Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-025 - PERSCARE-2-11 amendments to the Personal Care Manual

Current through Register Vol. 49, No. 6, June, 2024
Section II
Personal Care
203.000
IndependentChoices
IndependentChoices began as a Cash and Counseling Demonstration
				and Evaluation Project. IndependentChoices seeks to increase the opportunity
				for consumer direction and control for Medicaid beneficiaries receiving or
				needing personal care by offering a cash allowance and counseling services in
				place of traditionally provided personal care. IndependentChoices and how it
				related to the Personal Care State Plan program is referenced in this manual
				and the IndependentChoices provider manual.
213.000
Scope of the Program
A. Personal care services are primarily based
			 on the assessed physical dependency need for "hands-on" services with the
			 following activities of daily living (ADL): eating, bathing, dressing, personal
			 hygiene, toileting and ambulating. Hands-on assistance in at least one of these
			 areas is required. This type of assistance is provided by a personal care aide
			 based on a beneficiary's physical dependency needs (as opposed to purely
			 housekeeping services). A plan of care is developed through the assessment
			 process and is based on a beneficiary's dependency in at least one of the
			 above-listed activities of daily living. While not a part of the eligibility
			 criteria, the need for assistance with other tasks and IADLs (Instrumental
			 Activities of Daily Living) are considered in the assessment. Both types of
			 assistance are considered when determining the amount of overall personal care
			 assistance authorized. Routines or IADLs include meal preparation, incidental
			 housekeeping, laundry, medication assistance, etc. These tasks are also defined
			 and described in this section of this provider manual.
B. The tasks the aide performs are similar to
			 those that a nurse's aide would normally perform if the beneficiary were in a
			 hospital or nursing facility.
C.
			 Personal care services may be similar to or overlap some services that home
			 health aides furnish.
1. Home health aides may
			 provide personal care services in the home under the home health
			 benefit.
2. Skilled services that
			 only a health professional may perform are not considered personal care
			 services.
D. Personal
			 care services, as described in this manual, are furnished to an individual who
			 is not an inpatient or resident of a hospital, nursing facility, intermediate
			 care facility for persons with intellectual disabilities, or institution for
			 mental disease that are:
1. Authorized for the
			 individual by a physician in accordance with a plan of treatment or otherwise
			 authorized for the individual in accordance with a service plan approved by the
			 State, e.g., ElderChoices, IndependentChoices;
2. Furnished in the beneficiary's home, and
			 at the State's option, in another location.
3. Provided by an individual qualified to
			 provide such services and who is not a member of the beneficiary's family. See
			 Section 222.100, part A, for the
			 definition of "a member of the beneficiary's family".
E. Personal care for Medicaid-eligible
			 individuals under the age of 21 requires prior authorization. See Sections
			 240.000 through
			 246.000.
F. Only Class A Home Health agencies, Class B
			 Home Health agencies and Private Care agencies may provide personal care in all
			 State-approved locations. Residential care facilities, public schools,
			 education service cooperatives and DDS facilities may provide personal care
			 only within their own facilities. School districts and education service
			 cooperatives may not provide personal care in the beneficiary's home unless the
			 home is deemed a public school in accordance with the Arkansas Department of
			 Education guidelines set forth in Section
			 213.520.
213.310
I
			 ndependentChoices Program, Title XIX State Plan Program
IndependentChoices is operated by the Division of Aging and
				Adult Services (DAAS) and operates under the authority of the Title XIX State
				Plan with the Division of Medical Services responsible for administrative and
				financial authority.
IndependentChoices offers an opportunity to Medicaid-eligible
				adults with disabilities (age 18 and older) and the elderly (age 65 and older)
				to direct their personal care. The beneficiary chooses a cash allowance in lieu
				of agency personal care services. IndependentChoices provides qualifying
				beneficiaries with counseling and training to assist them with information to
				fulfill their role as an employer. The beneficiary as the employer will hire,
				train, supervise and, if necessary, terminate the services of their employee.
				In addition to hiring an employee, the beneficiary may use part of their budget
				to purchase goods and services that lessen their physical dependency needs. In
				addition to counseling support services, participants may receive Financial
				Management Services (FMS) from a DMS contracted provider. The FMS provider will
				assist the participant by processing timesheets, withholding and reporting
				State and Federal taxes, issuing a W-2 to all employees who meet the tax
				threshold and refunding taxes to the participant and the employee when the
				threshold was not met. The FMS provider also coordinates the accuracy and
				coordination of the forms used to establish the Medicaid beneficiary as an
				employer and to employ a worker. The FMS provider representing the Medicaid
				beneficiary will obtain permissions and execute an IRS Form 2678 to act as the
				beneficiary's agent.
NOTE: The IndependentChoices Program is required to
				follow the rules and regulations of the State Plan approved Personal Care
				Program, unless stated otherwise in this manual.
214.000
The Physician's Role in
			 Personal Care
A. A personal care
			 service plan is designed to direct an appropriate amount of individual
			 assistance to a beneficiary's physical dependency needs.
B. The physician is essential to the
			 determination of what constitutes an appropriate amount of assistance.
1. The physician evaluates the relationships
			 among the beneficiary's health status, physical dependency needs and daily
			 routines and activities.
2. The
			 physician helps the beneficiary and the personal care provider design an
			 individualized plan to address the beneficiary's individual physical
			 dependencies.
C.
			 Personal care services may commence on or after the date of the beneficiary's
			 attending physician's signature on an individualized personal care service
			 plan, authorizing the services.
