Current through Register Vol. 49, No. 9, September, 2024
Section II
Personal Care
203.000
IndependentChoices
IndependentChoices began as a Cash and Counseling Demonstration
and Evaluation Project. IndependentChoices seeks to increase the opportunity
for consumer direction and control for Medicaid beneficiaries receiving or
needing personal care by offering a cash allowance and counseling services in
place of traditionally provided personal care. IndependentChoices and how it
related to the Personal Care State Plan program is referenced in this manual
and the IndependentChoices provider manual.
213.000
Scope of the Program
A. Personal care services are primarily based
on the assessed physical dependency need for "hands-on" services with the
following activities of daily living (ADL): eating, bathing, dressing, personal
hygiene, toileting and ambulating. Hands-on assistance in at least one of these
areas is required. This type of assistance is provided by a personal care aide
based on a beneficiary's physical dependency needs (as opposed to purely
housekeeping services). A plan of care is developed through the assessment
process and is based on a beneficiary's dependency in at least one of the
above-listed activities of daily living. While not a part of the eligibility
criteria, the need for assistance with other tasks and IADLs (Instrumental
Activities of Daily Living) are considered in the assessment. Both types of
assistance are considered when determining the amount of overall personal care
assistance authorized. Routines or IADLs include meal preparation, incidental
housekeeping, laundry, medication assistance, etc. These tasks are also defined
and described in this section of this provider manual.
B. The tasks the aide performs are similar to
those that a nurse's aide would normally perform if the beneficiary were in a
hospital or nursing facility.
C.
Personal care services may be similar to or overlap some services that home
health aides furnish.
1. Home health aides may
provide personal care services in the home under the home health
benefit.
2. Skilled services that
only a health professional may perform are not considered personal care
services.
D. Personal
care services, as described in this manual, are furnished to an individual who
is not an inpatient or resident of a hospital, nursing facility, intermediate
care facility for persons with intellectual disabilities, or institution for
mental disease that are:
1. Authorized for the
individual by a physician in accordance with a plan of treatment or otherwise
authorized for the individual in accordance with a service plan approved by the
State, e.g., ElderChoices, IndependentChoices;
2. Furnished in the beneficiary's home, and
at the State's option, in another location.
3. Provided by an individual qualified to
provide such services and who is not a member of the beneficiary's family. See
Section 222.100, part A, for the definition of "a member of the beneficiary's
family".
E. Personal
care for Medicaid-eligible individuals under the age of 21 requires prior
authorization. See Sections 240.000 through 246.000.
F. Only Class A Home Health agencies, Class B
Home Health agencies and Private Care agencies may provide personal care in all
State-approved locations. Residential care facilities, public schools,
education service cooperatives and DDS facilities may provide personal care
only within their own facilities. School districts and education service
cooperatives may not provide personal care in the beneficiary's home unless the
home is deemed a public school in accordance with the Arkansas Department of
Education guidelines set forth in Section 213.520.
213.310
I ndependentChoices Program,
Title XIX State Plan Program
IndependentChoices is operated by the Division of Aging and
Adult Services (DAAS) and operates under the authority of the Title XIX State
Plan with the Division of Medical Services responsible for administrative and
financial authority.
IndependentChoices offers an opportunity to Medicaid-eligible
adults with disabilities (age 18 and older) and the elderly (age 65 and older)
to direct their personal care. The beneficiary chooses a cash allowance in lieu
of agency personal care services. IndependentChoices provides qualifying
beneficiaries with counseling and training to assist them with information to
fulfill their role as an employer. The beneficiary as the employer will hire,
train, supervise and, if necessary, terminate the services of their employee.
In addition to hiring an employee, the beneficiary may use part of their budget
to purchase goods and services that lessen their physical dependency needs. In
addition to counseling support services, participants may receive Financial
Management Services (FMS) from a DMS contracted provider. The FMS provider will
assist the participant by processing timesheets, withholding and reporting
State and Federal taxes, issuing a W-2 to all employees who meet the tax
threshold and refunding taxes to the participant and the employee when the
threshold was not met. The FMS provider also coordinates the accuracy and
coordination of the forms used to establish the Medicaid beneficiary as an
employer and to employ a worker. The FMS provider representing the Medicaid
beneficiary will obtain permissions and execute an IRS Form 2678 to act as the
beneficiary's agent.
NOTE: The IndependentChoices Program is required to
follow the rules and regulations of the State Plan approved Personal Care
Program, unless stated otherwise in this manual.
214.000
The Physician's Role in
Personal Care
A. A personal care
service plan is designed to direct an appropriate amount of individual
assistance to a beneficiary's physical dependency needs.
B. The physician is essential to the
determination of what constitutes an appropriate amount of assistance.
1. The physician evaluates the relationships
among the beneficiary's health status, physical dependency needs and daily
routines and activities.
2. The
physician helps the beneficiary and the personal care provider design an
individualized plan to address the beneficiary's individual physical
dependencies.
C.
Personal care services may commence on or after the date of the beneficiary's
attending physician's signature on an individualized personal care service
plan, authorizing the services.
