I. Employ qualified case managers who
reside in or near the area of responsibility and who meet at least one of
the following qualifications:
3.
Have two years' experience in the
delivery of human services, including without limitation having performed
satisfactorily as a case manager for a period of two years (experience must be
within the past three years).
A copy of the current certification must accompany the provider
application and Medicaid contract.
262.100
HCPCS Procedure Codes
The following procedure codes must be billed for ARChoices
Services.
Electronic and paper claims now require the same National
Place of Service code.
|
Procedure Code
|
Modifiers
|
Description
|
Unit of Service
|
National POS for Claims
|
|
S5125
|
U2
|
Agency Attendant Care Traditional
|
15 minutes
|
12, 99
|
|
S5170 S5170
|
U2
|
Home-Delivered Meals Frozen Home-Delivered Meal
|
1 meal 1 meal
|
12 12
|
|
S5170
|
U1
|
Emergency Home Delivered Meals
|
1 meal
|
12
|
|
S5161
|
UA
|
Personal Emergency Response System
|
1 day
|
12
|
|
S5160
|
|
Personal Emergency Response System -
Installation
|
One install
|
12
|
|
S5100
|
U1
|
Adult Day Services, 8 to 20 units per date of
service
|
15 minutes
|
99
|
|
S5100
|
|
Adult Day Services, 21 to 40 units per date of
service
|
15 minutes
|
99
|
|
S5100
|
TD, U1
|
Adult Day Health Services, 8 to 20 units per date of
service
|
15 minutes
|
99
|
|
S5100
|
TD
|
Adult Day Health Services, 21 to 40 units per date of
service
|
15 minutes
|
99
|
|
S5150
|
|
Respite Care - In-Home
|
15 minutes
|
12
|
|
S5135
|
|
Respite Care - Short-Term Facility-Based
|
15 minutes
|
99, 21, 32
|
|
T1005
|
|
Respite Care - Long-Term Facility-Based
|
15 minutes
|
21, 32, 99
|
|
T2015
|
|
Prevocational Services Skills Development
|
15 minutes
|
11, 12, 99
|
|
T2015
|
U3
|
Prevocational Services Career Exploration
|
15 minutes
|
11, 12, 99
|
262.220
Rounding
When a quotient contains decimals, look at the numbers after
the decimal point.
A. If the number
after the decimal point is 500 (e.g., 3.500) or less (e.g., 3.495) round
downward to the whole number displayed before the decimal point (three (3), in
this example)
B. If the number
after the decimal is 501 (e.g., 3.501) or greater (e.g., 3.576) round upward to
the whole number one (1) greater than the whole number displayed before the
decimal point (four (4) in this example, because it is a whole number one
greater than three (3)).
214.200
Service Plan Review and Renewal
7-1-20
A. A personal care service plan
is effective for up to one (1) year from the date of the beneficiary's last
independent assessment.
B. Personal
care services may not continue past the one-year anniversary of the last
independent assessment until DHS professional staff or contractor(s) designated
by DHS authorizes a revised service plan, or renews, or extends the
authorization of an existing service plan.
214.300
Authorization of ARChoices
Person Centered Service Plan and Personal Care Individual Service Plan
The DHS RN is responsible for developing an ARChoices
Person-Centered Service Plan (PCSP) that includes both waiver and non-waiver
services. Once developed, the PCSP is signed by the DHS RN authorizing the
services listed.
The signed ARChoices PCSP will suffice as the "Personal Care
Authorization" for services required in the Personal Care Program. The personal
care individualized service plan, developed by the Personal Care provider, is
still required.
As the ARChoices PCSP is effective for one (1) year from the
date of the beneficiary's last independent assessment, the authorization for
personal care services, when included on the ARChoices PCSP, will be for one
(1) year from the date of the beneficiary's last independent assessment, unless
revised by the DHS RN or the personal care individualized service plan needs to
be revised, whichever occurs first.
NOTE: For ARChoices beneficiaries who receive personal
care through traditional agency services or have chosen to receive their
personal care services through the IndependentChoices Program, the ARChoices
PCSP, signed by a DHS RN, will serve as the authorization for personal care
services for one year from the date of the beneficiary's last independent
assessment, as described above.
The responsibility of developing a personal care individualized
service plan is not placed with the DHS 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 individualized service plan
authorizations obtained by DHS RNs.