1. The
			 beneficiary's attending physician is responsible for the decision to authorize
			 personal care services.
2. The
			 beneficiary's attending physician must be the beneficiary's primary care
			 physician (PCP) unless the beneficiary is exempt from PCP requirements.
a. In this manual, "physician" and "attending
			 physician" both mean "the physician primarily responsible for the medical
			 management of the patient," unless they are otherwise defined in a particular
			 context.
b. "Primary care
			 physician" and "PCP" are explained in Section I of this manual.
214.100
Physician Authorization of Personal Care Services
A. An individualized personal care service
			 plan signed (original signature) and dated by the beneficiary's PCP or
			 attending physician, constitutes the physician's personal care authorization.
			 Services may continue uninterrupted as long as the services are reauthorized
			 prior to the expiration of the current service plan end date. The uninterrupted
			 continuation is also dependent upon the physician having a face-to-face visit
			 with the beneficiary within 60 days prior to the date that the physician signs
			 the service plan. If the physician informs that he or she had not seen the
			 beneficiary in the past 60 days, the beneficiary is expected to have the
			 face-to-face visit prior to the beginning of the new service plan begin date.
			 Should this not occur, personal care services must be discontinued until the
			 face-to-face visit occurs unless for health and safety reasons the physician
			 requests in writing that personal care services continue and informs of the
			 date the face-to-face visit is scheduled. Should the services be discontinued,
			 the requesting provider is required to resubmit page 6 of the DMS-618 to the
			 physician asking that the physician make a correction to the date field and
			 initial the date services are reauthorized per the most recent face-to-face
			 visit. When services are interrupted, the corrected date represents the new
			 begin date of the service plan.
1. The
			 attending physician and the beneficiary must have a face-to-face visit before
			 the physician may authorize personal care services, unless the physician has
			 seen the beneficiary within the 60 days preceding the beginning date of service
			 established in the proposed service plan or 60 days prior to the date the
			 physician signs the DMS-618.
2. The
			 attending physician must review the assessment and service plan to ensure that
			 the personal care aide's assigned tasks appropriately address the beneficiary's
			 individual physical dependency needs.
3. Based on the assessment and the
			 physician's medical evaluation, the attending physician must authorize only
			 individualized personal care services that constitute medically necessary
			 assistance with the beneficiary's physical dependency needs in the
			 beneficiary's home or other authorized locations rather than in an
			 institution.
B. The
			 personal care service plan authorized by the physician must specify the
			 following items.
1. The date services are to
			 begin (may not be earlier than the date of the physician's
			 signature.)
2. The duration of need
			 for services
3. The expected
			 results of the services
C. Personal care services may not begin
			 initially before the date the beneficiary's attending physician signs the
			 individualized personal care service plan.
D. Services may not commence before the
			 beginning date of service established by the authorized service plan.
E. The physician may change the frequency,
			 scope or duration of service in the service plan.
F. The physician may add to, delete from or
			 otherwise modify the service plan.
G. The physician's authorization of the
			 service plan must be by dated original signature only. A stamp or signature
			 initialed by a
locum tenens
is the only acceptable substitute
			 for an original signature by the attending physician.
H. The physician must date and sign or
			 initial any revisions to the service plan, as well as any attachments he or she
			 adds to the service plan.
I. The
			 physician must maintain a copy of the signed service plan and signed copies of
			 any subsequent authorized service plan revisions with the beneficiary's
			 permanent medical record.
214.110
The Physician's Notification of
			 Service Plan Authorization
The physician may communicate the authorization of a service
				plan by telephone, fax or e-mail to expedite service delivery.
A. If the service plan is transmitted via
			 fax, the facsimile copy of the physician's original signature satisfies the
			 "original signature" requirement (see Section 214.100, part G). The physician
			 must maintain the original document with the original signature(s) in his or
			 her files.
B. If the service plan
			 is communicated by telephone, the physician must forward the completed
			 authorized service plan with original signature and authorization date to the
			 personal care provider no later than 14 working days following the authorized
			 beginning date of personal care service.
NOTE: Throughout this manual, it is emphasized that
				services may not begin until the date of the physician's signature authorizing
				services. When services begin based on a
verbal
				authorization
from the physician, and a written authorization with
				the physician's signature is received within the 14 day timeframe, the
				authorization must clearly state the date services were authorized based on the
				verbal order. Rarely, if ever, will the date of the verbal order and the date
				of the written order be the same, however, the authorization date must be
				clearly documented and linked to the verbal order if services begin prior to
				the date of the physician's signature.
214.200
Service Plan Review and Renewal
A. A personal care service plan
			 terminates six (6) months after its initial or revised beginning date of
			 service, unless described otherwise in this section. See
NOTE
below.
1. The beneficiary's physician must
			 review the service plan no less often than every six months, unless described
			 otherwise in this section. See
NOTE
below.
2. Upon completion of the six-month review,
			 the physician may authorize continued personal care services, either unchanged
			 or with modifications; or the physician may order that services
			 cease.
B. Personal care
			 services may not continue past the six-month anniversary of an initial or
			 revised beginning date of service until the beneficiary's physician authorizes
			 a revised service plan or renews the authorization of an existing service plan.
NOTE: Under specific circumstances, a service plan may be
				authorized for more
than six (6) months, not to exceed one year. If the
				physician's authorization for personal care services is based on a CHRONIC
				CONDITION that will not improve within the next six (6) months, the service
				plan may be authorized for more than six (6) months, not to exceed one year.