1. The
beneficiary's attending physician is responsible for the decision to authorize
personal care services.
2. The
beneficiary's attending physician must be the beneficiary's primary care
physician (PCP) unless the beneficiary is exempt from PCP requirements.
a. In this manual, "physician" and "attending
physician" both mean "the physician primarily responsible for the medical
management of the patient," unless they are otherwise defined in a particular
context.
b. "Primary care
physician" and "PCP" are explained in Section I of this manual.
214.100
Physician Authorization of Personal Care Services
A. An individualized personal care service
plan signed (original signature) and dated by the beneficiary's PCP or
attending physician, constitutes the physician's personal care authorization.
Services may continue uninterrupted as long as the services are reauthorized
prior to the expiration of the current service plan end date. The uninterrupted
continuation is also dependent upon the physician having a face-to-face visit
with the beneficiary within 60 days prior to the date that the physician signs
the service plan. If the physician informs that he or she had not seen the
beneficiary in the past 60 days, the beneficiary is expected to have the
face-to-face visit prior to the beginning of the new service plan begin date.
Should this not occur, personal care services must be discontinued until the
face-to-face visit occurs unless for health and safety reasons the physician
requests in writing that personal care services continue and informs of the
date the face-to-face visit is scheduled. Should the services be discontinued,
the requesting provider is required to resubmit page 6 of the DMS-618 to the
physician asking that the physician make a correction to the date field and
initial the date services are reauthorized per the most recent face-to-face
visit. When services are interrupted, the corrected date represents the new
begin date of the service plan.
1. The
attending physician and the beneficiary must have a face-to-face visit before
the physician may authorize personal care services, unless the physician has
seen the beneficiary within the 60 days preceding the beginning date of service
established in the proposed service plan or 60 days prior to the date the
physician signs the DMS-618.
2. The
attending physician must review the assessment and service plan to ensure that
the personal care aide's assigned tasks appropriately address the beneficiary's
individual physical dependency needs.
3. Based on the assessment and the
physician's medical evaluation, the attending physician must authorize only
individualized personal care services that constitute medically necessary
assistance with the beneficiary's physical dependency needs in the
beneficiary's home or other authorized locations rather than in an
institution.
B. The
personal care service plan authorized by the physician must specify the
following items.
1. The date services are to
begin (may not be earlier than the date of the physician's
signature.)
2. The duration of need
for services
3. The expected
results of the services
C. Personal care services may not begin
initially before the date the beneficiary's attending physician signs the
individualized personal care service plan.
D. Services may not commence before the
beginning date of service established by the authorized service plan.
E. The physician may change the frequency,
scope or duration of service in the service plan.
F. The physician may add to, delete from or
otherwise modify the service plan.
G. The physician's authorization of the
service plan must be by dated original signature only. A stamp or signature
initialed by a locum tenens is the only acceptable substitute
for an original signature by the attending physician.
H. The physician must date and sign or
initial any revisions to the service plan, as well as any attachments he or she
adds to the service plan.
I. The
physician must maintain a copy of the signed service plan and signed copies of
any subsequent authorized service plan revisions with the beneficiary's
permanent medical record.
214.110
The Physician's Notification of
Service Plan Authorization
The physician may communicate the authorization of a service
plan by telephone, fax or e-mail to expedite service delivery.
A. If the service plan is transmitted via
fax, the facsimile copy of the physician's original signature satisfies the
"original signature" requirement (see Section 214.100, part G). The physician
must maintain the original document with the original signature(s) in his or
her files.
B. If the service plan
is communicated by telephone, the physician must forward the completed
authorized service plan with original signature and authorization date to the
personal care provider no later than 14 working days following the authorized
beginning date of personal care service.
NOTE: Throughout this manual, it is emphasized that
services may not begin until the date of the physician's signature authorizing
services. When services begin based on a verbal
authorization from the physician, and a written authorization with
the physician's signature is received within the 14 day timeframe, the
authorization must clearly state the date services were authorized based on the
verbal order. Rarely, if ever, will the date of the verbal order and the date
of the written order be the same, however, the authorization date must be
clearly documented and linked to the verbal order if services begin prior to
the date of the physician's signature.
214.200
Service Plan Review and Renewal
A. A personal care service plan
terminates six (6) months after its initial or revised beginning date of
service, unless described otherwise in this section. See
NOTE
below.
1. The beneficiary's physician must
review the service plan no less often than every six months, unless described
otherwise in this section. See NOTE below.
2. Upon completion of the six-month review,
the physician may authorize continued personal care services, either unchanged
or with modifications; or the physician may order that services
cease.
B. Personal care
services may not continue past the six-month anniversary of an initial or
revised beginning date of service until the beneficiary's physician authorizes
a revised service plan or renews the authorization of an existing service plan.
NOTE: Under specific circumstances, a service plan may be
authorized for more
than six (6) months, not to exceed one year. If the
physician's authorization for personal care services is based on a CHRONIC
CONDITION that will not improve within the next six (6) months, the service
plan may be authorized for more than six (6) months, not to exceed one year.
The physician must sign the service plan and documentation must be included on
the service plan verifying the chronic condition and the lack of expected
improvement over the length of the service plan.
