Current through Register Vol. 49, No. 9, September, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE
AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY
25. Home and Community Care for Functionally
Disabled Klderly Individuals, as defined, described and limited in Supplement 2
to Attachment 3.1 -A. and Appendices A-G to Supplement 2 to Attachment 3.1-A.
_________ provided X not
provided
26. Personal care
services furnished to an individual who is not an inpatient or resident of a
hospital, nursing facility, intermediate care facility for the mentally
retarded, or institution for mental disease that are (A) authorized for the
individual by a physician in accordance with a plan of treatment, (B) provided
by an individual who is qualified to provide such services and who is not a
member of the individual's family, and (C) furnished in a home.
X Provided: X
State Approved (Not Physician) Service Plan Allowed X
Services Outside the Home Also Allowed X Limitations
Described on Attachment
______ Not Provided.
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES -OTHER
TYPES OF CARE
ATTACHMENT 4J9-B
5.
Personal care furnished in accordance with the requirements at
42 CFR §
440.167 and with regulations promulgated,
established and published for the Arkansas Medicaid Personal Care Program by
the Division of Medical Services.
(a) Except
as otherwise noted in the plan, state developed fee schedule rates are the same
for both governmental and private providers of personal care services and the
fee schedule and any annual/periodic adjustments to the fee schedule are
published on the Medicaid website at www.medicaid.state.ar.us.
(b) Reimbursement for Personal Care Program
Services is by fee schedule, at the lesser of the billed charge or the Title
XIX (Medicaid) maximum allowable fee per unit of service. Effective for dates
of service on and after July 1, 2004, one unit equals fifteen minutes of
service.
(c) Effective for dates of
service on and after July 1,2007, reimbursement to enrolled Residential Care
Facilities (RCFs) for personal care services furnished to Medicaid eligible
residents (i.e., clients) is based on a multi-hour rate system not to exceed
one day, based on the individual clients' levels of care. A client's level of
care is determined from the service units required by his or her service plan.
Rates will be recalculated as needed to maintain parity with other Personal
Care providers when revisions of the Title XIX maximum allowable fee occur. The
effective date of any such revised rates shall be the effective date of the
revised fee.
(d) Agencies rates are
set as of July 1, 2009 and are effective for services on or after that
date.
AMOUNT, DURATION AND SCOPE OF SERVICES
PROVIDED
ATTACHMENT 3.1-A
I. Personal Care
A. Personal care services are provided by a
personal care aide to assist with a client's physical dependency needs. The
personal care aide must have at least 24 hours classroom training and a minimum
of supervised practical training of 16 hours provided by or under the
supervision of a registered nurse for a total of no less than 40
hours.
B. Personal care services
furnished to an individual who is not an inpatient or resident of a hospital,
nursing facility, intermediate care facility for the mentally retarded, or
institution for mental disease that are -
1.
Authorized for the individual by a physician in accordance with a plan of
treatment or (at the option of the State) otherwise authorized for the
individual in accordance with a service plan approved by the State;
2. Provided by an individual who is qualified
to provide such services and who is not a member of the individual's family,
and
3. Furnished in a home, and at
the State's option, in another location, including licensed residential
care facility.
C.
The State defines "a member of the individual's family" as:
1. A spouse,
2. A minor's parent, stepparent, foster
parent or anyone acting as a minor's parent.
3. A minor's "guardian of the person" or
anyone acting as a minor's "guardian of the person" or
4. An adult's "guardian of the person" or
anyone acting as an adult's "guardian of the person".
D. Personal care services are covered for
categorically needy individuals only.
E. Personal care services are medically
necessary, prescribed services to assist clients with their physical dependency
needs.
1. Personal care services involve
"hands-on" assistance, by a personal care aide, with a client's physical
dependency needs (as opposed to purely housekeeping services).
2. The tasks the aide performs are similar to
those that a nurse's aide would normally perform if the client were in a
hospital or nursing facility.
F. Prior authorization is required for
personal care for beneficiaries under age 21.
G. Effective for dates of service on or after
April 1, 2002, for services beyond 64 hours per calendar month per beneficiary
aged 21 or older, the provider must request a benefit extension. Extensions of
the personal care benefit will be provided for beneficiaries aged 21 and older
when extended benefits are determined to be medically necessary.