215.200
Personal Care Provider's Prior
Authorization Request
A. As part of
each prior authorization request, each provider shall submit a complete and
accurate form designated by DHS. The provider is not required to submit a
proposed Individualized Service Plan to DHS.
B. The completed form designed by DHS shall
include all information applicable to the individual beneficiary, including:
1. Beneficiary and provider
information;
2. Certification that
the beneficiary's service plan will not duplicate any other in-home services of
which the provider is aware;
3. The
total number of hours per month the provider seeks to offer the
beneficiary;
4. Detailed
information on all personal assistance available to the beneficiary through
other sources, including informal caregivers (e.g., family, friends), community
organizations (e.g., Meals on Wheels), Medicare (e.g., Medicare home health
aide services), or the beneficiary's Medicare Advantage health plan;
5. The frequency of in-person supervisory
visits to be made by an agency supervisor based on the specific needs of the
beneficiary and the recommendations of an agency-designated registered nurse;
and,
6. The signed approval of the
beneficiary or the beneficiary's legal representative.
C. When a beneficiary has two or more
personal care providers, the providers should cooperate in the required nursing
evaluation and the preparation and submission of the prior authorization
request and completed form designated by DHS on behalf of the
beneficiary.
D. When an individual
will receive some or all of his or her services in a congregate setting, the
assessment must reflect the RN's determination that the individual is an
appropriate candidate for services delivered in that setting. See Section
216.201 and Sections 220.110 through 220.112.
E. Before furnishing any personal care
services to an individual, the provider must prepare a complete and accurate
Individualized Service Plan with proposed hours/minutes and frequency of needed
tasks consistent with the aggregate number of hours authorized under the Task
and Hour Standards (as described in Section 240.100). The service plan must be
prepared, certified, and signed by a supervisor or registered nurse. The
service plan and all subsequent revisions must be kept by the personal care
provider as Documentation under Section 221.000.
215.320
Identifying Frequency of
In-Person Supervisory Visits
A. A
registered nurse designated by the personal care provider must identify and
recommend the frequency for in-person visits to be made by the supervisor of
the personal care aide, based on the specific needs of the
beneficiary.
B. The frequency of
in-person visits shall be at least every 365 days and shall be determined
jointly by the personal care provider and the beneficiary or the beneficiary's
legal representative, based on the recommendations of the registered
nurse.
C. The individualized
service plan must identify the agreed frequency, the risk factors that are
specific to that beneficiary, and a justification for the agreed frequency. The
risk factors identified by the service plan must include without limitation any
relevant medical diagnoses; the beneficiary's mental status; the presence of
family or other residents in the beneficiary's home, and the frequency of their
presence; and the beneficiary's physical dependency needs, including the
activities of daily living (ADL) with which the beneficiary needs
assistance.
D. If the frequency
identified in the service plan is less than the frequency recommended by the
registered nurse, the service plan shall identify the medical justification for
the reduced frequency.
E. If the
beneficiary has a significant change of condition affecting a risk factor, the
registered nurse shall review the frequency of in-person visits and recommend
changes as appropriate.
215.330
Service Plan Revisions
NOTE: Subsections (A) (3) and (B) are not applicable to
IndependentChoices program.
A.
A personal care provider must amend a beneficiary's individualized service plan
to document any 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 thirty (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.
Changes in the amount, frequency or duration of a service must be documented in
the medical record,
b. The reasons
for the service variances must be written daily in the service
documentation.
4. A
service plan revision must be authorized by DHS professional staff or
contractor(s) designated by DHS only if the provider requests to increase or
decrease the total monthly hours. DHS professional staff or the DHS contractor
will review the request and determine, based on application of the Task and
Hour Standards described in Section 240.100, the amount of adjustment to make
in prior authorized minutes. DHS professional staff or the DHS contractor will
revise the number of minutes in Interchange.
B. Providers may not reduce a beneficiary's
services without prior authorization by DHS professional staff or contractor(s)
designated by DHS
C. The personal
care provider must document medical reasons for service plan
revisions.
D. The new beginning
date of service is the date authorized by DHS professional staff or
contractor(s) designated by DHS.
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.
215.351
Service Plan Requirements for
Multiple Providers 7-1-20
When a beneficiary receives services from more than one
personal care provider, each provider must comply with the following
requirements.
A. Each provider must
create an individualized service plan and collaborate with the beneficiary's
other personal care provider(s) to create a comprehensive service plan.
1. Each comprehensive service plan must
clearly state which provider provides which services, where and on which day(s)
they do so, which time(s) of day they furnish services and the maximum and
minimum amount of time per day and per week that the provider will take to
perform those services.
