Idaho Admin. Code r. 16.03.10.303

Current through September 2, 2024

Section 16.03.10.303 - PERSONAL CARE SERVICES: COVERAGE AND LIMITATIONS

01.Medical Care and Services. PCS services include medically-oriented tasks related to a participant's physical or functional requirements, as opposed to housekeeping or skilled nursing care, provided in the participant's home or personal residence. The provider must deliver at least one (1) of the following services:

a. Basic personal care and grooming to include bathing, care of the hair, assistance with clothing, and basic skin care;

b. Assistance with bladder or bowel requirements that may include helping the participant to and from the bathroom or assisting the participant with bedpan routines;

c. Assistance with food, nutrition, and diet activities including preparation of meals if incidental to medical need;

d. The continuation of active treatment training programs in the home setting to increase or maintain participant independence for the participant with developmental disabilities;

e. Assisting the participant with physician-ordered medications that are ordinarily self-administered, in accordance with IDAPA 24.34.01, "Rules of the Idaho Board of Nursing," Subsection 490.05;

f. Non-nasogastric gastrostomy tube feedings if authorized by BLTC prior to implementation and if the following requirements are met:

i. The task is not complex and can be safely performed in the given participant care situation;

ii. A Licensed Registered Nurse (RN) has assessed the participant's nursing care needs and has developed a written standardized procedure for gastrostomy tube feedings, individualized for the participant's characteristics and needs;

iii. Individuals to whom the procedure can be delegated are identified by name. The RN must provide proper instruction in the performance of the procedure, supervise a return demonstration of safe performance of the procedure, state in writing the strengths and weaknesses of the individual performing the procedure, and evaluate the performance of the procedure at least monthly;

iv. Any change in the participant's status or problem related to the procedure must be reported immediately to the RN;

v. The individualized procedure, the supervised performance of the procedure, and follow-up evaluation of the performance of the procedure must be documented in writing by the supervising RN and must be readily available for review, preferably with the participant's record; and

vi. Routine medication may be given by the personal assistant through the non-nasogastric tube if authorized by the supervising RN.

02.Non-Medical Care and Services. PCS services may also include non-medical tasks. In addition to performing at least one (1) of the services listed in Subsections 303.01.a. through 303.01.f. of this rule, the provider may also perform the following services, if no natural supports are available:

a. Incidental housekeeping services essential to the participant's comfort and health, including changing bed linens, rearranging furniture to enable the participant to move around more easily, laundry, and room cleaning incidental to the participant's treatment. Cleaning and laundry for any other occupant of the participant's residence are excluded.

b. Accompanying the participant to clinics, physicians' office visits or other trips that are reasonable for the purpose of medical diagnosis or treatment.

c. Shopping for groceries or other household items specifically required for the health and maintenance of the participant.

03.Place of Service Delivery. PCS may be provided in the participant's own home or personal residence. The participant's personal residence may be a Certified Family Home or a Residential Assisted Living Facility, or a PCS Family Alternate Care Home. The following living situations are specifically excluded as a personal residence:

a. Certified nursing facilities or hospitals.

b. Licensed Intermediate Care Facilities for Persons with Intellectual Disabilities (ICFs/IID).

c. A home that receives payment for specialized foster care, professional foster care or group foster care, as described in IDAPA 16.06.01, "Child and Family Services."

04.Type of Service Limitations. The provider is excluded from delivering the following services:

a. Irrigation or suctioning of any body cavities that require sterile procedures or the application of dressings involving prescription medication and aseptic techniques;

b. Insertion or sterile irrigation of catheters;

c. Injecting fluids into the veins, muscles or skin; and

d. Administering medication.

05.Participant Service Limitations.

a. Adults who receive PCS under the State Medicaid Plan option are limited to a maximum of sixteen (16) hours per week per participant.

b. Children who meet the necessity criteria for EPSDT services under IDAPA 16.03.09 "Medicaid Basic Plan Benefits," Section 882, may receive up to twenty-four (24) hours per day of PCS per child through the month of their twenty-first birthday.

06.Provider Coverage Limitations.

a. The provider must not bill for more time than was actually spent in service delivery.

b. No provider home, regardless of the number of providers in the home, may serve more than two (2) children who are authorized for eight (8) or more hours of PCS per day.

Idaho Admin. Code r. 16.03.10.303

Effective March 17, 2022