DAR File No. 39131

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-38

Personal Care Service

Notice of Proposed Rule

(Amendment)

DAR File No.: 39131
Filed: 02/09/2015 09:37:47 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to consolidate the scope of personal care services to the Medicaid provider manual.

Summary of the rule or change:

This amendment removes all provisions in the rule text and defers to the scope of services found in the Personal Care Utah Medicaid Provider Manual and in the Medicaid State Plan.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• 42 CFR 440.167
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because services provided to Medicaid recipients remain unaffected by this change.

local governments:

There is no impact to local governments because they do not fund or provide Medicaid services to Medicaid recipients.

small businesses:

There is no impact to small businesses because services provided to Medicaid recipients remain unaffected by this change.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to Medicaid providers and to Medicaid recipients because services provided to Medicaid recipients remain unaffected by this change.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid recipient because services provided remain unaffected by this change.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no impact on business because no requirements have been changed by the amendment.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/31/2015

This rule may become effective on:

04/07/2015

Authorized by:

David Patton, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-38. Personal Care Services.

R414-38-1. Introduction.

The Personal Care Services program provides a scope of services for Medicaid recipients in accordance with the Personal Care Utah Medicaid Provider Manual and Attachment 4.19-B of the Medicaid State Plan, as incorporated into Section R414-1-5.

[R414-38-1. Introduction and Authority.

Personal Care Service is an optional Medicaid Title XIX service, and is authorized by Section 1905(a)(18) of the Social Security Act and 42 CFR 440.170(f), 1992 ed., which are adopted and incorporated by reference.

 

R414-38-2. Definitions.

In addition to the definitions in R414-1, the following definitions also apply to this rule:

(1) "Home health agency" means a public agency or private organization which is licensed by the Department of Health under authority of Title 26, Chapter 21.

(2) "Relative" means a spouse, parent, step-parent, son, daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person denoted by the prefix "grand" or "great", or the spouse of any of the persons specified in this definition, even if the marriage has been terminated by death or dissolution.

 

R414-38-3. Client Eligibility Requirements.

Personal care service is available to categorically and medically needy individuals who meet the following conditions:

(1) The client is non-bedbound.

(2) The client is unable to perform two or more of the following personal care tasks:

(a) self-administration of medications due to memory lapse;

(b) body waste elimination, including the use of a urinal, commode, or bedpan;

(c) bathing or showering, including getting in or out of the tub or shower;

(d) skin care;

(e) ambulation, including use of cane, crutches, walker, wheelchair, or other assistive device;

(f) personal grooming, including oral care, hair care, shaving (with electric razor), dressing, and nail care;

(g) nutritional requirements, including meal planning, preparation, cleanup, and motivation to eat.

(3) The client's family is unable or unwilling to provide the extent of personal care service needed.

(4) The client needs personal care to:

(a) maintain the capacity to function, retard disease progression, or prevent regression and complications; or

(b) achieve satisfactory level of comfort and dignity during terminal stages of an illness; or

(c) receive assistance while recovering from an acute condition.

 

R414-38-4. Program Access Requirements.

(1) A physician must prescribe the necessary personal care services.

(2) Only a home health agency licensed in accordance with Title 26, Chapter 21, may provide personal care services.

(3) Only a personal care aide or home health aide (performing only personal care level tasks) who has obtained a certificate of completion from the State Office of Education, or a licensed practical nurse, or a registered nurse, may provide the personal care services.

(4) A licensed registered nurse must supervise the providing of personal care services.

(5) Personal care services are a covered service only for clients who receive these services in their residence, not in an institution.

(6) Initially, a licensed registered nurse must complete a personal care assessment to assess the client's functional level, the adaptability of the client's residence to the providing of personal care, and to identify family support systems or individuals willing to assume the responsibility for care when the client is unable to do so. A licensed registered nurse must also complete a personal care assessment at least at the required time of recertification (approximately every six months), or sooner if the client's condition warrants it.

 

R414-38-5. Service Coverage.

(1) Services provided by the personal care provider may include:

(a) reminding the client to take medication, and observing the client who is able to self-administer medication;

(b) providing minimal assistance with, or supervision of, bathing and personal hygiene including shampoo and hair care, skin care according to the client's plan of care, and shaving (with electric razor only);

(c) providing nail care as outlined in the client's plan of care;

(d) providing meal service, including special diets, meal planning, preparation, feeding if necessary, and cleanup;

(e) providing oral hygiene, including tooth or denture care;

(f) assisting with ambulation, including arm support, use of cane, crutches, walker, wheelchair, or other assistive device;

(g) assisting with bladder and bowel requirements or problems, including helping the client to and from the bathroom, or assisting non-bedbound clients with bedpan routines, but excluding assistance with enemas, suppositories, or ostomy care;

(h) making brief occasional trips outside the home for the client to receive medical examination or treatment, or for shopping to meet the client's health care or nutritional needs;

(i) taking proper measures for the client's safety and comfort, including good hand washing techniques, proper disposal of body waste, and explanation and application of smoking precautions;

(j) administering emergency first aid;

(k) observing and reporting significant changes in the client or the home environment;

(l) performing household services (if related to a medical need) as are essential to the client's health and comfort in the home, e.g., changing of bed linens, or rearranging furniture to enable the client to move about more easily in the home.

(2) Medicaid may not reimburse the home health agency for personal care services provided by the client's relatives.

(3) Providers may not provide personal care services for a client on the same day that Medicaid home health aide services are provided.

(4) Personal care services are limited to 60 hours per month.

 

R414-38-6. Plan of Care.

(1) The attending physician must write the orders on which the plan of care is established and certify the need for personal care services.

(2) The home health agency staff must develop the plan of care, in consultation with the attending physician and based upon the physician's orders, and deliver the personal care services according to this plan.

(3) The home health agency's licensed registered nurse must sign the plan of care, and incorporate it into the client's permanent record.

(4) The home health agency's licensed registered nurse must record and sign all of the physician's oral orders, and obtain the physician's signature on these orders.

(5) The home health agency staff must alert the attending physician promptly of any changes in the client's condition that suggest a need to alter the plan of care.

 

R414-38-7. Recertification.

The attending physician must review the total plan of care as often as the severity of the client's functional limitation requires, or at least once every six months. The home health agency's licensed registered nurse must sign this review.

 

R414-38-8. Supervision.

(1) The licensed registered nurse must make a supervisory visit to the client's residence at least once every two months, to assure that care is adequate and provided according to written instructions.

(2) The licensed registered nurse may make this visit either when the personal care aide is present to observe and assist, or when the personal care aide is absent, to assess relationships and determine whether goals are being met.]

 

KEY: [m]Medicaid

Date of Enactment or Last Substantive Amendment: [1993]2015

Notice of Continuation: March 7, 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3