Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-006 - SPA #2020-0011; ARChoices Medicaid Provider Manual, Personal Care Medicaid Provider Manual, and Targeted Case Management Medicaid Provider Manual

Current through Register Vol. 49, No. 6, June, 2024
Supplement 1 to Attachment 3.1-A
Revised:
July 1, 2020
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY
				ACT
State/Territory: ARKANSAS
TARGETED CASE MANAGEMENT SERVICES [Target Group]
Monitoring and follow-up activities include making necessary
				adjustments in the care plan and service arrangements with providers, according
				to established program guidelines.
Monitoring visits may be as frequent as necessary, within
				established Medicaid maximum allowable limitations.
Monitoring is allowed through regular contacts with service
				providers at least every other month to verify that appropriate services are
				provided in a manner that is in accordance with the service plan and assuring
				through contacts with the beneficiary, at least monthly, that the beneficiary
				continues to participate in the service plan and is satisfied with
				services.
Face to face monitoring contacts must be completed as often as
				deemed necessary, based on the professional judgment of the TCM, but no less
				frequent than established in Medicaid TCM program policy.
Case management includes contacts with non-eligible individuals
				that are directly related to identifying the eligible individual's needs and
				care, for the purposes of helping the eligible individual access services;
				identifying needs and supports to assist the eligible individual in obtaining
				services; providing case managers with useful feedback, and alerting case
				managers to changes in the eligible individual's needs. (
				42 CFR
				440.169(e) )
Qualifications of providers (
				42 CFR
				441.18(a)(8)(v) and 42 CFR
				441.18(b))
:
Case management providers must be certified by the Division of
Provider Services and Quality Assurance
on an annual basis, unless
				approved otherwise by the Division of Medical Services, based on performance
				evaluations or other approved data.
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY
				ACT
State/Territory: ARKANSAS
TARGETED CASE MANAGEMENT SERVICES [Target Group]
In order to be certified by the Division of
Provider
				Services and Quality Assurance
, the provider must meet the following
				qualifications:
A. Be located in the
			 state of Arkansas
B. Be licensed as
			 a Class A or Class B Home Health Agency or Private Care Agency by the Arkansas
			 Department of Health or a unit of state government or be a private or public
			 incorporated agency whose stated purpose is to provide case management to the
			 elderly or adults with physical disabilities.
C. Is able to demonstrate one year of
			 experience in performing case management services (experience must be within
			 the past 3 years);
D. Be able to
			 demonstrate one year of experience in working specifically with individuals in
			 the targeted group (experience must be within the past 3 years);
E. Have an administrative capacity to insure
			 quality of services in accordance with state and federal
			 requirements;
F. Have the financial
			 management capacity and system that provides documentation of services and
			 costs;
G. Have the capacity to
			 document and maintain individual case records in accordance with state and
			 federal requirements;
H. Be able to
			 demonstrate that the provider has current liability coverage, and
I. Employ qualified case managers who
reside in or near the area of responsibility and who meet at least one of
			 the following qualifications:
1.
Licensed in the state of Arkansas as a social worker (Licensed Master
			 Social Worker or Licensed Certified Social Worker), a registered nurse, or a
			 licensed practical nurse;
2.
Have a bachelor's degree from an accredited institution in a health and
			 human services or related field; or
3.
Have two years' experience in the
			 delivery of human services, including without limitation having performed
			 satisfactorily as a case manager for a period of two years (experience must be
			 within the past three years).
A copy of the current certification must accompany the provider
				application and Medicaid contract.
262.100
HCPCS Procedure Codes
The following procedure codes must be billed for ARChoices
				Services.
Electronic and paper claims now require the same National
				Place of Service code.
Procedure Code
Modifiers
Description
Unit of Service
National POS for Claims
S5125
U2
Agency Attendant Care Traditional
15 minutes
12, 99
S5170 S5170
U2
Home-Delivered Meals Frozen Home-Delivered Meal
1 meal 1 meal
12 12
S5170
U1
Emergency Home Delivered Meals
1 meal
12
S5161
UA
Personal Emergency Response System
1 day
12
S5160
Personal Emergency Response System -
						  Installation
One install
12
S5100
U1
Adult Day Services, 8 to 20 units per date of
						  service
15 minutes
99
S5100
Adult Day Services, 21 to 40 units per date of
						  service
15 minutes
99
S5100
TD, U1
Adult Day Health Services, 8 to 20 units per date of
						  service
15 minutes
99
S5100
TD
Adult Day Health Services, 21 to 40 units per date of
						  service
15 minutes
99
S5150
Respite Care - In-Home
15 minutes
12
S5135
Respite Care - Short-Term Facility-Based
15 minutes
99, 21, 32
T1005
Respite Care - Long-Term Facility-Based
15 minutes
21, 32, 99
T2015
Prevocational Services Skills Development
15 minutes
11, 12, 99
T2015
U3
Prevocational Services Career Exploration
15 minutes
11, 12, 99
262.220
Rounding
When a quotient contains decimals, look at the numbers after
				the decimal point.
A. If the number
			 after the decimal point is 500 (e.g., 3.500) or less (e.g., 3.495) round
			 downward to the whole number displayed before the decimal point (three (3), in
			 this example)
B. If the number
			 after the decimal is 501 (e.g., 3.501) or greater (e.g., 3.576) round upward to
			 the whole number one (1) greater than the whole number displayed before the
			 decimal point (four (4) in this example, because it is a whole number one
			 greater than three (3)).
214.200
Service Plan Review and Renewal
			 7-1-20
A. A personal care service plan
			 is effective for up to one (1) year from the date of the beneficiary's last
			 independent assessment.