				The physician must sign the service plan and documentation must be included on
				the service plan verifying the chronic condition and the lack of expected
				improvement over the length of the service plan.
NOTE: An advanced practice nurse (APN) enrolled in the
				Arkansas Medicaid Program seeing patients in a Rural Health Clinic or Federally
				Qualified Health Center enrolled in the Arkansas Medicaid Program as an RHC or
				FQHC may sign the personal care service plan/order if practicing within an
				environment for which his/her certification applies and within the scope
				of
his/her certification. No MD signature is required in
				addition to the APN's signature unless required by their license and/or
				certification.
214.300
Authorization of ElderChoices
			 Plan of Care and Personal Care
Service Plan
The DAAS RN is responsible for developing an ElderChoices Plan
				of Care that includes both waiver and non-waiver services. Once developed, the
				Plan of Care is signed by the DAAS RN authorizing the services listed.
The signed ElderChoices Plan of Care will suffice as the "
				Personal Care Authorization" for services required in the Personal Care
				Program. The signature of the DAAS RN on the ElderChoices Plan of Care simply
				replaces the need for the physician's signature authorizing personal care
				services. The personal care service plan, developed by the Personal Care
				provider, is still required.
As the ElderChoices Plan of Care is effective for one year,
				once signed by the DAAS RN; the authorization for personal care services, when
				included on the ElderChoices Plan of Care, will be for one year from the date
				of the DAAS RN's signature, unless revised by the DAAS RN or the personal care
				service plan needs to be revised, whichever occurs first. If personal care
				services continue unchanged as authorized on the ElderChoices Plan of Care, a
				new service plan is not required at the 6-month interval.
NOTE: For ElderChoices participants who receive personal
				care through traditional agency services or have chosen to receive their
				personal care services through the IndependentChoices Program, the ElderChoices
				plan of care, signed by a DAAS RN, will serve as the authorization for personal
				care services for one year from the date of the DAAS RN's signature, as
				described above.
The responsibility of developing a personal care service plan
				is not placed with the DAAS RN. The personal care provider is still required to
				complete a service plan, as described in the Arkansas Medicaid Personal Care
				Provider Manual.
The Arkansas Medicaid Program waives no other Personal Care
				Program requirements with regard to personal care service plan authorizations
				obtained by DAAS RNs.
214.310
Development of ElderChoices
			 Plan of Care
If personal care services are not currently being provided when
				the DAAS RN develops the ElderChoices Plan of Care, the DAAS RN will determine
				if personal care services are needed. If so, the service, amount, frequency,
				duration and the recipient's provider of choice will be included on the
				ElderChoices Plan of Care. A copy of the ElderChoices Plan of Care and a Start
				of Care form (AAS-9510) will be forwarded to the personal care provider, as is
				current practice for waiver services. The Start of Care form must be returned
				to the DAAS RN within 10 working days from mailing or action may be taken by
				the DAAS RN to secure another personal care provider or modify the ElderChoices
				Plan of Care. (The ElderChoices Plan of Care is dated the date it is mailed.)
				Before taking action to secure another provider or modifying the Plan of Care,
				the applicant and/or family members will be contacted to discuss possible
				alternatives. Communications related to participation in the IndependentChoices
				program will be conveyed electronically through "tasks" communicated through
				Med Compass software, a new data system used to help manage waiver and
				IndependentChoices services.
This Plan of Care supersedes any other Plan of Care that may
				have been previously developed by another Medicaid provider for the applicant.
				The ElderChoices Plan of Care must include all appropriate ElderChoices
				services and certain non-waiver services appropriate for the applicant, such as
				Personal Care.
An agency providing services to an ElderChoices beneficiary
				must report these services to the DAAS RN. The services being provided to the
				ElderChoices beneficiary must be included on the ElderChoices Plan of Care.
				Prior to beginning services or revising services provided to an ElderChoices
				beneficiary, contact the DAAS RN so the Plan of Care is properly revised and
				approved. Please report all changes in services and changes in the ElderChoices
				beneficiary's circumstances to the DAAS RN immediately upon learning of the
				change. Certain services provided to an ElderChoices beneficiary that are not
				included on the ElderChoices Plan of Care may be subject to recoupment by the
				Medicaid Program.
If the DAAS RN is aware that personal care services are
				currently being provided when the ElderChoices Plan of Care is developed, the
				DAAS RN will contact the personal care provider to verify the current order and
				amount of personal care services in place If requested verbally, the request
				must be documented in the ElderChoices nurse narrative. It is the personal care
				provider's responsibility to provide the requested information to the DAAS RN
				immediately upon receipt of the request. If a copy is not received within 10
				working days of the request, the DAAS RN will process the ElderChoices Plan of
				Care, as developed by the DAAS RN.
NOTE: It is the IndependentChoices employer or personal
				care provider's responsibility to place information regarding their presence in
				the home in a prominent location so that the DAAS RN will be aware that they
				are serving the beneficiary. Preferably, the provider will place the
				information on the refrigerator or under the phone the applicant uses, unless
				the applicant objects. If so, the provider will place the information in a
				location satisfactory to the applicant, as long as it is readily available and
				easily accessible by the DAAS RN.
The personal care service plan developed by the personal care
				provider must meet all requirements as detailed in the personal care provider
				manual. This includes, but is not limited to, the amount of personal care
				services, personal care tasks, frequency and duration. The DAAS RN will not
				alter the current number of personal care units, unless a waiver Plan of Care
				cannot be developed
without duplicating services
. If
				personal care units must be altered, the DAAS RN will contact the personal care
				provider to discuss available alternatives prior to making any revisions. The
				ElderChoices Plan of Care and the required justification for each service
				remains the responsibility of the DAAS RN. Therefore, final decisions regarding
				services included on the ElderChoices Plan of Care rest with the DAAS
				RN.