NOTE: An advanced practice nurse (APN) enrolled in the
Arkansas Medicaid Program seeing patients in a Rural Health Clinic or Federally
Qualified Health Center enrolled in the Arkansas Medicaid Program as an RHC or
FQHC may sign the personal care service plan/order if practicing within an
environment for which his/her certification applies and within the scope
of
his/her certification. No MD signature is required in
addition to the APN's signature unless required by their license and/or
certification.
214.300
Authorization of ElderChoices
Plan of Care and Personal Care
Service Plan
The DAAS RN is responsible for developing an ElderChoices Plan
of Care that includes both waiver and non-waiver services. Once developed, the
Plan of Care is signed by the DAAS RN authorizing the services listed.
The signed ElderChoices Plan of Care will suffice as the "
Personal Care Authorization" for services required in the Personal Care
Program. The signature of the DAAS RN on the ElderChoices Plan of Care simply
replaces the need for the physician's signature authorizing personal care
services. The personal care service plan, developed by the Personal Care
provider, is still required.
As the ElderChoices Plan of Care is effective for one year,
once signed by the DAAS RN; the authorization for personal care services, when
included on the ElderChoices Plan of Care, will be for one year from the date
of the DAAS RN's signature, unless revised by the DAAS RN or the personal care
service plan needs to be revised, whichever occurs first. If personal care
services continue unchanged as authorized on the ElderChoices Plan of Care, a
new service plan is not required at the 6-month interval.
NOTE: For ElderChoices participants who receive personal
care through traditional agency services or have chosen to receive their
personal care services through the IndependentChoices Program, the ElderChoices
plan of care, signed by a DAAS RN, will serve as the authorization for personal
care services for one year from the date of the DAAS RN's signature, as
described above.
The responsibility of developing a personal care service plan
is not placed with the DAAS RN. The personal care provider is still required to
complete a service plan, as described in the Arkansas Medicaid Personal Care
Provider Manual.
The Arkansas Medicaid Program waives no other Personal Care
Program requirements with regard to personal care service plan authorizations
obtained by DAAS RNs.
214.310
Development of ElderChoices
Plan of Care
If personal care services are not currently being provided when
the DAAS RN develops the ElderChoices Plan of Care, the DAAS RN will determine
if personal care services are needed. If so, the service, amount, frequency,
duration and the recipient's provider of choice will be included on the
ElderChoices Plan of Care. A copy of the ElderChoices Plan of Care and a Start
of Care form (AAS-9510) will be forwarded to the personal care provider, as is
current practice for waiver services. The Start of Care form must be returned
to the DAAS RN within 10 working days from mailing or action may be taken by
the DAAS RN to secure another personal care provider or modify the ElderChoices
Plan of Care. (The ElderChoices Plan of Care is dated the date it is mailed.)
Before taking action to secure another provider or modifying the Plan of Care,
the applicant and/or family members will be contacted to discuss possible
alternatives. Communications related to participation in the IndependentChoices
program will be conveyed electronically through "tasks" communicated through
Med Compass software, a new data system used to help manage waiver and
IndependentChoices services.
This Plan of Care supersedes any other Plan of Care that may
have been previously developed by another Medicaid provider for the applicant.
The ElderChoices Plan of Care must include all appropriate ElderChoices
services and certain non-waiver services appropriate for the applicant, such as
Personal Care.
An agency providing services to an ElderChoices beneficiary
must report these services to the DAAS RN. The services being provided to the
ElderChoices beneficiary must be included on the ElderChoices Plan of Care.
Prior to beginning services or revising services provided to an ElderChoices
beneficiary, contact the DAAS RN so the Plan of Care is properly revised and
approved. Please report all changes in services and changes in the ElderChoices
beneficiary's circumstances to the DAAS RN immediately upon learning of the
change. Certain services provided to an ElderChoices beneficiary that are not
included on the ElderChoices Plan of Care may be subject to recoupment by the
Medicaid Program.
If the DAAS RN is aware that personal care services are
currently being provided when the ElderChoices Plan of Care is developed, the
DAAS RN will contact the personal care provider to verify the current order and
amount of personal care services in place If requested verbally, the request
must be documented in the ElderChoices nurse narrative. It is the personal care
provider's responsibility to provide the requested information to the DAAS RN
immediately upon receipt of the request. If a copy is not received within 10
working days of the request, the DAAS RN will process the ElderChoices Plan of
Care, as developed by the DAAS RN.
NOTE: It is the IndependentChoices employer or personal
care provider's responsibility to place information regarding their presence in
the home in a prominent location so that the DAAS RN will be aware that they
are serving the beneficiary. Preferably, the provider will place the
information on the refrigerator or under the phone the applicant uses, unless
the applicant objects. If so, the provider will place the information in a
location satisfactory to the applicant, as long as it is readily available and
easily accessible by the DAAS RN.
