(NEW 7/1/07 ML #3088)
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A personal care service provider enrolled as a qualified service provider shall be paid based on 15 minute increments using a provider specific 15 minute unit rate, which may not exceed the maximum 15 minute unit rate established by the department.
A personal care service provider enrolled as a qualified service provider, who resides with an individual eligible to receive personal care services, may elect to be paid a daily rate for each day personal care services are provided for at least 15 minutes. The daily rate may not exceed the maximum per day rate established by the department and may be paid to no more than one QSP.
A personal care service provider enrolled as a basic care assistance provider shall be paid a daily rate if personal care services are needed and provided every day. The daily rate is an average per day rate that is provider specific and may not exceed the maximum per day rate established by the department. The daily rate is applicable to all eligible individuals needing and receiving daily personal care services from the basic care assistance provider and does not vary based on the amount of services provided daily. If personal care services are provided intermittently to an individual, the basic care assistance provider shall be paid based on the maximum agency 15 minute unit rate for the services provided to that individual.
Case management activities must be documented in the case file before payment for case management can be requested. The authorizing agent may be paid for targeted case management (TCM) for a Medicaid eligible individual in need of long term care services only if the individual is not receiving case management under any HCBS waiver or other targeted case management provisions. No claim may be made for TCM when a change in funding source for case management occurs or if an individual is not eligible for Medicaid. When accessing Targeted Case Management payment, documentation must support that the individual is at risk of requiring long-term care services this can be narrated on the SFN 1047, Application for Services, or in the assessment narrative.