Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 70 - MO HealthNet Division
Chapter 91 - Personal Care Program
Section 13 CSR 70-91.010 - Personal Care Program
Universal Citation: 13 MO Code of State Regs 70-91.010
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment revises section (3) regarding the MHD criteria for providers of personal care services, section (5) regarding criteria for providers of advanced personal care services, and section (6) regarding requirements for separately authorized nurse visits. In addition, obsolete language and agency names were updated throughout the regulation, with changes to sections (1) through (6).
(1) Persons Eligible for Personal Care Services. Any person who is determined eligible by the Family Support Division for Title XIX benefits and is found to be in medical need of personal care services as an alternative to institutional care. Persons must be assessed, approved, and case-managed by the Department of Health and Senior Services or its designee as described in this rule to be eligible for personal care services. Eligibility procedures for personal care services are as follows:
(A) Requirements for Personal Care Services.
1. The participant must need an institutional
level of care which is defined as twenty-four-(24-) hour institutional care on
an inpatient or residential basis in a hospital or nursing facility (NF) and
approved by the Department of Health and Senior Services or its designee.
2. Level of care will be
determined by the Department of Health and Senior Services or its
designee.
3. The participant must
agree to an in-home assessment performed by the Department of Health and Senior
Services or its designee of his/her physical, social, and functional ability to
benefit from personal care services;
(B) Obtaining Personal Care Services.
1. If the participant meets all of the
eligibility and assessment criteria, the Department of Health and Senior
Services or its designee will develop an initial personal care plan to
authorize personal care services on a scheduled basis to eligible participants
in their own homes, licensed Residential Care Facilities (RCFs) I or II, or
Assisted Living Facilities (ALFs) as an alternative to twenty-four-(24-) hour
institutional care on an inpatient or residential basis in a hospital or NF.
The Department of Health and Senior Services or its designee will forward a
copy of the personal care plan to the participant's attending physician and to
the personal care provider who will be delivering care. Upon the receipt of the
personal care plan, the provider of care must initiate care within ten (10)
calendar days of receipt and the physician must register any comments or
requests for changes within thirty (30) days of receipt or the personal care
plan will stand as written by the Department of Health and Senior Services or
its designee.
2. The personal care
plan will be developed in collaboration with and signed by the participant. The
plan will include an identification of the services and tasks to be provided,
frequency of services, and the maximum number of units of service for which the
participant is eligible per month.
3. A new in-home assessment and personal care
plan may be completed by the Department of Health and Senior Services or its
designee as needed to redetermine need for personal care services or to adjust
the monthly amount of authorized units. The service provider must always have
an active service plan. Only the Department of Health and Senior Services or
its designee, not the service provider, may increase the overall maximum number
of units for which the individual is eligible per month. Any service plan
developed in accordance with paragraphs (1)(B)2. and 3. is a state-approved
service plan.
4. The participant
will be informed of the option of services available to him/her in accordance
with the level-of-care determination and assessment findings; and
(C) Discontinuing Personal Care
Services. The following policies and procedures for discontinuing personal care
services shall be followed:
1. Services for a
participant shall be discontinued by a provider agency under the following
circumstances:
A. When the participant's case
is closed by the Department of Health and Senior Services or its
designee;
B. When the provider
learns of circumstances that require the closure of a case for reasons
including but not limited to death entry into a nursing home, or the
participant no longer needs services. In these circumstances, the provider
shall notify the Department of Health and Senior Services or its designee in
writing and request that the participant's services be discontinued;
C. When the participant is noncompliant with
the agreed-upon plan of care. Noncompliance requires persistent actions by the
participant or family which negate the services provided by the agency. After
all alternatives have been explored and exhausted, the provider shall notify
the Department of Health and Senior Services or its designee in writing of the
noncompliant acts and request that the participant's services be
discontinued;
D. When the
participant or participant's family threatens or abuses the personal care aide
or other agency staff to the point where the staff's welfare is in jeopardy and
corrective action has failed. The provider shall notify the Department of
Health and Senior Services or its designee of the threatening or abusive acts
and may request that the service authorization be discontinued;
E. When a provider is unable to continue to
meet the maintenance needs of a participant. In these circumstances, the
provider shall notify the Department of Health and Senior Services or its
designee in writing and request that the participant's services be
discontinued; or
F. When a provider
is unable to continue to meet the maintenance needs of a participant whose plan
of care requires advanced personal care services. In these circumstances the
provider shall provide written notice of discharge to the participant or
participant's family and the Department of Health and Senior Services or its
designee at least twenty-one (21) days prior to the date of discharge. During
this twenty-one- (21-) day period, the Department of Health and Senior Services
or its designee shall assist in making appropriate arrangements with the
participant for transfer to another agency, institutional placement, or other
appropriate care. Regardless of circumstances, the personal care provider must
continue to provide care in accordance with the plan of care for these
twenty-one (21) days or until alternate arrangements can be made by the
Department of Health and Senior Services or its designee, whichever comes
first; and
2.