The personal care service plan developed by the personal care
provider must meet all requirements as detailed in the personal care provider
manual. This includes, but is not limited to, the amount of personal care
services, personal care tasks, frequency and duration. The DAAS RN will not
alter the current number of personal care units, unless a waiver Plan of Care
cannot be developed without duplicating services. If
personal care units must be altered, the DAAS RN will contact the personal care
provider to discuss available alternatives prior to making any revisions. The
ElderChoices Plan of Care and the required justification for each service
remains the responsibility of the DAAS RN. Therefore, final decisions regarding
services included on the ElderChoices Plan of Care rest with the DAAS
RN.
NOTE: For the IndependentChoices program, services are
effective the date of the DAAS RN's signature on the assessment tool or the
waiver plan of care, whichever is the latter of the two.
214.320
Revisions to the
ElderChoices Plan of Care
Requested changes to the personal care services included on the
ElderChoices Plan of Care may originate with the personal care RN or the DAAS
RN, based on the recipient's circumstances. Unless requested by an
IndependentChoices beneficiary, the individual or agency requesting revisions
to the Personal Care services on the ElderChoices Plan of Care is responsible
for securing any required signatures authorizing the change prior to the
ElderChoices Plan of Care being revised. The DAAS RN will obtain electronic
signatures for dates of service on or after January 1, 2013.
If revised by the DAAS RN, a copy of the revised ElderChoices
Plan of Care and a Start of Care Form (AAS-9510) will be mailed to the personal
care provider within 10 working days after being revised. If authorization is
secured by the Personal Care agency, a copy of the revised personal care order,
signed by the physician, must be sent to the DAAS RN prior to implementing any
revisions. Once received, the ElderChoices Plan of Care will be revised
accordingly within 10 days of its receipt. If any problems are encountered with
implementing the requested revisions, the DAAS RN will contact the personal
care provider to discuss possible alternatives. These discussions and the final
decision regarding the requested revisions must be documented in the nurse
narrative. The final decision, as stated above, rests with the DAAS RN.
214.400
Reporting Personal
Care Services Provided to Beneficiaries in the
Alternatives For Adults With Physical Disabilities Waiver
Program
When an applicant is assessed by the Alternatives for Adults
with Physical Disabilities Waiver RN/Counselor, a plan of care is developed. As
in other Medicaid waiver programs, this plan of care supersedes any other plan
of care that may have been previously developed by another Medicaid provider
for the applicant. The Alternatives plan of care must include all waiver and
non-waiver services appropriate for the applicant, such as Personal Care. The
Alternatives Plan of Care must also include any services reimbursed by payers
other than Medicaid.
Providers enrolled in the Medicaid Program to provide any of
these non-waiver services and who are providing services to an Alternatives
beneficiary, must report these services to the DAAS Waiver RN/Counselor. This
information is required, regardless of the payer of services. Information
required may include, but is not limited to, plans of care, prescriptions for
services, changes in status, etc. If a provider provides any
service to an individual who is participating in the Alternatives for Adults
with Physical Disabilities Waiver Program, he or she must report these services
immediately to the DAAS Waiver RN/Counselor in his or her area. Any service
billed to Medicaid through a provider's provider identification number may be
subject to recoupment if the service is not included on the Alternatives plan
of care.
Providers who are unsure about whether an individual is
participating in the Alternatives for Adults with Physical Disabilities Waiver
Program should contact either the individual or the Alternatives Waiver
RN/Counselor.
215.100
Assessment and Service Plan Formats
A.
The Division of Medical Services (DMS), in some circumstances and for certain
specified providers, requires exclusive use of form DMS-618
(
View or print form DMS-618.) to satisfy
particular Program documentation requirements.
1. Whether Medicaid does or does not require
exclusive use of form DMS-618, all documentation required by the Personal Care
Program must meet or exceed DMS regulations as stated in this manual and other
official communications.
2. When
using form DMS-618, attachments may be necessary to complete assessments and
service plans and/or to comply with other rules.
a. An assessing Registered Nurse (RN) must
sign or initial and date each attachment he or she adds to a required personal
care document.
b. The authorizing
physician must sign (or initial) and date each attachment he or she adds to a
service plan or other required document.
B. The Division of Medical Services requires
Residential Care Facility (RCF) Personal Care providers to use exclusively form
DMS-618 and to comply with all rules applicable to RCFs regarding the use of
form DMS-618.
C. For assessments
completed on individuals participating in the IndependentChoices Program, the
following applies:
For IndependentChoices participants who are also active waiver
participants in the ElderChoices Program, the DMS-618 is not required.Only the
AR Path assessment will be used by the DAAS RN. The assessment tool used for
waiver level of care determination and the waiver plan of care will suffice to
support authorization for personal care services, if signed by the DAAS RN.
Eligibility for personal care services is based on the same criteria as state
plan personal care services. Services are effective the date of the DAAS RN's
signature on the waiver assessment tool or the waiver plan of care, whichever
is the latter of the two. Personal care services provided prior to that date
are not eligible for Medicaid reimbursement. The waiver assessment tool and the
waiver plan of care must include, at least, the information included on the
DMS-618 that is utilized to support the medical necessity, eligibility and
amount of personal care services provided through IndependentChoices or agency
personal care services. This information is required in documentation whether
or not an extension of benefits is requested. As with all required
documentation, this information must be available in the participant's chart or
electronic record and available for audit and Quality Management Strategy
reviews.