NOTE: For the IndependentChoices program, services are
				effective the date of the DAAS RN's signature on the assessment tool or the
				waiver plan of care, whichever is the latter of the two.
214.320
Revisions to the
			 ElderChoices Plan of Care
Requested changes to the personal care services included on the
				ElderChoices Plan of Care may originate with the personal care RN or the DAAS
				RN, based on the recipient's circumstances. Unless requested by an
				IndependentChoices beneficiary, the individual or agency requesting revisions
				to the Personal Care services on the ElderChoices Plan of Care is responsible
				for securing any required signatures authorizing the change prior to the
				ElderChoices Plan of Care being revised. The DAAS RN will obtain electronic
				signatures for dates of service on or after January 1, 2013.
If revised by the DAAS RN, a copy of the revised ElderChoices
				Plan of Care and a Start of Care Form (AAS-9510) will be mailed to the personal
				care provider within 10 working days after being revised. If authorization is
				secured by the Personal Care agency, a copy of the revised personal care order,
				signed by the physician, must be sent to the DAAS RN prior to implementing any
				revisions. Once received, the ElderChoices Plan of Care will be revised
				accordingly within 10 days of its receipt. If any problems are encountered with
				implementing the requested revisions, the DAAS RN will contact the personal
				care provider to discuss possible alternatives. These discussions and the final
				decision regarding the requested revisions must be documented in the nurse
				narrative. The final decision, as stated above, rests with the DAAS RN.
214.400
Reporting Personal
			 Care Services Provided to Beneficiaries in the
Alternatives For Adults With Physical Disabilities Waiver
				Program
When an applicant is assessed by the Alternatives for Adults
				with Physical Disabilities Waiver RN/Counselor, a plan of care is developed. As
				in other Medicaid waiver programs, this plan of care supersedes any other plan
				of care that may have been previously developed by another Medicaid provider
				for the applicant. The Alternatives plan of care must include all waiver and
				non-waiver services appropriate for the applicant, such as Personal Care. The
				Alternatives Plan of Care must also include any services reimbursed by payers
				other than Medicaid.
Providers enrolled in the Medicaid Program to provide any of
				these non-waiver services and who are providing services to an Alternatives
				beneficiary, must report these services to the DAAS Waiver RN/Counselor. This
				information is required, regardless of the payer of services. Information
				required may include, but is not limited to, plans of care, prescriptions for
				services, changes in status, etc. If a provider provides
any
service to an individual who is participating in the Alternatives for Adults
				with Physical Disabilities Waiver Program, he or she must report these services
				immediately to the DAAS Waiver RN/Counselor in his or her area. Any service
				billed to Medicaid through a provider's provider identification number may be
				subject to recoupment if the service is not included on the Alternatives plan
				of care.
Providers who are unsure about whether an individual is
				participating in the Alternatives for Adults with Physical Disabilities Waiver
				Program should contact either the individual or the Alternatives Waiver
				RN/Counselor.
215.100
Assessment and Service Plan Formats
A.
			 The Division of Medical Services (DMS), in some circumstances and for certain
			 specified providers, requires exclusive use of form DMS-618
			 (
View or print form DMS-618.
) to satisfy
			 particular Program documentation requirements.
1. Whether Medicaid does or does not require
			 exclusive use of form DMS-618, all documentation required by the Personal Care
			 Program must meet or exceed DMS regulations as stated in this manual and other
			 official communications.
2. When
			 using form DMS-618, attachments may be necessary to complete assessments and
			 service plans and/or to comply with other rules.
a. An assessing Registered Nurse (RN) must
			 sign or initial and date each attachment he or she adds to a required personal
			 care document.
b. The authorizing
			 physician must sign (or initial) and date each attachment he or she adds to a
			 service plan or other required document.
B. The Division of Medical Services requires
			 Residential Care Facility (RCF) Personal Care providers to use exclusively form
			 DMS-618 and to comply with all rules applicable to RCFs regarding the use of
			 form DMS-618.
C. For assessments
			 completed on individuals participating in the IndependentChoices Program, the
			 following applies:
For IndependentChoices participants who are also active waiver
				participants in the ElderChoices Program, the DMS-618 is not required.Only the
				AR Path assessment will be used by the DAAS RN. The assessment tool used for
				waiver level of care determination and the waiver plan of care will suffice to
				support authorization for personal care services, if signed by the DAAS RN.
				Eligibility for personal care services is based on the same criteria as state
				plan personal care services. Services are effective the date of the DAAS RN's
				signature on the waiver assessment tool or the waiver plan of care, whichever
				is the latter of the two. Personal care services provided prior to that date
				are not eligible for Medicaid reimbursement. The waiver assessment tool and the
				waiver plan of care must include, at least, the information included on the
				DMS-618 that is utilized to support the medical necessity, eligibility and
				amount of personal care services provided through IndependentChoices or agency
				personal care services. This information is required in documentation whether
				or not an extension of benefits is requested. As with all required
				documentation, this information must be available in the participant's chart or
				electronic record and available for audit and Quality Management Strategy
				reviews.
215.330
Service Plan Revisions
NOTE: Subsections (A) (3) and (B) are not applicable to
				IndependentChoices program.
A.
			 The attending physician must authorize permanent service plan changes before
			 the provider amends service delivery.