Discontinuing services for a participant still in need of assistance shall
occur only after appropriate conferences with the Department of Health and
Senior Services or its designee, participant, and participant's
family.
(2) Basic personal care services are medically-oriented, maintenance services to assist with the activities of daily living when this assistance does not require devices and procedures related to altered body functions.
(A) To be eligible for basic personal care,
an individual must be in need of personal care services as an alternative to
institutional care as specified in section (1) of this rule.
(B) The following activities constitute basic
personal care services and shall be provided according to the plan of care:
1. Assistance with dietary needs, including
meal preparation and cleanup, and assistance with eating/feeding;
2. Assisting with dressing and grooming,
including helping with dressing and undressing, combing hair, and nail
care;
3. Assisting with bathing and
personal hygiene, including assisting with bathing, shampooing hair, oral
hygiene and denture care, and shaving;
4. Assisting with toileting and continence,
including assisting in going to the bathroom, and changing bed linen. This
category may also include the changing of beds for persons with medically
related limitations that prohibit the completion of this task;
5. Assisting with mobility and transfer,
including assisting with transfer and ambulation when participants can at least
partially bear own weight;
6.
Assisting with medication, including assisting with the self-administration of
medicine, applying nonprescription topical ointments or lotions; and
7. Medically related household tasks,
including approved homemaker and chore tasks.
(C) The encouragement and instruction of
participants in self-care may be a component of any other task as described
above; however, encouragement and instruction do not constitute a task in and
of themselves.
(3) Criteria for Providers of Personal Care Services.
(A) The provider of personal care services
must have a valid participation agreement with the Department of Social
Services, Missouri Medicaid Audit and Compliance Unit. The issuance of the
participation agreement is dependent upon acceptance of an application for
enrollment by the Missouri Medicaid Audit and Compliance Unit. The provider
must submit to the Missouri Medicaid Audit and Compliance Unit the written
proposal required to become a Title XX in-home services provider and be
approved to provide Title XX in-home services. Once approved to provide Title
XX in-home services by the Missouri Medicaid Audit and Compliance Unit, the
provider will be allowed to execute a Title XIX participation agreement with
the Missouri Medicaid Audit and Compliance Unit. Thereafter, a provider is not
required to actually accept or deliver services to participants who are
authorized for both programs or to participants who are authorized for Title XX
services only. For residential care facilities that wish to provide services
only to the eligible residents of their own facility, only the verification of
a state residential care facility license authorized by the Department of
Health and Senior Services, Division of Regulation and Licensure, will be
required for the Medicaid enrollment application. Providers must maintain their
approval to participate as a Title XX provider, whether or not they actually
serve Title XX eligible participants, in order to remain qualified to
participate in the Title XIX (Medicaid) Personal Care Program.
(B) The providers must agree to comply with
any evaluation conducted by the Missouri Medicaid Audit and Compliance Unit.
The Missouri Medicaid Audit and Compliance Unit may, in accordance with the
protective service mandate (Chapter 192, RSMo), take action to protect
participants from providers who are found to be out of compliance with the
requirements of its regulations and of any other regulations applicable to the
Personal Care Program, when such noncompliance is determined by the Missouri
Medicaid Audit and Compliance Unit to create a risk of injury or harm to
participants. Evidence of such risk may include unreliable or inadequate
provider documentation of services or training due to falsification or fraud,
the provider's failure to deliver services in a reliable and dependable manner,
or use of personal care aides who do not meet the minimum training standards of
this regulation. Immediate action by the Missouri Medicaid Audit and Compliance
Unit may include but is not limited to:
1.