215.330
Service Plan Revisions
NOTE: Subsections (A) (3) and (B) are not applicable to
IndependentChoices program.
A.
The attending physician must authorize permanent service plan changes before
the provider amends service delivery.
1. For
purposes of this requirement, a permanent service plan change is
one expected to last 30 days or more.
2. Service plan revisions must be made if a
beneficiary's condition changes to the extent that the personal care provider
must modify, add or delete tasks.
3. Service plan revisions must be made if the
provider identifies a need to increase or decrease the amount, frequency or
duration of service.
a. While changes in the
amount, frequency or duration of a service must be documented in the medical
record, an increase or a reduction of 10% or less in the average
amount of service (measured in service time) over a period of
fewer than 30 days does not in itself require a service plan revision. If the
amount of service remains unchanged, but the frequency or duration of a service
is modified, documentation of the reason for the change is required, but no
physician authorization is required.
b. The reasons for the service variances must
be written daily in the service documentation.
B. Providers may reduce a beneficiary's
services without the physician's prior authorization only by meeting the
following conditions:
1. The provider must
advise the physician of the reduction in services in writing, within 14 working
days following the first day of reduced services.
2. The provider must request the physician's
written approval of the reduction.
a. The
provider is responsible for obtaining the physician's signed
authorization.
b. The physician may
fax the signed authorization to the provider and maintain the original in the
beneficiary's file in the physician's office.
C. The physician must document medical
reasons for service plan revisions.
D. The new beginning date of service is the
date authorized by the physician.
E. Service plan revisions and updates since
the previous assessment must remain with the service plan. Updates since the
previous assessment must include documentation of when and why the change
occurred.
216.000
Coverage
A. Personal care
services, as described in this manual, are furnished to an individual who is
not an inpatient or resident of a hospital, nursing facility, intermediate care
facility for persons with intellectual disabilities, 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 qualified to
provide such services and who is not a member of the beneficiary's family. See
Section 222.100, part A, for the definition of "a member of the beneficiary's
family".
3. Prior authorized by DMS
or its designee when the beneficiary is under the age of 21,
4. Provided by an individual who is
a. Qualified to provide the
services,
b. Supervised by a
registered nurse (RN) or (when applicable) a Qualified Mental Retardation
Professional (QMRP) and
c. Not a
member of the beneficiary's family OR
d. Qualified to provide the service according
to approved policy in the IndependentChoices Program.
5. Furnished in the beneficiary's home or, at
the State's option, in another location.
B. Medicaid restricts coverage of personal
care to services directly helping a beneficiary with certain specified routines
and activities, regardless of the beneficiary's ability or inability to execute
other non-covered routines and activities.
216.400
Personal Care Aide Service and
Documentation Responsibility
NOTE: This section is not applicable to the
IndependentChoices program.
It is the responsibility of the personal care aide to
accomplish the following:
A. Perform
authorized tasks as instructed by the supervising RN or QMRP.
B. Maintain a service log.
1. The service log must be completed at the
time services are delivered.
2. If
the service log is not completed concurrently with service delivery, coverage
may be denied.
3. Refer to Sections
220.110 through 220.112 for service log requirements.
C. Provide necessary documentation showing
the date, time, nature and scope of authorized services delivered.
D. Provide necessary documentation showing
the date, time, nature and scope of emergency services delivered.
1. If an emergency requires the personal care
aide to perform a personal care service task not included on the personal care
service plan, the personal care aide must receive when possible, prior approval
from the supervising registered nurse or QMRP to perform the task.
2. When prior approval is not possible, the
personal care aide may perform the emergency service task, but she or he must
receive post-service approval from the supervising registered nurse or
QMRP.
3. Document the circumstances
in detail, describing:
a. The nature of the
emergency,
b. The action or task
required to resolve the emergency and
c. The justification for the unscheduled
service.
E. If
a personal care aide does not perform a particular task scheduled on the
service plan, the personal care aide must document why she or he did not
perform the task that day.
217.120
Duration of Benefit
Extension
A. Benefit extensions are
granted for six months or the life of the service plan, whichever is
shorter.
B. When the beneficiary's
diagnosis indicates a permanent disability or the physician signs the service
plan indicating a CHRONIC CONDITION that will not improve within the next six
(6) months, DMS may authorize services for one year. For individuals with
permanent disabilities, benefit extension requests will be necessary only once
every 12 months unless the service plan changes.
1. If there is a service plan revision, the
provider must submit a benefit extension request for the number of hours being
requested.
2. Upon approval of the
requested extension, the updated benefit extension approval file is valid for
12 months from the beginning of the month in which the revised service plan
takes effect.
3. If there is a
service plan revision before 12 months have passed, the provider must initiate
the benefit extension approval process again.
220.110
Service Log
NOTE: This section is not applicable to the
IndependentChoices program.