2. Each
comprehensive service plan must be authorized, signed and dated by the
provider.
B. Each time a
personal care provider intends to revise or renew a comprehensive service plan,
that provider must notify the beneficiary's other personal care provider(s) to
agree on the revision or renewal.
C. If the providers cannot agree on a
comprehensive service plan, plan revision or plan renewal, the providers shall
submit the various alternatives to DHS professional staff or contractor(s)
designated by DHS, who shall determine the terms of the final comprehensive
service plan.
D. Any Medicaid
provider having knowledge that another Medicaid provider has failed to comply
with a service plan, including a comprehensive service plan, shall notify the
DMS Director of such failure within ten (10) business days of the occurrence,
or sooner if the beneficiary's life or health is threatened
215.360
Changes of Condition
A. The individualized service plan must
identify individualized, beneficiary-specific standards, based on the
identified risk factors, for when a caregiver or supervisor must document and
report any significant change in the beneficiary's condition. A significant
change is one that exhibits a major decline or improvement in the physical or
mental health status of the beneficiary.
B. If a caregiver or supervisor observes a
significant change of condition, the caregiver or supervisor must document and
report the change of condition as required by the change-reporting standards
contained in the beneficiary's individualized service plan. Documentation must
include the time and date the change was identified by the caregiver and a full
description of the change.
C.
Within twenty-four (24) hours of a significant change of condition being
reported, a registered nurse must evaluate and document an assessment of the
beneficiary, including without limitation the reported change of
condition.
D. A change of condition
under this section may result in a change to the service plan or to the
frequency of supervisory visits, but it does not automatically result in a new
Independent Assessment by the DHS Independent Assessment Contractor.
Independent Assessments or Reassessments are governed by the provisions of the
Arkansas Independent Assessment Medicaid Provider Manual.
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, Level II assisted living facility,
intermediate care facility for persons with intellectual disabilities, or
institution for mental disease that are:
1.
Authorized for the individual by DHS professional staff or contractor(s)
designated by DHS 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 DHS professional staff or contractor(s) designated by
DHS
4. Provided by an individual
who is
a. Qualified to provide the
services;
b. Supervised by an
individual meeting the qualification set forth in Section 220.100;
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. Personal care services may be
provided in a beneficiary's home or while accompanying the beneficiary to other
locations, including without limitation for medical appointments or community
activities, subject to the restrictions on travel time in this
section.
C. Travel Time of Personal
Care Aide Accompanying Beneficiary:
1.
Personal care only covers personal care aide travel time when all of the
following apply:
a. The personal care aide
accompanies the beneficiary in the same vehicle as the beneficiary travels to
and returns from a community location for medical appointment or community
activity;
b. The travel time billed
is solely for necessary time in transit from the beneficiary's home to the
community location and the return travel from the community location to the
beneficiary's home;
c. The
beneficiary's participation in the local community activity is for the benefit
of the beneficiary and to meet the beneficiary's goals for independent living
in the community, and the travel, including stops, is not for the benefit or
convenience of any other person (including the personal care aide, a family
member, the driver, or other passengers);
d. The traveling activity itself is for
practical transit within the community and not for diversional or recreational
purposes of any kind;
e. The
beneficiary's Individualized Service Plan includes Personal Care service hours
for one or both of the following activities of daily living (ADLs): toileting
and mobility / ambulating;
f. While
in transit to and from the community location, the beneficiary requires, or is
likely to need given assessed functional limitations, hands-on assistance with
the ADL task of toileting or the ADL task of mobility/ambulating; and
g. The travel time is reasonable given
driving distances, traffic conditions, and weather, with time and locations
documented.
2. Travel
time is not reimbursable if any other adult person accompanying (or driving)
the beneficiary is a family member and is reasonably able to assist the
beneficiary in transit if needed.
3. Travel time accompanying a beneficiary
will count against the total number of Personal Care hours per month authorized
in the participant's Individualized Service Plan and prior
authorization.
4. Requesting Hours
for Travel Time of Attendant Accompanying Participant:
Beneficiaries vary in their medical appointments, participation
in community activities, the availability of family or other assistance they
may need while traveling, and the time involved when traveling to medical
appointments and local community activities. When covered, travel time of a
personal care aide accompanying a beneficiary is incident to but itself not the
ADL task of toileting or the ADL task of mobility/ambulating. Therefore, the
Task and Hour Standards are not currently used to help determine the number of
Personal Care hours, if any, associated solely with travel time of a personal
care aide accompanying a beneficiary to a medical visit or community
activity.