Removing the provider from any list of providers and, for participants who
request the unsafe and noncompliant provider, informing the participants of the
determination of noncompliance after which any informed choice will be honored
by the Department of Health and Senior Services or its designee; or
2. Informing current participants served by
the provider of the provider's noncompliance and that the Division of Senior
and Disability Services has determined the provider unable to deliver safe
care. Such participants will be allowed to choose a different provider from the
list maintained by the Department of Health and Senior Services or its
designee, which will then be immediately authorized to provide service to
them.
(C) The provider
agency must be available to provide care in accordance with the personal care
plan, utilizing universal precaution procedures as defined by the Centers for
Disease Control and Prevention.
(D)
The provider agency must monitor the overall physical care needs of the
participant. If the participant's condition warrants, contact the participant's
physician and inform the Department of Health and Senior Services or its
designee when additional case management activities by the Department of Health
and Senior Services or its designee are required.
1. Prior to the delivery of service, the
personal care aide shall receive a copy of the care plan for the participant
and be provided with information about the participant in order to
appropriately deliver services to meet the needs of the participant.
(E) For newly employed aides, the
provider agency must, at a minimum, provide twelve (12) hours of orientation
training, within thirty (30) days of employment.
1. In calculating these hours, the following
requirements shall apply:
A. At least two (2)
hours orientation to the provider agency and the agency's protocols for
handling emergencies;
B. With a
minimum of six (6) hours of training being completed prior to participant
contact;
C. Four (4) hours of
required orientation may be waived with adequate documentation in the
employee's records that the aide received similar training during the previous
twelve (12) months, with the exception of the statutorily required dementia
training;
D. If an aide is a
certified nurse assistant (CNA), licensed practical nurse, or registered nurse,
the provider agency may waive all hours of orientation training, with the
exception of the two (2) hours' provider agency orientation and the statutorily
required dementia training, with adequate documentation placed in the aide's
personnel record. The documentation shall include the employee's license or
certification number, which must be current and in good standing at the time
the training was waived.
2. An additional five (5) hours of in-service
training annually are required after the first twelve (12) months of
employment. The provider may waive the required annual five (5) hours of
in-service training and require only two (2) hours of refresher training
annually when the aide has been employed for three (3) years and has completed
fifteen (15) hours of in-service training. In-service training curricula shall
include updates on Alzheimer's disease and related dementia.
3. Personal care aides employed by an RCF II
or ALF are exempt from the training requirements defined in paragraphs (3)(E)1.
and 2. of this rule if they have completed the training requirements described
in subdivisions (9) and (10) of subsection 3 of section
198.073, RSMo.
4. The provider agency shall have written
documentation of all basic and in-service training provided which includes, at
a minimum, a report of each employee's training in that employee's personnel
record. The report shall document the dates of all classroom or on-the-job
training, trainer's name, topics, number of hours and location, the date of the
first participant contact, and shall include the aide's signature. If a
provider waives any in-service training, the employee's training record shall
contain supportive data for the waiver.
(F) The requirements that have been adopted
by the Division of Senior and Disability Services at
19 CSR
15-7.021(18)(A) through (Q) and (18)(T) through
(W) shall apply to all providers of personal
care services and advanced personal care services.
(G) The provider agency must employ an
administrative supervisor of the day-to-day delivery of direct personal care
services possessing at least the following qualifications:
1. Be at least twenty-one (21) years of age;
and
2. Shall be a registered nurse
(RN) who is currently licensed in Missouri; or have at least a baccalaureate
degree; or be a licensed practical nurse (LPN) who is currently licensed in
Missouri with at least one (1) year of experience with the care of the elderly,
or individuals with disabilities or medically complex conditions; or have at
least two (2) years' experience with the care of the elderly, or individuals
with disabilities or medically complex conditions.