Instructions in this section apply to all beneficiaries'
service logs, with one exception. Effective for dates of service on and after
March 1, 2008, RCF Personal Care providers maintain their service logs by means
of the format and instructions of form DMS-873, "Arkansas Department of
Human Services Division of Medical Services Instructions for completing the
Service Log & Aide Notes For Personal Care Services in a Residential Care
Facility". Effective for dates of service on and after March 1, 2008,
form DMS-873 is found in Section V of this manual and DMS requires that RCF
Personal Care providers use it exclusively for its designated purposes. See
Section 220.111 for special documentation requirements regarding multiple
beneficiaries who are attended by one aide. Those instructions at Section
220.111 do not apply to RCF Personal Care providers, effective for dates of
service on and after March 1, 2008. See Section 220.112 for special
documentation requirements regarding multiple aides attending one beneficiary.
Those instructions at Section 220.112 do not apply to RCF Personal Care
providers, effective for dates of service on and after March 1, 2008. The
examples in these sections and in Section 220.110 are related to food
preparation, but personal care beneficiaries may receive other services in
congregate settings if their individual assessments support their receiving
assistance in that fashion.
A.
Medicaid covers only service time that is supported by an aide's service
log.
B. Service time in excess of
the maximum service time estimates in the authorized service plan is covered
only when the provider complies with the rules in Sections 215.330 and 220.110
through 220.112.
C. The time
estimate in the service plan is not service documentation. It is an estimate of
the anticipated minimum and maximum daily duration of medically necessary
personal care aide service for an individual beneficiary.
D. For each service date, for each
beneficiary, the personal care aide must record the following:
1. The time of day the aide begins the
beneficiary's services.
2. The time
of day the aide ends a beneficiary's services. This is the time of day the aide
concludes the service delivery, not necessarily the time the aide leaves the
beneficiary's service delivery location.
3. Notes regarding the beneficiary's
condition as instructed by the service supervisor.
4. Task performance difficulties.
5. The justification for any emergency
unscheduled tasks and documentation of the prior-approval or post-approval of
the unscheduled tasks.
6. The
justification for not performing any scheduled service plan required
tasks.
7. Any other observations
the aide believes are of note or that should be reported to the
supervisor.
E. If the
aide discontinues performing service-plan-required tasks at any time before
completing all of the required tasks for the day, the aide will record:
1. The beginning time of the
non-service-plan-required activities,
2. The ending time of the
non-service-plan-required activities,
3. The beginning time of the aide's
resumption of service-plan-required activities and
4. The beginning and ending times of any
subsequent breaks in service-plan-required aide activities.
5. If the aide discontinues or interrupts the
beneficiary's service-plan-required activities at one location to begin
service-plan-required activities at another location, the aide must record the
beginning and ending times of service at each location.
221.000
Documentation
NOTE: This section is not applicable to the
IndependentChoices program.
Rule D in this section is effective for dates of service
on and after March 1, 2008.
The personal care provider must keep and make available to
authorized representatives of the Arkansas Division of Medical Services, the
State Medicaid Fraud Control Unit and representatives of the Department of
Health and Human Services and its authorized agents or officials; records
including:
A. If applicable,
certification by the Home Health State Survey Agency as a participant in the
Title XVIII Program. Agencies that provided Medicaid personal care services
before July 1, 1986 are exempt from this requirement.
B. When applicable, copies of pertinent
residential care facility license(s) issued by the Office of Long Term
Care.
C. Medicaid
contract.
D. Effective for dates of
service on and after March 1, 2008, RCF Personal Care providers will be
required, when requested by DHS, to provide payroll records to validate service
plans and service logs.
E.
Documents signed by the supervising RN or QMRP, including:
1. The initial and all subsequent
assessments.
2. Instructions to the
personal care aide regarding:
a. The tasks the
aide is to perform,
b. The
frequency of each task and
c. The
maximum number of hours and minutes per month of aide service authorized by the
beneficiary's attending physician.
3. Notes arising from the supervisor's visits
to the service delivery location, regarding:
a. The condition of the
beneficiary,
b. Evaluation of the
aide's service performance,
c. The
beneficiary's evaluation of the aide's service performance and
d. Difficulties the aide encounters
performing any tasks.
4. The service plan and service plan revisions:
a. The justifications for service plan
revisions,
b. Justification for
emergency, unscheduled tasks and
c.
Documentation of prior or post approval of unscheduled
tasks.
F. Any
additional or special documentation required to satisfy or to resolve questions
arising during, from or out of an investigation or audit. "Additional or
special documentation," refers to notes, correspondence, written or transcribed
consultations with or by other healthcare professionals (i.e., material in the
beneficiary's or provider's records relevant to the beneficiary's personal care
services, but not necessarily specifically mentioned in the foregoing
requirements). "Additional or special documentation," is not a generic
designation for inadvertent omissions from program policy. It does not imply
and one should not infer from it that, the State may arbitrarily demand media,
material, records or documentation irrelevant or unrelated to Medicaid Program
policy as stated in this manual and in official program
correspondence.
G. The personal
care aide's training records, including:
1.
Examination results,
2. Skills test
results and
3. Personal care aide
certification.
