and cognitive status. An individual must be impaired (have a score of at least 2) for any 1 ADL, or impaired (a score of at least 1) in 3 of the 4 IADLs. See the Instructions for Completing the Functional Assessment on scoring ADLs and IADLs.
The assessment measures the degree to which an individual can perform various tasks that are essential to independent living. Information on each of the ADLs or IADLs can be collected by observation, by direct questioning of the individual, or by interview with a significant other. The case manager shall maintain documentation supporting the level of impairment and shall include the following information if applicable:
Reason for inability to complete the activity or task
Kind of aid the individual uses (e.g., a grab bar or stool for bathing)
Kind of help the individual requires (e.g., preparing the bath, washing back and feet, complete bed bath) and the frequency of the need to have the help (e.g. units of services needed)
Who provides the help
Reasons for inability of a spouse or parent of a minor child to perform the activity or task for the individual
The individual’s health, safety and welfare needs that need to be addressed
Document the anticipated outcome as a result of service provision
Other pertinent information
A comprehensive assessment must be completed initially before any personal care services can be authorized and annually thereafter. A review of the individual’s needs must be completed every six months or when there is a significant change in the individual’s needs.