(H) The supervisor's responsibilities shall
include, at a minimum, the following:
1.
Establish, implement, and enforce a policy governing communicable diseases that
prohibits provider staff contact with participants when the employee has a
communicable condition, including colds or flu. Assure that reporting
requirements governing communicable diseases, including hepatitis and
tuberculosis, as set by the Missouri Department of Health and Senior Services
(19 CSR
20-20.020), are carried out;
2. Monitor the provision of services by the
personal care worker to assure that services are being delivered in accordance
with the personal care plan. This shall be primarily in the form of an at least
monthly review and comparison of the worker's records of provided services with
the personal care plan. The monitoring reports shall be available for review by
the Departments of Social Services and Health and Senior Services upon request.
Documentation, including the reason, must be kept on authorized services/units
not delivered;
3. Make an on-site
visit at least annually to evaluate each personal care worker's performance and
the adequacy of the service plan, including review of the plan of care with the
participant. The personal care worker may or may not be present for this
evaluation. A written record of the evaluation shall be maintained in the
personnel file of the personal care worker. This record must contain, at a
minimum, the participant's name and address, the date and time of the visit,
personal care worker's name, observations related to the participant's receipt
of care plan delivery, the participant's satisfaction of the personal care
worker's performance, and the adequacy of the service plan. In addition, the
evaluation shall be signed and dated by the supervisor who prepared it and by
the personal care worker. If the required evaluation is not performed or not
documented, the personal care worker's qualifications to provide the services
may be presumed inadequate and all payments made for services by that personal
care worker may be recouped;
4.
Approve, in advance, all changes to the plan of care based on supervisory
on-site visits, information from the personal care worker, or observation by
the RN, or a combination of these. Approval of changes shall be noted and dated
in the participant's file;
5. Make
appropriate recommendations to the Department of Health and Senior Services or
its designee including proposed increase, reduction, or termination of
services; or need for increased Department of Health and Senior Services
involvement based on supervisory on-site visits, review of reports, information
from the personal care worker, observation by the RN; or a combination of
these;
6. Be available for regular
case conferences with the Department of Health and Senior Services or its
designee; and
7. Assist in
orientation and personal care training for personal care workers.
(I) If the supervisor is not an
RN, the provider agency must have a designated RN currently licensed in
Missouri either on staff or employed as a consultant.
(J) The RN's responsibility shall include to
review and initial all on-site visit reports made by the administrative
supervisor. If supervised by an RN, an LPN or Graduate Nurse (GN) may perform
this RN supervisory responsibility.
(K) An in-home personal care worker shall
meet the following requirements:
1. Be at
least eighteen (18) years of age;
2. Be able to read, write, and follow
directions; and
3. May not be a
family member of the participant for whom personal care is to be provided. A
family member is defined as a spouse; parent; sibling; child by blood,
adoption, or marriage (step-child); grandparent; or grandchild.
(4) Reimbursement.
(A) Payment will be made in accordance with
the fee per unit of service as defined and determined by the MO HealthNet
Division.
1. A unit of service is fifteen
(15) minutes.
2. Documentation for
services delivered by the provider must include the following:
A. The participant's name and Medicaid
number;
B. The date of
service;
C. The time spent
providing the service which must be documented in one (1) of the following
manners:
(I) When a personal care aide is
providing services to one (1) individual in a private home setting and devotes
undivided attention to the care required by that individual, the actual clock
time the aide began the services for that visit shall be documented as the
start time, and the actual clock time the aide finished the care for the visit
shall be documented as the stop time per Electronic visit Verification (EVV)
regulation 13 CSR 70-3.320; and
(II) When the personal care services are
provided in a congregate living setting, such as RCFs I and II or ALFs, when
on-site supervision is available and personal care aide staff will divide their
time among a number of individuals, the following must be documented: all tasks
performed for each participant by date of service and by staff shifts during
each twenty-four- (24-) hour period;
D. A description of the service;
and
E. The name of the personal
care aide who provided the service.
3. A provider may not bill time spent in the
delivery of service of less than one (1) unit of service for any participant.