For an ARChoices beneficiary, the number of hours allowed for
travel time of a personal care aide will be determined by the DHS nurse in the
beneficiary's Person-Centered Service Plan.
For other beneficiaries, the provider may include in the prior
authorization request justification for travel time, based on the beneficiary's
community activities, need for a personal care aide to accompany them, and the
distances and roundtrip travel times typically involved. Based on this
information and consistent with the above requirements, the contractor
designated by DHS to process prior authorization requests, or if there is no
contractor designated by DHS, DHS professional staff, may increase the number
of Personal Care hours per month covered in the Individualized Service Plan and
prior authorization to reasonably accommodate the travel time of a personal
care aide accompanying the beneficiary.
220.100
Service Supervision
A. The provider must assure that the delivery
of personal care services by personal care aides is supervised.
1. A supervisor must be a licensed nurse or
have completed two (2) years of full-time study at an accredited institution of
higher learning. An individual who has a high school diploma or general
equivalency diploma may substitute one (1) year of fulltime employment in a
supervisory capacity in a healthcare facility or community-based agency for one
(1) year at an institution of higher education.
2. Alternatively, a Qualified Intellectual
Disabilities Professional (QIDP) may fulfill the supervision requirement for
personal care services to beneficiaries residing in alternative living
situations or alternative family homes, licensed and certified by DPSQA as
personal care providers.
3. An
individual who personally provides personal care services to a beneficiary may
not supervise another personal care aide providing personal care services to
that same beneficiary.
B.
The supervisor has the following responsibilities.
1. The supervisor must instruct the personal
care aide in
a. Which routines, activities and
tasks to perform in executing a beneficiary's service plan;
b. The minimum frequency of each routine or
activity; and
c. The maximum number
of hours per month of personal care service delivery, as authorized in the
service plan.
2. At least
once a month, the supervisor must
a. Review
the aide's records;
b. Document the
record review; and
c. If necessary,
further instruct the aide and document the nature of and the reasons for
further instructions.
3.
At least annually, the supervisor must visit the beneficiary at the service
delivery location to conduct on-site evaluation.
a. Medicaid requires that at least one of
these supervisory visits annually must be when the aide is not
present.
b. If the frequency of
in-home supervisory visits for a beneficiary is greater than one annually, at
least one visit must be while the aide is present and furnishing
services.
4. When the
aide is present during the visit the supervising RN or QIDP must
a. Observe and document;
(1). The condition of the
beneficiary;
(2). The type and
quality of the personal care aide's service provision;
(3). The interaction and relationship between
the beneficiary and the aide; and
(4). Any changes or additions to any risk
factors relevant to the needed frequency of in-person supervisory
visits.
b. Consult with
the agency-designated registered nurse regarding modifications to the service
plan, if necessary, based on the observations and findings from the visit and
document the consultation in the beneficiary's records; and,
c. If necessary, further instruct the aide
and document the nature of and the reasons for further instructions.
5. When the aide is not present
during the visit, the supervisor must
a.
Observe and document the condition of the beneficiary;
b. Observe and document, from available
evidence, the type and quality of the personal care aide's service
provision;
c. Observe, document,
and report any changes or additions to any risk factors relevant to the needed
frequency of in-person supervisory visits;
d. Query the beneficiary or the beneficiary's
representative and document pertinent information regarding the beneficiary's
opinion of:
(1). The type and quality of the
aide's service;
(2). The aide's
conduct; and
(3). The adequacy of
the working relationship of the beneficiary and the aide.
e. Consult with the agency-designated
registered nurse regarding modifications to the service plan, if necessary,
based on observations and findings from the visit and document the consultation
in the beneficiary's records; and
f. Further instruct the aide, if necessary,
and document the nature of and the reasons for further instructions.
C. The provider must
review the service plan and the aide's records as necessary. The review will
ensure that the daily aggregate time estimate in the service plan accurately
reflects the actual average time the aide spends delivering personal care aide
services to a beneficiary.
221.000
Documentation
NOTE: This section is not applicable to the
IndependentChoices program.
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
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 supervisor or, Qualified Intellectual Disabilities
Professional (QIDP), or agency-designated registered nurse including without
limitation:
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 DHS
professional staff or contractor(s) designated by DHS.
3. Notes arising from a 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;
c.