1. For
			 purposes of this requirement, a
permanent
service plan change is
			 one expected to last 30 days or more.
2. Service plan revisions must be made if a
			 beneficiary's condition changes to the extent that the personal care provider
			 must modify, add or delete tasks.
3. Service plan revisions must be made if the
			 provider identifies a need to increase or decrease the amount, frequency or
			 duration of service.
a. While changes in the
			 amount, frequency or duration of a service must be documented in the medical
			 record, an increase or a reduction of 10% or less in the average
amount
of service (measured in service time) over a period of
			 fewer than 30 days does not in itself require a service plan revision. If the
			 amount of service remains unchanged, but the frequency or duration of a service
			 is modified, documentation of the reason for the change is required, but no
			 physician authorization is required.
b. The reasons for the service variances must
			 be written daily in the service documentation.
B. Providers may reduce a beneficiary's
			 services without the physician's prior authorization only by meeting the
			 following conditions:
1. The provider must
			 advise the physician of the reduction in services in writing, within 14 working
			 days following the first day of reduced services.
2. The provider must request the physician's
			 written approval of the reduction.
a. The
			 provider is responsible for obtaining the physician's signed
			 authorization.
b. The physician may
			 fax the signed authorization to the provider and maintain the original in the
			 beneficiary's file in the physician's office.
C. The physician must document medical
			 reasons for service plan revisions.
D. The new beginning date of service is the
			 date authorized by the physician.
E. Service plan revisions and updates since
			 the previous assessment must remain with the service plan. Updates since the
			 previous assessment must include documentation of when and why the change
			 occurred.
216.000
Coverage
A. Personal care
			 services, as described in this manual, are furnished to an individual who is
			 not an inpatient or resident of a hospital, nursing facility, intermediate care
			 facility for persons with intellectual disabilities, or institution for mental
			 disease that are:
1. Authorized for the
			 individual by a physician in accordance with a plan of treatment or (at the
			 option of the State) otherwise authorized for the individual in accordance with
			 a service plan approved by the State;
2. Provided by an individual qualified to
			 provide such services and who is not a member of the beneficiary's family. See
			 Section 222.100, part A, for the
			 definition of "a member of the beneficiary's family".
3. Prior authorized by DMS or its designee
			 when the beneficiary is under the age of 21,
4. Provided by an individual who is
a. Qualified to provide the
			 services,
b. Supervised by a
			 registered nurse (RN) or (when applicable) a Qualified Mental Retardation
			 Professional (QMRP) and
c. Not a
			 member of the beneficiary's family OR
d. Qualified to provide the service according
			 to approved policy in the IndependentChoices Program.
5. Furnished in the beneficiary's home or, at
			 the State's option, in another location.
B. Medicaid restricts coverage of personal
			 care to services directly helping a beneficiary with certain specified routines
			 and activities, regardless of the beneficiary's ability or inability to execute
			 other non-covered routines and activities.
216.400
Personal Care Aide Service and
			 Documentation Responsibility
NOTE: This section is not applicable to the
				IndependentChoices program.
It is the responsibility of the personal care aide to
				accomplish the following:
A. Perform
			 authorized tasks as instructed by the supervising RN or QMRP.
B. Maintain a service log.
1. The service log must be completed at the
			 time services are delivered.
2. If
			 the service log is not completed concurrently with service delivery, coverage
			 may be denied.
3. Refer to Sections
			 220.110 through
			 220.112 for service log
			 requirements.
C. Provide
			 necessary documentation showing the date, time, nature and scope of authorized
			 services delivered.
D. Provide
			 necessary documentation showing the date, time, nature and scope of emergency
			 services delivered.
1. If an emergency
			 requires the personal care aide to perform a personal care service task not
			 included on the personal care service plan, the personal care aide must receive
			 when possible, prior approval from the supervising registered nurse or QMRP to
			 perform the task.
2. When prior
			 approval is not possible, the personal care aide may perform the emergency
			 service task, but she or he must receive post-service approval from the
			 supervising registered nurse or QMRP.
3. Document the circumstances in detail,
			 describing:
a. The nature of the
			 emergency,
b. The action or task
			 required to resolve the emergency and
c. The justification for the unscheduled
			 service.
E. If
			 a personal care aide does not perform a particular task scheduled on the
			 service plan, the personal care aide must document why she or he did not
			 perform the task that day.
217.120
Duration of Benefit
			 Extension
A. Benefit extensions are
			 granted for six months or the life of the service plan, whichever is
			 shorter.
B. When the beneficiary's
			 diagnosis indicates a permanent disability or the physician signs the service
			 plan indicating a CHRONIC CONDITION that will not improve within the next six
			 (6) months, DMS may authorize services for one year. For individuals with
			 permanent disabilities, benefit extension requests will be necessary only once
			 every 12 months unless the service plan changes.
1. If there is a service plan revision, the
			 provider must submit a benefit extension request for the number of hours being
			 requested.
2. Upon approval of the
			 requested extension, the updated benefit extension approval file is valid for
			 12 months from the beginning of the month in which the revised service plan
			 takes effect.
3. If there is a
			 service plan revision before 12 months have passed, the provider must initiate
			 the benefit extension approval process again.
220.110
Service Log
NOTE: This section is not applicable to the
				IndependentChoices program.