However, time spent in the delivery of service of less than one (1) full unit
for any participant may be accrued by the provider to establish a unit of
service. In no event may time spent in the delivery of service be accrued
beyond the last day of the calendar month in which such services were
rendered.
4. The fee per unit of
service will be based on the determination by the state agency of the
reasonable cost of providing the covered services on a statewide basis and
within the mandatory maximum payment limitations.
(B) Conditions for Reimbursement.
1. The personal care plan will be the
authorization for payment of service.
2. The total monthly payment for basic
personal care services made on behalf of an individual who requires basic
personal care only cannot exceed sixty percent (60%) of the average statewide
monthly cost for care in a nursing facility as defined in
13 CSR
70-10.010(4)(Q) (excluding
intermediate care facilities for individuals with intellectual disabilities
(ICFs/IID)).
3. The average monthly
cost to the state for care in an NF as defined in
13 CSR
70-10.010(4)(Q) (excluding ICFs/IID)
will be established in the month of May of each state fiscal year which will
become effective on July 1 of the following state fiscal year.
4. Payment will be made on the lower of the
established rate per service unit or the provider's billed charges.
5. Rates will be established for personal
care services in private homes, licensed RCFs I and II, and ALFs.
(5) Advanced personal care services are maintenance services provided to a participant in the participant's home to assist with activities of daily living when this assistance requires devices and procedures related to altered body functions.
(A) Persons Eligible for Advanced Personal
Care Services. Any person who is determined eligible for Title XIX benefits
from the Family Support Division, found to be in need of personal care services
as an alternative to institutional care as specified in section (1) of this
rule, and who requires devices and procedures related to altered body functions
is eligible for advanced personal care services.
(B) The following activities constitute
advanced personal care services and shall be provided according to the plan of
care:
1. Routine personal care of persons
with ostomies (including tracheostomies, gastrostomies, colostomies all with
well-healed stoma), which includes changing bags and soap and water hygiene
around ostomy site;
2. Personal
care of persons with external, indwelling, and suprapubic catheters, which
include changing bags and soap and water hygiene around site;
3. Removal of external catheters, inspect
skin and reapply catheter;
4.
Administration of prescribed bowel programs, including use of suppositories and
sphincter stimulation per protocol and enemas (prepacked only) without
contraindicating rectal or intestinal conditions;
5. Application of medicated (prescription)
lotions, ointments or dry, aseptic dressings to unbroken skin including stage I
decubitus;
6. Application of
aseptic dressings to superficial skin breaks or abrasions as directed by a
licensed nurse;
7. Manual
assistance with noninjectable medications as set up by a licensed
nurse;
8. Passive range of motion
(nonresistive flexion of joint within normal range) delivered in accordance
with the care plan; and
9. Use of
assistive device for transfers.
(C) Instruction and encouragement to the
participant in ways to become more self-sufficient in advanced personal care
may be a component of all tasks as described above; however, instruction and
encouragement in and of themselves do not constitute a task.
(D) Advanced Personal Care Plans. Plans of
care which include advanced personal care services must be developed by the
provider agency RN in collaboration with state agency staff or its
designee.
(E) Criteria for
Providers of Advanced Personal Care Services. Providers of advanced personal
care must meet all criteria for providers of personal care services described
in section (3) of this rule. Providers must sign an addendum to their Title XIX
Personal Care Provider Agreement and must possess a valid contract with the
Missouri Medicaid Audit and Compliance Unit to provide Title XX services
including advanced personal care services. Residential care facilities wishing
to provide advanced personal care services to the eligible residents of their
own facility only may do so with a signed addendum to their Title XIX Personal
Care Provider Agreement.
1. All advanced
personal care aides employed by the provider must be an LPN or a certified
nurse assistant; or a competency-evaluated home health aide having completed
both written and demonstration portions of the test required by the Missouri
Department of Health and Senior Services and
42 CFR
484.80; or have successfully completed
personal care aide training. In addition, advanced personal care aides may not
be related to the participant to whom they provide personal care, as defined in
paragraph (3)(K)3. of this rule.
2.