H. The
personal care aide's daily service notes for each beneficiary, reflecting:
1. The date of service,
2. The routines performed on that date of
service, noted to affirm completion of each task.
3. The time of day the aide began performing
the first service-plan-required task for the beneficiary;
4. The time of day the aide stopped
performing any service-plan-required task to perform any
non-service-plan-required function;
5. The time of day the aide stopped
performing any non-service-plan-required function to resume
service-plan-required tasks and
6.
The time of day the aide completed the last service-plan-required task for the
day for that beneficiary.
I. Notes, orders and records reflecting the
activities of the physician, the supervising RN or QMRP, the aide and the
beneficiary or the beneficiary's representative; as those activities affect
delivering personal care services.
222.100
Personal Care Aide Selection,
Training and Continuing Education
NOTE: This section is not applicable to the
IndependentChoices program.
A.
The beneficiary must receive Medicaid Personal Care services from a certified
personal care aide who is not a member of the beneficiary's family. The
Medicaid agency defines, "a member of the beneficiary's family" as:
1. A spouse.
2. A minor's parent, stepparent, foster
parent or anyone acting as a minor's parent.
3. Legal guardian of the person.
4. Attorney-in-fact granted authority to
direct the beneficiary's care.
B. Personal care aides must be selected on
the basis of such factors as:
1. A
sympathetic attitude toward the care of the sick,
2. An ability to read, write and carry out
directions and
3. Maturity and
ability to deal effectively with the demands of the job.
C. The personal care provider is responsible
for ensuring that personal care aides in its employ are:
1. Certified as personal care
aides,
2. Participate in all
required in-service training and
3.
Maintain at least "satisfactory" competency evaluations from their supervisors
in all personal care tasks they perform.
D. DMS will deem valid the Certified Personal
Care Aide status of an individual with
1.
Personal Care Aide Certification conferred before April 1, 1998, and
2. Documentation of ongoing compliance with
Personal Care Program policies in effect before April 1, 1998, regarding
continuing education and competency requirements.
3. The deemed status will be effective for
dates of service on and after April 1, 1998, conditional upon the certified
aide's continuing compliance with program policies.
E. A qualified training program (see Section
222.110) may waive the training component of personal care aide certification
requirements for individuals who can document previous experience as personal
care aides, nurse's aides or similar occupations requiring the same skills
needed by personal care aides.
1. The
qualified training program must verify the individual's previous
experience.
2. The individual must
pass the personal care aide examinations and skills tests.
F. Certified Nursing Assistants with current
valid credentials are deemed qualified personal care aides.
G. Certified Home Health Aides with current
valid credentials are deemed qualified personal care aides.
222.110
Conduct of
Training
NOTE: This section is not applicable to the
IndependentChoices program.
A. A
personal care aide training program may be offered by any organization meeting
the standards in this section for:
1.
Instructor qualifications,
2.
Content and duration of personal care aide training and
3. Documentation of personal care aide
training and certification.
B. Personal Care provider agencies conducting
personal care aide training must maintain their training program
documentation.
C. Personal Care
providers hiring or contracting with individuals or organizations to conduct
personal care aide training must maintain the individual's or organization's
training program documentation. The provider is responsible for maintaining the
training program documentation file.
D. Required training program documentation
includes:
1. The number of hours each of
classroom instruction and supervised practical training.
2. Names and qualifications of instructors
and copies of licenses of supervising registered nurses.
3. Street addresses and physical locations of
training sites, including facility names when applicable.
4. Maintaining samples of the forms used to
document the beneficiary's consent to the training in their home, if the
training includes supervised practical training in the home.
5. The course outline.
6. Lesson plans.
7. The instructor's methods of supervising
trainees during practical training.
8. The training program's methods and
standards for, determining whether a trainee can read and write well enough to
perform satisfactorily the duties of a personal care aide.
9. The training program's method of
evaluating written tests, oral exams (if any) and skills tests, including the
relative weights of each in the minimum standard for successful completion of
the course.
10. The training
program's minimum standard for successful completion of the course.
11. Evidence and documentation of successful
completions (Certificates supported by internal records).
E. Personal Care providers are responsible
for the upkeep of all required training program documentation.
F. A qualified personal care aide training
and certification program must include instruction in each of the subject areas
listed in Section 222.120.
G.
Classroom and supervised practical training must total at least 40 hours.
1. Minimum classroom training time is 24
hours.
2. Minimum time for
supervised practical training is 16 hours.
a.
"Supervised practical training" means training in a laboratory or other setting
in which:
(1) . The trainee demonstrates
knowledge by performing tasks on an individual while
(2) . The trainee is under supervision as
defined in Section 220.100.
b. Trainees must complete at least 16 hours
of classroom training before beginning any supervised practical
training.
3. Supervised
practical training may occur at locations other than the site of the classroom
training.
a. However, trainees must complete
at least 24 hours of classroom training before undertaking any supervised
practical training at an actual service delivery site.
b. The training program must have the written
consent of the beneficiary or the beneficiary's representative if aide trainees
furnish any of the beneficiary's services at the beneficiary's service delivery
location.