Instructions in this section apply to all beneficiaries'
				service logs, with one exception. Effective for dates of service on and after
				March 1, 2008, RCF Personal Care providers maintain their service logs by means
				of the format and instructions of form DMS-873,
"Arkansas Department of
				Human Services Division of Medical Services Instructions for completing the
				Service Log & Aide Notes For Personal Care Services in a Residential Care
				Facility"
. Effective for dates of service on and after March 1, 2008,
				form DMS-873 is found in Section
				V of this manual and DMS requires
				that RCF Personal Care providers use it exclusively for its designated
				purposes. See Section
				220.111 for special documentation
				requirements regarding multiple beneficiaries who are attended by one aide.
				Those instructions at Section
				220.111 do not apply to RCF
				Personal Care providers, effective for dates of service on and after March 1,
				2008. See Section
				220.112 for special documentation
				requirements regarding multiple aides attending one beneficiary. Those
				instructions at Section
				220.112 do not apply to RCF
				Personal Care providers, effective for dates of service on and after March 1,
				2008. The examples in these sections and in Section
				220.110 are related to food
				preparation, but personal care beneficiaries may receive other services in
				congregate settings if their individual assessments support their receiving
				assistance in that fashion.
A.
			 Medicaid covers only service time that is supported by an aide's service
			 log.
B. Service time in excess of
			 the maximum service time estimates in the authorized service plan is covered
			 only when the provider complies with the rules in Sections
			 215.330 and
			 220.110 through
			 220.112.
C. The time estimate in the service plan is
			 not service documentation. It is an estimate of the anticipated minimum and
			 maximum daily duration of medically necessary personal care aide service for an
			 individual beneficiary.
D. For each
			 service date, for each beneficiary, the personal care aide must record the
			 following:
1. The time of day the aide begins
			 the beneficiary's services.
2. The
			 time of day the aide ends a beneficiary's services. This is the time of day the
			 aide concludes the service delivery, not necessarily the time the aide leaves
			 the beneficiary's service delivery location.
3. Notes regarding the beneficiary's
			 condition as instructed by the service supervisor.
4. Task performance difficulties.
5. The justification for any emergency
			 unscheduled tasks and documentation of the prior-approval or post-approval of
			 the unscheduled tasks.
6. The
			 justification for not performing any scheduled service plan required
			 tasks.
7. Any other observations
			 the aide believes are of note or that should be reported to the
			 supervisor.
E. If the
			 aide discontinues performing service-plan-required tasks at any time before
			 completing all of the required tasks for the day, the aide will record:
1. The beginning time of the
			 non-service-plan-required activities,
2. The ending time of the
			 non-service-plan-required activities,
3. The beginning time of the aide's
			 resumption of service-plan-required activities and
4. The beginning and ending times of any
			 subsequent breaks in service-plan-required aide activities.
5. If the aide discontinues or interrupts the
			 beneficiary's service-plan-required activities at one location to begin
			 service-plan-required activities at another location, the aide must record the
			 beginning and ending times of service at each location.
221.000
Documentation
NOTE: This section is not applicable to the
				IndependentChoices program.
Rule D in this section is effective for dates of service
				on and after March 1, 2008.
The personal care provider must keep and make available to
				authorized representatives of the Arkansas Division of Medical Services, the
				State Medicaid Fraud Control Unit and representatives of the Department of
				Health and Human Services and its authorized agents or officials; records
				including:
A. If applicable,
			 certification by the Home Health State Survey Agency as a participant in the
			 Title XVIII Program. Agencies that provided Medicaid personal care services
			 before July 1, 1986 are exempt from this requirement.
B. When applicable, copies of pertinent
			 residential care facility license(s) issued by the Office of Long Term
			 Care.
C. Medicaid
			 contract.
D. Effective for dates of
			 service on and after March 1, 2008, RCF Personal Care providers will be
			 required, when requested by DHS, to provide payroll records to validate service
			 plans and service logs.
E.
			 Documents signed by the supervising RN or QMRP, including:
1. The initial and all subsequent
			 assessments.
2. Instructions to the
			 personal care aide regarding:
a. The tasks the
			 aide is to perform,
b. The
			 frequency of each task and
c. The
			 maximum number of hours and minutes per month of aide service authorized by the
			 beneficiary's attending physician.
3. Notes arising from the supervisor's visits
			 to the service delivery location, regarding:
a. The condition of the
			 beneficiary,
b. Evaluation of the
			 aide's service performance,
c. The
			 beneficiary's evaluation of the aide's service performance and
d. Difficulties the aide encounters
			 performing any tasks.
4. The service plan and service plan revisions:
a. The justifications for service plan
			 revisions,
b. Justification for
			 emergency, unscheduled tasks and
c.
			 Documentation of prior or post approval of unscheduled
			 tasks.
F. Any
			 additional or special documentation required to satisfy or to resolve questions
			 arising during, from or out of an investigation or audit. "Additional or
			 special documentation," refers to notes, correspondence, written or transcribed
			 consultations with or by other healthcare professionals (i.e., material in the
			 beneficiary's or provider's records relevant to the beneficiary's personal care
			 services, but not necessarily specifically mentioned in the foregoing
			 requirements). "Additional or special documentation," is not a generic
			 designation for inadvertent omissions from program policy. It does not imply
			 and one should not infer from it that, the State may arbitrarily demand media,
			 material, records or documentation irrelevant or unrelated to Medicaid Program
			 policy as stated in this manual and in official program
			 correspondence.
G. The personal
			 care aide's training records, including:
1.
			 Examination results,
2. Skills test
			 results and
3. Personal care aide
			 certification.
H. The
			 personal care aide's daily service notes for each beneficiary, reflecting:
1. The date of service,
2. The routines performed on that date of
			 service, noted to affirm completion of each task.