Personal care providers are required to provide training to advanced personal
care aides, in addition to the orientation training described in section (3) of
this rule. The additional training shall consist of a minimum of six (6) hours
and must be completed prior to the provision of any advanced personal care
tasks. Providers may waive this six (6) hours of training if one (1) of the
following are met:
A. The proposed advanced
personal care (APC) aide is an LPN or CNA currently licensed or registered in
the state of Missouri; or
B. The
proposed advanced personal care aide has previously completed advanced personal
care training from a Medicaid or Social Services Block Grant (SSBG) in-home
provider agency, and that same personal care aide has been employed by a
Medicaid or SSBG in-home provider agency as an advanced personal care aide
within the prior six (6) months.
3. Advanced personal care aides employed by
an RCF II are exempt from the training requirements defined in paragraphs
(5)(E)1. and 2. of this rule if they have completed the training requirements
described in subdivisions (9) and (10) of subsection 3 of section
198.073, RSMo, as
amended.
4. The additional advanced
personal care training must include, at a minimum, the following topics:
A. Observation of the participant and
reporting observation;
B.
Application of ointments/lotions to unbroken skin;
C. Manual assistance with oral
medications;
D. Prevention of
decubiti;
E. Bowel routines (rectal
suppositories, sphincter stimulation);
F. Enemas;
G. Personal care for persons with ostomies
and catheters;
H. Proper cleaning
of catheter bags;
I. Positioning
and support of the participant;
J.
Range of motion exercises;
K.
Application of nonsterile dressings to superficial skin breaks; and
L. Universal precaution procedures as defined
by the Centers for Disease Control and Prevention.
5. Advanced personal care tasks as specified
at (5)(B)1. through 9. shall not be assigned to or performed by any advanced
personal care aide who is not a licensed nurse until the aide has been fully
trained to perform the task, the RN, LPN or GN has personally observed
successful execution of the task and the RN, LPN, or GN has personally
certified this in the aide's personnel record. An LPN or GN observing the
execution of a task must be trained in the APC tasks and observed by the RN
supervisor for successful completion of each task, and the RN supervisor must
personally certify this in the LPN's or GN's personnel record. Only RN visits
necessary for task observation and certification in the home may be prior
authorized and billed to MO HealthNet Division as an authorized nurse visit, as
described in section (6) of this rule. RN task observation and certification in
a laboratory, or other non-home setting, may not be billed.
6. The RN, LPN, or GN may observe the
execution of any of the tasks in a participant's home or lab setting. However,
it is the responsibility of the provider to ensure the aide is properly trained
to execute tasks that may have variation from the lab setting to the
participant's home setting.
7. For
participants receiving advanced personal care services, it is required that
on-site RN visits be conducted at intervals of no greater than six (6) months.
During these visits, the RN must conduct and document an evaluation of the
participant's condition, continued eligibility for the program, and the
adequacy of the care plan. The RN must sign the evaluation and the provider
shall maintain documentation of the evaluation in the participant's record. The
evaluation must be produced upon request of the Division of Senior and
Disability Services or the Missouri Medicaid Audit and Compliance
Unit.
(F) Reimbursement.
1. Payment for advanced personal care
services will be made in accordance with the fee per unit of service as defined
and determined by the MO HealthNet Division. The fee per unit (fifteen (15)
minutes) of service will be based on the determination of the state agency of
the reasonable cost of providing the covered services on a statewide basis and
within the mandatory maximum payment limitations.
2. Conditions for reimbursement.
A. An advanced personal care plan is
required. It is to be developed by the Department of Health and Senior Services
or its designee in cooperation with the provider agency's RN. The provider
agency is responsible for obtaining the participant's physician's approval for
the plan.
B. The total monthly
payment for advanced personal care services as described in this section and
for personal care services as described in sections (1)-(7) of this rule made
on behalf of an individual cannot exceed one hundred percent (100%) of the
average statewide monthly cost for care in an NF as defined in
13 CSR
70-10.010(4)(Q) (excluding ICFs/
IID).
C. The average monthly cost
to the state for care in an NF, as defined in
13 CSR
70-10.010(4)(Q) (excluding ICF/ IID),
will be established in the month of May of each state fiscal year, which will
become effective on July 1 of the following state fiscal year.
