Mo. Code Regs. tit. 19 § 15-8.100

Current through Register Vol. 49, No. 21, November 1, 2024.

Section 19 CSR 15-8.100 - Definitions

PURPOSE: This rule defines terms used in establishing procedures for the provision of consumer-directed services under the Department of Health and Senior Services to eligible consumers through eligible vendors, subject to legislative appropriations.

(1) As used in this rule and other rules established for consumer-directed services (CDS), except as otherwise required for the context, the following terms shall have the meanings ascribed:

(A) Adjusted gross income. The amount reported to the Internal Revenue Service (IRS) as adjusted gross income on the previous calendar year's income tax return for the consumer and the consumer's spouse;

(B) Assets. Any tangible, real, or personal property as would be reported to the Department of Social Services (DSS), Family Support Division (FSD) for the purpose of determining eligibility for Medicaid;

(C) Consumer. A physically disabled person determined by the Department of Health and Senior Services (DHSS) to be eligible to receive consumer-directed services (CDS). Consumer does not include any individual with a legal limitation of his or her ability to make decisions, including the appointment of a guardian or conservator, or who has an effective power of attorney that authorizes another person to act as the agent or on behalf of the individual for any of the duties required by the CDS program;

(D) Consumer-directed. The hiring, training, supervising, and directing of the personal care attendant (attendant) by the physically disabled person;

(E) Consumer-directed services (CDS). All services that are required or may be provided as part of the CDS program;

(F) Disability-related medical expenses. Any medical expense, as defined and approved by the IRS, that is directly related to the consumer's disability;

(G) Health care coverage. Any insurance policy that provides personal care assistance benefits;

(H) Income. Any income as would be reported to DSS/FSD for the purpose of determining eligibility for Medicaid;

(I) Live independently. To reside and perform routine tasks of daily living and activities of daily living and activities in the community in a noninstitutional or unsupervised residential setting;

(J) Non-Medicaid eligible (NME). Has been found by DSS/FSD not to be eligible to participate under guidelines established by the Medicaid state plan;

(K) Non-Medicaid eligible (NME) program. Financial assistance for CDS through eligible vendors for individuals who are NME consumers;

(L) Personal care assistance (PCA) services. Those routine tasks provided to meet the unmet needs required by a physically disabled person to enable him or her to live independently;

(M) Personal care attendant (attendant). A person, other than the consumer's spouse, who performs PCA services for a physically disabled person;

(N) Physically disabled. Loss of, or loss of use of, all or part of the neurological, muscular or skeletal functions of the body to the extent that person requires the assistance of another person to accomplish routine tasks;

(O) Routine tasks. Routine tasks and instrumental activities of daily living include, but are not limited to, the following:

1. Bowel and bladder elimination;

2. Dressing and undressing;

3. Moving into and out of bed;

4. Preparation and consumption of food and drink;

5. Bathing and grooming;

6. Shopping/transportation;

7. Maintenance and use of prostheses, aids, equipment and other similar devices; and/or

8. Ambulation, housekeeping, or other functions of daily living based on an independent living philosophy as specified in state law and regulation;

(P) Undue hardship. The result of a significantly difficult circumstance experienced by the disabled consumer that creates a situation of burden, risk or harm to the consumer. Undue hardship includes, but is not limited to, the following:

1. Loss of consumer's income;

2. Overall disintegration of the family;

3. Abuse and neglect;

4. Misuse of child labor; and/or

5. Presence of physical contraindication(s);

(Q) Unit of service. One unit equals fifteen (15) minutes;

(R) Unmet needs. Routine tasks and activities of daily living which cannot be reasonably met by members of the consumer's household or other current support systems without causing undue hardship; and

(S) Vendor. Any person, firm or corporation having a written agreement with DHSS to provide services, including monitoring and oversight of the attendant, orientation and training of the consumer, and fiscal conduit services necessary for delivery of CDS to physically disabled persons.

19 CSR 15-8.100

AUTHORITY: sections 208.900, 208.927 and 208.930, RSMo Supp. 2005.* This rule originally filed as 5 CSR 90-7.010. Original rule filed Jan. 10, 1985, effective May 13, 1985. Amended: Filed Aug. 1, 1988, effective Nov. 25, 1988. Emergency amendment filed Aug. 31, 1992, effective Sept. 10, 1992, expired Jan. 9, 1993. Amended: Filed Aug. 31, 1992, effective April 8, 1993. Amended: Filed May 31, 1994, effective Dec. 30, 1994. Amended: Filed Oct. 31, 1996, effective June 30, 1997. Amended: Filed June 28, 2001, effective Jan. 30, 2002. Amended: Filed Sept. 12, 2003, effective April 30, 2004. Moved to 19 CSR 15-8.100, effective Aug. 29, 2005. Emergency amendment filed Dec. 15, 2005, effective Dec. 25, 2005, expired June 23, 2006. Amended: Filed Dec. 15, 2005, effective July 30, 2006.

*Original authority: 208.900, RSMo 2005; 208.927, RSMo 2005; and 208.930, RSMo 2005.