3. The time of day the aide began performing
			 the first service-plan-required task for the beneficiary;
4. The time of day the aide stopped
			 performing any service-plan-required task to perform any
			 non-service-plan-required function;
5. The time of day the aide stopped
			 performing any non-service-plan-required function to resume
			 service-plan-required tasks and
6.
			 The time of day the aide completed the last service-plan-required task for the
			 day for that beneficiary.
I. Notes, orders and records reflecting the
			 activities of the physician, the supervising RN or QMRP, the aide and the
			 beneficiary or the beneficiary's representative; as those activities affect
			 delivering personal care services.
222.100
Personal Care Aide Selection,
			 Training and Continuing Education
NOTE: This section is not applicable to the
				IndependentChoices program.
A.
			 The beneficiary must receive Medicaid Personal Care services from a certified
			 personal care aide who is not a member of the beneficiary's family. The
			 Medicaid agency defines, "a member of the beneficiary's family" as:
1. A spouse.
2. A minor's parent, stepparent, foster
			 parent or anyone acting as a minor's parent.
3. Legal guardian of the person.
4. Attorney-in-fact granted authority to
			 direct the beneficiary's care.
B. Personal care aides must be selected on
			 the basis of such factors as:
1. A
			 sympathetic attitude toward the care of the sick,
2. An ability to read, write and carry out
			 directions and
3. Maturity and
			 ability to deal effectively with the demands of the job.
C. The personal care provider is responsible
			 for ensuring that personal care aides in its employ are:
1. Certified as personal care
			 aides,
2. Participate in all
			 required in-service training and
3.
			 Maintain at least "satisfactory" competency evaluations from their supervisors
			 in all personal care tasks they perform.
D. DMS will deem valid the Certified Personal
			 Care Aide status of an individual with
1.
			 Personal Care Aide Certification conferred before April 1, 1998, and
2. Documentation of ongoing compliance with
			 Personal Care Program policies in effect before April 1, 1998, regarding
			 continuing education and competency requirements.
3. The deemed status will be effective for
			 dates of service on and after April 1, 1998, conditional upon the certified
			 aide's continuing compliance with program policies.
E. A qualified training program (see Section
			 222.110 ) may waive the training
			 component of personal care aide certification requirements for individuals who
			 can document previous experience as personal care aides, nurse's aides or
			 similar occupations requiring the same skills needed by personal care aides.
1. The qualified training program must verify
			 the individual's previous experience.
2. The individual must pass the personal care
			 aide examinations and skills tests.
F. Certified Nursing Assistants with current
			 valid credentials are deemed qualified personal care aides.
G. Certified Home Health Aides with current
			 valid credentials are deemed qualified personal care aides.
222.110
Conduct of
			 Training
NOTE: This section is not applicable to the
				IndependentChoices program.
A. A
			 personal care aide training program may be offered by any organization meeting
			 the standards in this section for:
1.
			 Instructor qualifications,
2.
			 Content and duration of personal care aide training and
3. Documentation of personal care aide
			 training and certification.
B. Personal Care provider agencies conducting
			 personal care aide training must maintain their training program
			 documentation.
C. Personal Care
			 providers hiring or contracting with individuals or organizations to conduct
			 personal care aide training must maintain the individual's or organization's
			 training program documentation. The provider is responsible for maintaining the
			 training program documentation file.
D. Required training program documentation
			 includes:
1. The number of hours each of
			 classroom instruction and supervised practical training.
2. Names and qualifications of instructors
			 and copies of licenses of supervising registered nurses.
3. Street addresses and physical locations of
			 training sites, including facility names when applicable.
4. Maintaining samples of the forms used to
			 document the beneficiary's consent to the training in their home, if the
			 training includes supervised practical training in the home.
5. The course outline.
6. Lesson plans.
7. The instructor's methods of supervising
			 trainees during practical training.
8. The training program's methods and
			 standards for, determining whether a trainee can read and write well enough to
			 perform satisfactorily the duties of a personal care aide.
9. The training program's method of
			 evaluating written tests, oral exams (if any) and skills tests, including the
			 relative weights of each in the minimum standard for successful completion of
			 the course.
10. The training
			 program's minimum standard for successful completion of the course.
11. Evidence and documentation of successful
			 completions (Certificates supported by internal records).
E. Personal Care providers are responsible
			 for the upkeep of all required training program documentation.
F. A qualified personal care aide training
			 and certification program must include instruction in each of the subject areas
			 listed in Section
			 222.120.
G. Classroom and supervised practical
			 training must total at least 40 hours.
1.
			 Minimum classroom training time is 24 hours.
2. Minimum time for supervised practical
			 training is 16 hours.
a. "Supervised practical
			 training" means training in a laboratory or other setting in which:
(1) . The trainee demonstrates knowledge by
			 performing tasks on an individual while
(2) . The trainee is under supervision as
			 defined in Section
			 220.100.
b. Trainees must complete at least 16 hours
			 of classroom training before beginning any supervised practical
			 training.
3. Supervised
			 practical training may occur at locations other than the site of the classroom
			 training.
a. However, trainees must complete
			 at least 24 hours of classroom training before undertaking any supervised
			 practical training at an actual service delivery site.
b. The training program must have the written
			 consent of the beneficiary or the beneficiary's representative if aide trainees
			 furnish any of the beneficiary's services at the beneficiary's service delivery
			 location.
