California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51350 - Personal Care Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Personal care services as specified in section
					 51183 are provided when authorized
					 by the staff of a designated county department based on the state approved
					 Uniformity Assessment tool. To the extent not inconsistent with statutes and
					 regulations governing the Medi-Cal program, the needs assessment process shall
					 be governed by the Department of Social Services' Manual of Policies and
					 Procedures Sections
					 30-760,
					 30-761, and
					 30-763.
(b) Personal care services may be provided
					 only to a categorically needy beneficiary as defined in Welfare and
					 Institutions Code, Section
					 14050.1,
					 who has a chronic, disabling condition that causes functional impairment that
					 is expected to last at least 12 consecutive months or that is expected to
					 result in death within 12 months and who is unable to remain safely at home
					 without the services. The services shall be provided in the beneficiary's home
					 or other locations as may be authorized by the Director subject to federal
					 approval. Personal care services authorized shall not exceed 283 hours in a
					 calendar month.
(c) Personal care
					 services will be prescribed by a physician. The beneficiary's medical necessity
					 for personal care shall be certified by a licensed physician. Physician
					 certification shall be done annually.
(d) Registered nurse supervision consists of
					 review of the service plan and provision of supportive intervention. The nurse
					 shall review each case record at least every twelve months. The nurse shall
					 make home visits to evaluate the beneficiary's condition and the effectiveness
					 of personal care services based on review of the case record or whenever
					 determined as necessary by staff of a designated county department. If
					 appropriate, the nurse shall arrange for medical follow-up. All nurse
					 supervision activities shall be documented and signed in the case record of the
					 beneficiary.
(e) Paramedical
					 services when included in the personal care plan of treatment must be ordered
					 by a licensed health care professional lawfully authorized by the State. The
					 order shall include a statement of informed consent saying that the beneficiary
					 has been informed of the potential risks arising from receipt of such services.
					 The statement of informed consent shall be signed and dated by the beneficiary,
					 the personal representative of the beneficiary, or in the case of a minor, the
					 legal parent or guardian.
(f)
					 Grooming shall exclude cutting with scissors or clipping toenails.
(g) Menstrual care is limited to external
					 application of sanitary napkin and cleaning. Catheter insertion, ostomy
					 irrigation and bowel program are not bowel or bladder care but
					 paramedical.
(h) Repositioning,
					 transfer skin care, and range of motion exercises have the following
					 limitations:
(1) Includes moving from one
					 sitting or lying position to another sitting or lying position; e.g., from bed
					 to or from a wheelchair, or sofa, coming to a standing position and/or rubbing
					 skin and repositioning to promote circulation and prevent skin breakdown.
					 However, if decubiti have developed, the need for skin and wound care is a
					 paramedical service.
(2) Range of
					 motion exercises shall be limited to the general supervision of exercises which
					 have been taught to the beneficiary by a licensed therapist or other health
					 care professional to restore mobility restricted because of the injury, disuse
					 or disease. Range of motion exercises shall be limited to maintenance therapy
					 when the specialized knowledge or judgment of a qualified therapist is not
					 required and the exercises are consistent with the beneficiary's capacity and
					 tolerance. Such exercises shall include the carrying out of maintenance
					 programs. i.e., the performance of the repetitive exercises required to
					 maintain function, improve gait, maintain strength or endurance; passive
					 exercises to maintain range of motion in paralyzed extremities; and assistive
					 walking.