DAR File No. 39131
This rule was published in the March 1, 2015, issue (Vol. 2015, No. 5) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Personal Care Service
Notice of Proposed Rule
DAR File No.: 39131
Filed: 02/09/2015 09:37:47 AM
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.
There is no impact to local governments because they do not fund or provide Medicaid services to Medicaid recipients.
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@example.com
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:
This rule may become effective on:
David Patton, Executive Director
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
R414-38. Personal Care Service.
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.
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
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
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
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.
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
(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
Date of Enactment or Last Substantive Amendment: [
Notice of Continuation: March 7, 2012
Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3
More information about a Notice of Proposed Rule is available online.
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2015/b20150301.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at firstname.lastname@example.org. For questions about the rulemaking process, please contact the Division of Administrative Rules.