(1) . A copy of the beneficiary's
			 consent must be maintained in the file of each aide trainee receiving
			 supervised practical training at the beneficiary's service delivery
			 location.
(2) . The beneficiary's
			 daily service documentation must include the names of the supervising RN and
			 the personal care aide trainees.
4. The training of personal care aides and
			 the supervision of personal care aides during the supervised practical portion
			 of the training must be performed by or under the general supervision of a
			 registered nurse whose current credentials are on file with the provider.
a. The qualified registered nurse must
			 possess a minimum of 2 years of nursing experience, at least 1 year of which
			 must be in the provision of in-home health care.
b. Other individuals may provide instruction
			 under the supervision of the qualified registered nurse.
c. Supervised practical training with a
			 consenting personal care beneficiary for a subject must be personally
			 supervised by:
(1) . The qualified registered
			 nurse or
(2) . By a licensed
			 practical nurse under the general supervision of the qualified registered
			 nurse.
H. Providers must maintain documentation
			 demonstrating that aide training meets the requirements set forth herein.
222.120
Personal
			 Care Aide Training Subject Areas
NOTE: This section is not applicable to the
				IndependentChoices program.
A.
			 Correct conduct toward beneficiaries, including respect for the beneficiary,
			 the beneficiary's privacy and the beneficiary's property.
B. Understanding and following spoken and
			 written instructions.
C.
			 Communications skills, especially the skills needed to:
1. Interact with beneficiaries,
2. Report relevant and required information
			 to supervisors and
3. Report events
			 accurately to public safety personnel and to emergency and medical
			 personnel.
D.
			 Record-keeping, including:
1. The role and
			 importance of record keeping and documentation.
2. Service documentation requirements and
			 procedures, especially all documentation Medicaid requires of personal care
			 aides, as described in Medicaid Personal Care Program policy statements current
			 at the time of the aide's training.
3. Reporting and documenting non-medical
			 observations of beneficiary status.
4. Reporting and documenting, when pertinent,
			 the beneficiary's observations regarding their own status.
E. Recognizing and reporting, to the
			 supervising RN or QRMP, when changes in the beneficiary's condition or status
			 require the aide to perform tasks differently than instructed.
F. State law regarding delegation of nursing
			 tasks to unlicensed personnel.
G.
			 Basic elements of body functioning, and the types of changes in body function,
			 easily recognizable by a layperson, that an aide must report to a
			 supervisor.
H. Safe transfer
			 techniques and ambulation.
I.
			 Normal range of motion and positioning.
J. Recognizing emergencies and knowledge of
			 emergency procedures.
K. Basic
			 household safety and fire prevention.
L. Maintaining a clean, safe and healthy
			 environment.
M. Instruction in
			 appropriate and safe techniques in personal hygiene and grooming that include
			 how to assist the beneficiary with:
1. Bed
			 bath
2. Sponge, tub or shower
			 bath
3. Shampoo; sink, tub or
			 bed
4. Nail and skin care
5. Oral hygiene
6. Toileting and elimination
7. Shaving
8. Assistance with eating
9. Assistance with dressing
10. Efficient, safe and sanitary meal
			 preparation
11.
			 Dishwashing
12. Basic housekeeping
			 procedures
13. Laundry
			 skills
222.130
Personal Care Aide Certification
NOTE: This section is not applicable to the
				IndependentChoices program.
A.
			 A personal care aide trainee must pass an examination based on the curriculum
			 of the personal care aide training course.
1.
			 Some of the examination may be oral.
2. Examinations must include written
			 questions requiring written answers, in sufficient number for instructors or
			 other qualified training program personnel to determine that trainees meet or
			 surpass a minimum standard for reading and writing.
B. The personal care aide candidate must
			 demonstrate the ability to perform all tasks required of personal care aides,
			 by meeting or exceeding minimum standards in a personal care services skills
			 test.
C. An aide trainee
			 successfully completing training must receive a dated certificate confirming
			 that the individual is a Certified Personal Care Aide qualified for employment
			 in that capacity.
1. The certificate must
			 contain the name of the training entity.
2. The certificate must contain the signature
			 of an individual authorized by the training program to certify the
			 qualifications of personal care aides.
222.140
In-Service Training
NOTE: This section is not applicable to the
				IndependentChoices program.
Medicaid requires personal care aides to participate in at
				least twelve (12) hours of in-service training every twelve (12) months after
				achieving Personal Care Aide certification.
A. Each in-service training session must be
			 at least 1 hour in length.
1. When
			 appropriate, in-service training may occur at a personal care service delivery
			 location when the aide is furnishing personal care services.
2. In-service training at a service delivery
			 site may occur only if the beneficiary or the beneficiary's representative has
			 given prior written consent for training activities to occur concurrently with
			 the beneficiary's care.
B. The Personal Care Program provider agency
			 and the personal care aide must maintain documentation that they are meeting
			 the in-service training requirement.
244.000
Duration of PA
A. Personal Care PAs are generally assigned
			 for six months or for the life of the service plan, whichever is
			 shorter.
B. The contracted QIO may
			 validate a PA for one year if the provider requests an extended PA because the
			 beneficiary is an individual with a permanent disability or the physician signs
			 the service plan indicating a CHRONIC CONDITION that will not improve within
			 the next six (6) months.
1. A one-year PA
			 remains valid only if the service plan and services remain unchanged and the
			 provider meets all Personal Care Program requirements.
2. Providers receiving extended PAs for
			 individuals with a permanent disability must continue to follow Personal Care
			 Program policy regarding regular assessments and service plan renewals and
			 revisions.