Idaho Admin. Code r. 16.03.10.304

Current through September 2, 2024

Section 16.03.10.304 - PERSONAL CARE SERVICES: PROCEDURAL REQUIREMENTS

01.Service Delivery Based on Plan of Care or NSA. All PCS services are provided based on a written plan of care or a negotiated service agreement (NSA). The requirements for the NSA for participants in Residential Assisted Living Facilities are under IDAPA 16.03.22, "Residential Assisted Living Facilities." The requirements for the NSA for participants in CFH are described in IDAPA 16.03.19, "Certified Family Homes." The Personal Assistance Agency and the participant who lives in their own home are responsible to prepare the plan of care.

a. The plan of care for participants who live in their own homes or in a PCS Family Alternate Care Home is based on:

i. The physician's or authorized provider's information, if applicable;

ii. The results of the UAI for adults, the children's PCS assessment and, if applicable, the QIDP's assessment and observations of the participant; and

iii. Information obtained from the participant.

b. The plan of care must include all aspects of medical and non-medical care that the provider needs to perform, including the amount, type, and frequency of necessary services.

c. The plan of care must be updated based upon treatment results or a change(s) in the participant's needs, or both, but at least annually.

d. The plan of care or NSA must meet the person-centered planning requirements under these rules.

02.Service Supervision. The delivery of PCS is overseen by an RN or Qualified Intellectual Disabilities Professional (QIDP). The Department will identify the need for supervision.

a. Oversight must include the following:

i. Assistance in the development of the written plan of care;

ii. Review of the treatment given by the personal assistant through a review of the participant's PCS record as maintained by the provider;

iii. Re-evaluation of the plan of care as necessary; and

iv. Immediate notification of the guardian, emergency contact, or family members of any significant changes in the participant's physical condition or response to the services delivered.

b. All participants who are developmentally disabled, other than those with only a physical disability as determined by the Department, may receive oversight by a QIDP as defined in 42 CFR 483.430. Oversight must include:

i. Assistance in the development of the plan of care for those aspects of active treatment that are provided in the participant's personal residence by the personal assistant;

ii. Review of the care or training programs given by the personal assistant through a review of the participant's PCS record as maintained by the provider and through on-site interviews with the participant;

iii. Re-evaluation of the plan of care as necessary, but at least annually; and

iv. An on-site visit to the participant to evaluate any change of condition when requested by the personal assistant, the Personal Assistance Agency, the nurse supervisor, the service coordinator, or the participant.

03.Prior Authorization Requirements. All PCS services must be prior authorized by the Department. Authorizations will be based on the information from:

a. The children's PCS assessment or UAI for adults;

b. The individual service plan developed by the Personal Assistance Agency; and

c. Any other medical information that supports the medical need.

04.Record Requirements for a Participant's Home. PCS records must be maintained for all participants receiving PCS in their own homes or in a PCS Family Alternate Care Home.

a. PCS provider must maintain documentation of every visit made to the participant's home and record the following information:

i. Date and time of visit;

ii. Length of visit;

iii. Services provided during the visit; and

iv. Documentation of any changes noted in the participant's condition or any deviations from the plan of care.

b. The participant or legal guardian must verify services were delivered by signing the documentation.

c. The Plan of Care must be signed by the provider indicating that they will deliver services according to the authorized service plan and consistent with home and community-based requirements.

d. A copy of the information required in Subsection 304.04 of this rule must be maintained and available in a format accessible to the participant in their home. Failure to maintain this information may result in recovery of funds paid for undocumented services.

e. Electronic Visit Verification (EVV) systems. as described in Section 041 of these rules will not take the place of documentation requirements of Subsection 304.04 of this rule but may be used to generate documentation retained in the participant's home.

05.PCS Record Requirements for a Participant in a Residential Assisted Living Facility (RALF) or CFH. The PCS records must be maintained on all participants who receive PCS in a RALF or CFH.

a. Additional PCS record requirements for RALF participants are under IDAPA 16.03.22, "Residential Assisted Living Facilities."

b. Additional PCS record requirements for CFH participants are under IDAPA 16.03.19, "Certified Family Homes."

c. The participant or legal guardian must sign the NSA agreeing to the delivery of services as specified.

d. The NSA must be signed by the supervisory nurse or agency personnel responsible for developing the NSA with the participant and must indicate that they will deliver services according to the authorized NSA and consistent with home and community-based requirements.

06.Provider Responsibility for Notification. The Personal Assistance Agency is responsible to notify the Department and the physician or authorized provider when any significant changes in the participant's condition are noted during service delivery. This notification must be documented in the Personal Assistance Agency record.

Idaho Admin. Code r. 16.03.10.304

Effective July 1, 2024