(1) . A copy of the beneficiary's
consent must be maintained in the file of each aide trainee receiving
supervised practical training at the beneficiary's service delivery
location.
(2) . The beneficiary's
daily service documentation must include the names of the supervising RN and
the personal care aide trainees.
4. The training of personal care aides and
the supervision of personal care aides during the supervised practical portion
of the training must be performed by or under the general supervision of a
registered nurse whose current credentials are on file with the provider.
a. The qualified registered nurse must
possess a minimum of 2 years of nursing experience, at least 1 year of which
must be in the provision of in-home health care.
b. Other individuals may provide instruction
under the supervision of the qualified registered nurse.
c. Supervised practical training with a
consenting personal care beneficiary for a subject must be personally
supervised by:
(1) . The qualified registered
nurse or
(2) . By a licensed
practical nurse under the general supervision of the qualified registered
nurse.
H. Providers must maintain documentation
demonstrating that aide training meets the requirements set forth herein.
222.120
Personal
Care Aide Training Subject Areas
NOTE: This section is not applicable to the
IndependentChoices program.
A.
Correct conduct toward beneficiaries, including respect for the beneficiary,
the beneficiary's privacy and the beneficiary's property.
B. Understanding and following spoken and
written instructions.
C.
Communications skills, especially the skills needed to:
1. Interact with beneficiaries,
2. Report relevant and required information
to supervisors and
3. Report events
accurately to public safety personnel and to emergency and medical
personnel.
D.
Record-keeping, including:
1. The role and
importance of record keeping and documentation.
2. Service documentation requirements and
procedures, especially all documentation Medicaid requires of personal care
aides, as described in Medicaid Personal Care Program policy statements current
at the time of the aide's training.
3. Reporting and documenting non-medical
observations of beneficiary status.
4. Reporting and documenting, when pertinent,
the beneficiary's observations regarding their own status.
E. Recognizing and reporting, to the
supervising RN or QRMP, when changes in the beneficiary's condition or status
require the aide to perform tasks differently than instructed.
F. State law regarding delegation of nursing
tasks to unlicensed personnel.
G.
Basic elements of body functioning, and the types of changes in body function,
easily recognizable by a layperson, that an aide must report to a
supervisor.
H. Safe transfer
techniques and ambulation.
I.
Normal range of motion and positioning.
J. Recognizing emergencies and knowledge of
emergency procedures.
K. Basic
household safety and fire prevention.
L. Maintaining a clean, safe and healthy
environment.
M. Instruction in
appropriate and safe techniques in personal hygiene and grooming that include
how to assist the beneficiary with:
1. Bed
bath
2. Sponge, tub or shower
bath
3. Shampoo; sink, tub or
bed
4. Nail and skin care
5. Oral hygiene
6. Toileting and elimination
7. Shaving
8. Assistance with eating
9. Assistance with dressing
10. Efficient, safe and sanitary meal
preparation
11.
Dishwashing
12. Basic housekeeping
procedures
13. Laundry
skills
222.130
Personal Care Aide Certification
NOTE: This section is not applicable to the
IndependentChoices program.
A.
A personal care aide trainee must pass an examination based on the curriculum
of the personal care aide training course.
1.
Some of the examination may be oral.
2. Examinations must include written
questions requiring written answers, in sufficient number for instructors or
other qualified training program personnel to determine that trainees meet or
surpass a minimum standard for reading and writing.
B. The personal care aide candidate must
demonstrate the ability to perform all tasks required of personal care aides,
by meeting or exceeding minimum standards in a personal care services skills
test.
C. An aide trainee
successfully completing training must receive a dated certificate confirming
that the individual is a Certified Personal Care Aide qualified for employment
in that capacity.
1. The certificate must
contain the name of the training entity.
2. The certificate must contain the signature
of an individual authorized by the training program to certify the
qualifications of personal care aides.
222.140
In-Service Training
NOTE: This section is not applicable to the
IndependentChoices program.
Medicaid requires personal care aides to participate in at
least twelve (12) hours of in-service training every twelve (12) months after
achieving Personal Care Aide certification.
A. Each in-service training session must be
at least 1 hour in length.
1. When
appropriate, in-service training may occur at a personal care service delivery
location when the aide is furnishing personal care services.
2. In-service training at a service delivery
site may occur only if the beneficiary or the beneficiary's representative has
given prior written consent for training activities to occur concurrently with
the beneficiary's care.
B. The Personal Care Program provider agency
and the personal care aide must maintain documentation that they are meeting
the in-service training requirement.
244.000
Duration of PA
A. Personal Care PAs are generally assigned
for six months or for the life of the service plan, whichever is
shorter.
B. The contracted QIO may
validate a PA for one year if the provider requests an extended PA because the
beneficiary is an individual with a permanent disability or the physician signs
the service plan indicating a CHRONIC CONDITION that will not improve within
the next six (6) months.
1. A one-year PA
remains valid only if the service plan and services remain unchanged and the
provider meets all Personal Care Program requirements.
2. Providers receiving extended PAs for
individuals with a permanent disability must continue to follow Personal Care
Program policy regarding regular assessments and service plan renewals and
revisions.