Documentation of prior or post approval of unscheduled tasks; and
d. Recommendation or justification for the
frequency needed for in-person supervisory visits.
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 agency-designated registered
nurse, the supervisor or QIDP, the aide and the beneficiary or the
beneficiary's representative; as those activities affect delivering personal
care services.
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;
and
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 twenty-four (24) hours.
2. Minimum time for supervised practical
training is sixteen (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 sixteen
(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 twenty-four (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 supervisor or QIDP
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 two (2) years of nursing experience, at least one (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 7-1-20
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; and
4. Reporting and documenting, when pertinent,
the beneficiary's observations regarding their own status.
E. Recognizing and reporting, to the
supervisor or Qualified Intellectual Disabilities Professional (QIDP), 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 as designated by the Arkansas State Board of
Nursing.
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; and
13. Laundry
skills.
N. Early
recognition and reporting of changes in client condition.
244.000
Duration of PA
Personal Care PAs are generally assigned for twelve (12) months
from the date of the last independent assessment or for the life of the service
plan, whichever is shorter, unless the beneficiary has a change in
condition.
204.000
Participation Requirements for Providers of Targeted Case Management for
Beneficiaries Ages Sixty (60) and Older Including ARChoices in Homecare Waiver
Participants
Providers of targeted case management who are restricted to
serving persons sixty (60) years of age and older or serving persons ages
twenty-one (21) and older with a physical disability and those sixty-five (65)
and older who participate in the ARChoices in Homecare (ARChoices) 1915(c)
waiver must be certified by the Division of Provider Services and Quality
Assurance (DPSQA) as an organization qualified to provide targeted case
management services.
In order to be certified by DPSQA, the provider must meet the
following qualifications:
A. Be
located in the state of Arkansas;
B. Be licensed as a Class A or Class B Home
Health Agency or Private Care Agency by the Arkansas Department of Health or a
unit of state government or be a private or public incorporated agency whose
stated purpose is to provide case management to the elderly or adults with
physical disabilities;
C. Be able
to demonstrate one year of experience in performing case management services.
(Experience must be within the past three (3) years);
D. Be able to demonstrate one year of
experience in working specifically with individuals in the targeted group.
(Experience must be within the past three (3) years);
E. Have an administrative capacity to ensure
quality of services in accordance with state and federal
requirements;
F. Have the financial
management capacity and system that provides documentation of services and
costs;
G. Have the capacity to
document and maintain individual case records in accordance with state and
federal requirements;
H. Be able to
demonstrate that the provider has current liability coverage; and
I. Employ qualified case managers who reside
in or near the area of responsibility and who meet at least one of the
following qualifications:
1. Licensed in the
state of Arkansas as a social worker (Licensed Master Social Worker or Licensed
Certified Social Worker), a registered nurse or a licensed practical
nurse;
2. Have a bachelor's degree
from an accredited institution in a health and human services or related field;
or
3. Have two years' experience in
the delivery of human services, including without limitation having performed
satisfactorily as a case manager for a period of two (2) years (experience must
be within the past three (3) years).
A copy of the current certification must accompany the provider
application and Medicaid contract.
218.300
Service Monitoring/Service Plan
Updating 7-1-20
This component includes activities and contacts that are
necessary to ensure the TCM care plan is effectively implemented and adequately
addressing the needs of the Medicaid-eligible beneficiary.
The maximum units allowed for this service may not exceed
six (6) units per monitoring visit when providers are dealing with
beneficiaries ages twenty-one (21) and older.
A. The activities and contacts may be with
the Medicaid-eligible beneficiary, family members, providers or other
entities.
B. They may be as
frequent as necessary, within established Medicaid maximum allowable
limitations, to help determine such things as:
1. Whether services are being furnished in
accordance with a Medicaid eligible beneficiary's plan of care;
2. The adequacy of the services in the plan
of care; and
3. Changes in the
needs or status of the Medicaid-eligible beneficiary
C. Monitoring is allowed through regular
contacts with service providers at least every month to verify that appropriate
services are provided in a manner that is in accordance with the service plan
and assuring through contacts with the beneficiary, at least every other month,
that the beneficiary continues to participate in the service plan and is
satisfied with services.
1. A face-to-face
monitoring contact with the beneficiary must be completed once every three (3)
months. Required contacts with the service providers may be conducted through
face-to-face contact or by telephone. Communication with service providers by
email or fax are allowed as described in Section 213.000, F.1.