D. Payment will be made on the lower of the
established rate per service unit or the provider's billed charges.
3. Rates will be established for
personal care services in private homes, licensed RCFs I and II, and
ALFs.
(6) Separately Authorized Nurses Visits.
(A) The
provisions of paragraph (3)(H)3. notwithstanding, reimbursement will be made
for visits by nurse to particular participants with special needs when the
visits are prior authorized by the Department of Health and Senior Services or
its designee. Providers of personal care services must have the capacity to
provide these authorized nurse visits in addition to the nonauthorized nurse
visits required by subsection (3)(J). Anytime an authorized nurse visit is
made, the nurse shall also, in addition to other duties, evaluate the adequacy
of the plan of care, including a review of the plan of care with the
participant.
(B) To be eligible to
receive the authorized nurse visit, the participant must-
1. Be determined eligible for Title XIX
benefits from the Family Support Division and found to be in need of personal
care services as an alternative to institutional care as specified in section
(1) of this rule;
2. Have no other
person available who could and would provide the services;
3. Require one (1) or more of the services
described in subsection (6)(D) as an alternative to institutionalized care;
and
4. Meet any additional criteria
of need set forth in subsection (6)(D).
(C) The services provided during the
authorized nurse visit shall not include any service which the participant
would be eligible to receive under either the Medicare (Title XVIII) or
Medicaid (Title XIX) Home Health programs. The services listed in subsection
(6)(D) do not qualify, by themselves, for reimbursement under either program.
However, should a participant otherwise be eligible for home health services,
then those services listed in paragraphs (6)(D)1.-4. will be provided by the
home health agency and not under the Personal Care Program.
(D) The services of the nurse shall provide
increased supervision of the aide, assessment of the participant's health, and
the suitability of the care plan to meet the participant's needs. These
services also shall include any referral or follow-up action indicated by the
nurse's assessment. These services, in addition, must include one (1) or more
of the following where appropriate to the needs of the participant and
authorized by the Department of Health and Senior Services or its designee:
1. The RN may fill insulin syringes in
advance per manufacturer's instructions for participants with diabetes who can
self-inject the medication but cannot fill their own syringe. This service
would include monitoring the participant's continued ability to self-administer
the insulin;
2. The RN may set up
oral medications in divided daily compartments for a participant who
self-administers prescribed medications but needs assistance and monitoring due
to a minimal level of disorientation or confusion;
3. The RN may monitor a participant's skin
condition when a participant is at risk of skin breakdown due to immobility,
incontinency, or both;
4. The RN
may provide nail care for a participant with diabetes or other medically
contraindicating conditions if the participant is unable to perform this
task;
5. The RN will be authorized
to visit all personal care participants who also receive advanced personal care
as described in section (4) of this rule, on a monthly basis, to evaluate the
adequacy of the authorized services to meet the needs and conditions of the
participant and to assess the advanced personal care aide's ability to carry
out the authorized services;
6. The
RN may provide on-the-job training to advanced personal care aides as described
in paragraph (5)(E)6. of this rule;
7. The visits authorized under section (6)
may be carried out by an LPN or GN, if under the direction of an RN;
or
8. The RN may be authorized to
provide other services in other situations, subject to the conditions set forth
in subsection (6)(C).
(E) Payment for the authorized nurse visit
will be made in accordance with the fee per unit of service as defined and
determined by the MO HealthNet Division.
1. A
unit of service is the visit. No minimum or maximum time is required to
constitute a visit.
2. The maximum
number of units which a participant can receive is twenty-six (26) within a
six- (6-) month period of time. The cost of the nurse visits are not included
in the spending cap set forth in paragraph (4) (B)2. but must be included in
the spending cap specified at subparagraph (5)(F)2.B.
(F) Documentation of the authorized nurse
visit shall include written notes and observations. These will be maintained in
the participant's file. In addition, notes of any verbal communication and
copies of any written communications with the participant's physician or other
health care professional concerning the care of that participant also will be
maintained in the participant's file.
*Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004; 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991; and 208.201, RSMo 1987.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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