2. A face-to-face contact is not considered a
covered monitoring contact unless the required monitoring form is completed
according to instructions, dated, signed by the targeted case manager, and
filed in the beneficiary's case record.
D. Updating includes:
1. Reexamining the beneficiary's
needs;
2. Identifying changes that
have occurred since the previous assessment;
3. Identifying hospitalizations or other
extended absences from the home;
4.
Altering the TCM service plan; and
5. Measuring the beneficiary's progress
toward service plan goals. Service plans should not be updated more than
quarterly unless there is a significant change in the beneficiary's needs.
Monitoring and follow-up activities include making necessary
adjustments in the TCM care plan and service arrangements with providers,
according to established program guidelines.
Face-to-face monitoring contacts must be completed as often as
deemed necessary, based on the professional judgment of the TCM, but no less
frequent than established in Medicaid TCM program policy.
E. Non-Covered Services include:
1. The updating of a tickler
system;
2. A case management agency
is not allowed to monitor or update an activity when the service being
monitored or updated is provided to the beneficiary by the same
agency;
3. However, the same agency
is allowed to be both the TCM agency and the agency providing a direct service,
such as personal care, home delivered meals, or PERS;
4. However, the agency is not allowed to bill
for a TCM monitoring contact when monitoring the quality of care or the
quality of the service provided by the same agency or when the purpose
of the contact is to monitor the progress of a service being in place,
delivered, having started, effective date, etc.;
5. In addition, TCM is not allowed when
monitoring is required through the direct service policy, such as with PERS
providers; and
6. Monitoring the
PERS service is a part of the certification policy for all PERS providers.
Additional monitoring of the PERS service by a TCM is not a covered TCM
service.
F. Examples of
case monitoring and service plan updating are shown below:
1. Example # 1
Provider "A" has been chosen by the beneficiary to provide home
delivered meals. The beneficiary has also chosen provider "A" for case
management services. Case management by provider "A" may not be billed for any
activity associated with the provision of home delivered meals. It is the
responsibility of the direct service provider to ensure quality services are
provided. In this example, the home delivered meal provider is responsible for
ensuring meals are delivered timely and to the beneficiary's satisfaction. Case
management activity does not include monitoring the provision of home delivered
meals by the same agency.
This same policy applies to any service where the case
management agency is the same agency providing the in-home service.
2. Example # 2
Provider "B" has been chosen by the beneficiary to provide
personal care. The beneficiary has also chosen provider "B" for targeted case
management services. Case management by provider "B" may not be billed for any
activity associated with the quality of the personal care services being
provided by the same agency. It is the responsibility of the direct service
provider to ensure quality services are provided.
In this example, the personal care provider is responsible for
ensuring personal care services are provided to the satisfaction of the
beneficiary and according to the plan of care (POC) that includes the personal
care service. This includes whether or not the aide performs the duties
assigned, arrives timely, stays the assigned period of time, is courteous, and
meets the requirements established for the Personal Care Program by the
Arkansas Medicaid Program.
G. A TCM provider is allowed to bill a
monitoring contact when the monitoring is for the purpose of verifying the
services included on the POC are sufficient based on the beneficiary's current
condition. This is also true when the case manager is contacted by the
beneficiary.
1. If the monitoring contact is
billed, based on this purpose, documentation must support the reason for the
contact, the results of the contact, and any changes requested to the POC.
a.
NOTE: This type activity,
when based on the beneficiary's condition and the sufficiency of the services
in place, may be billed regardless of whether or not the case manager and the
direct service provider are the same agency.
b. If the monitoring contact, whether
initiated by the case manager or the beneficiary, is not addressing
quality of care, the monitoring contact
is billable, if it meets the definition described in this manual.
2. The same policy applies to the
personal emergency response system (PERS) service. The TCM provider may test
the PERS unit when completing a monitoring visit, if the PERS unit is not
provided by the same agency as the TCM service.
a. Since the PERS providers are required to
test their units monthly, if they choose to meet that requirement by having
their targeted case managers test the units while in the home, this is not
considered a covered TCM service.
b. It does, however, meet the requirement
established for the PERS providers, if results of the testing are documented by
the PERS provider and available for audit.
H. All requests from case managers to
increase or decrease services or change service providers will be verified by
the DHS RN and justified by the DHS RN prior to any changes being made to the
waiver plan of care. This applies when the beneficiary is a participant in a
home and community-based waiver program.
See Section 262.100 for the appropriate procedure code and
modifier.