B. Personal
			 care services may not continue past the one-year anniversary of the last
			 independent assessment until DHS professional staff or contractor(s) designated
			 by DHS authorizes a revised service plan, or renews, or extends the
			 authorization of an existing service plan.
214.300
Authorization of ARChoices
			 Person Centered Service Plan and Personal Care Individual Service Plan
The DHS RN is responsible for developing an ARChoices
				Person-Centered Service Plan (PCSP) that includes both waiver and non-waiver
				services. Once developed, the PCSP is signed by the DHS RN authorizing the
				services listed.
The signed ARChoices PCSP will suffice as the "Personal Care
				Authorization" for services required in the Personal Care Program. The personal
				care individualized service plan, developed by the Personal Care provider, is
				still required.
As the ARChoices PCSP is effective for one (1) year from the
				date of the beneficiary's last independent assessment, the authorization for
				personal care services, when included on the ARChoices PCSP, will be for one
				(1) year from the date of the beneficiary's last independent assessment, unless
				revised by the DHS RN or the personal care individualized service plan needs to
				be revised, whichever occurs first.
NOTE: For ARChoices beneficiaries who receive personal
				care through traditional agency services or have chosen to receive their
				personal care services through the IndependentChoices Program, the ARChoices
				PCSP, signed by a DHS RN, will serve as the authorization for personal care
				services for one year from the date of the beneficiary's last independent
				assessment, as described above.
The responsibility of developing a personal care individualized
				service plan is not placed with the DHS 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 individualized service plan
				authorizations obtained by DHS RNs.
215.200
Personal Care Provider's Prior
			 Authorization Request
A. As part of
			 each prior authorization request, each provider shall submit a complete and
			 accurate form designated by DHS. The provider is not required to submit a
			 proposed Individualized Service Plan to DHS.
B. The completed form designed by DHS shall
			 include all information applicable to the individual beneficiary, including:
1. Beneficiary and provider
			 information;
2. Certification that
			 the beneficiary's service plan will not duplicate any other in-home services of
			 which the provider is aware;
3. The
			 total number of hours per month the provider seeks to offer the
			 beneficiary;
4. Detailed
			 information on all personal assistance available to the beneficiary through
			 other sources, including informal caregivers (e.g., family, friends), community
			 organizations (e.g., Meals on Wheels), Medicare (e.g., Medicare home health
			 aide services), or the beneficiary's Medicare Advantage health plan;
5. The frequency of in-person supervisory
			 visits to be made by an agency supervisor based on the specific needs of the
			 beneficiary and the recommendations of an agency-designated registered nurse;
			 and,
6. The signed approval of the
			 beneficiary or the beneficiary's legal representative.
C. When a beneficiary has two or more
			 personal care providers, the providers should cooperate in the required nursing
			 evaluation and the preparation and submission of the prior authorization
			 request and completed form designated by DHS on behalf of the
			 beneficiary.
D. When an individual
			 will receive some or all of his or her services in a congregate setting, the
			 assessment must reflect the RN's determination that the individual is an
			 appropriate candidate for services delivered in that setting. See Section
			 216.201 and Sections 220.110 through 220.112.
E. Before furnishing any personal care
			 services to an individual, the provider must prepare a complete and accurate
			 Individualized Service Plan with proposed hours/minutes and frequency of needed
			 tasks consistent with the aggregate number of hours authorized under the Task
			 and Hour Standards (as described in Section 240.100 ). The service plan must be
			 prepared, certified, and signed by a supervisor or registered nurse. The
			 service plan and all subsequent revisions must be kept by the personal care
			 provider as Documentation under Section 221.000.
215.320
Identifying Frequency of
			 In-Person Supervisory Visits
A. A
			 registered nurse designated by the personal care provider must identify and
			 recommend the frequency for in-person visits to be made by the supervisor of
			 the personal care aide, based on the specific needs of the
			 beneficiary.
B. The frequency of
			 in-person visits shall be at least every 365 days and shall be determined
			 jointly by the personal care provider and the beneficiary or the beneficiary's
			 legal representative, based on the recommendations of the registered
			 nurse.
C. The individualized
			 service plan must identify the agreed frequency, the risk factors that are
			 specific to that beneficiary, and a justification for the agreed frequency. The
			 risk factors identified by the service plan must include without limitation any
			 relevant medical diagnoses; the beneficiary's mental status; the presence of
			 family or other residents in the beneficiary's home, and the frequency of their
			 presence; and the beneficiary's physical dependency needs, including the
			 activities of daily living (ADL) with which the beneficiary needs
			 assistance.
D. If the frequency
			 identified in the service plan is less than the frequency recommended by the
			 registered nurse, the service plan shall identify the medical justification for
			 the reduced frequency.
E. If the
			 beneficiary has a significant change of condition affecting a risk factor, the
			 registered nurse shall review the frequency of in-person visits and recommend
			 changes as appropriate.
215.330
Service Plan Revisions
NOTE: Subsections (A) (3) and (B) are not applicable to
				IndependentChoices program.
A.
			 A personal care provider must amend a beneficiary's individualized service plan
			 to document any 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 thirty (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.
			 Changes in the amount, frequency or duration of a service must be documented in
			 the medical record,
b. The reasons
			 for the service variances must be written daily in the service
			 documentation.
4. A
			 service plan revision must be authorized by DHS professional staff or
			 contractor(s) designated by DHS only if the provider requests to increase or
			 decrease the total monthly hours. DHS professional staff or the DHS contractor
			 will review the request and determine, based on application of the Task and
			 Hour Standards described in Section 240.100, the amount of adjustment to make
			 in prior authorized minutes. DHS professional staff or the DHS contractor will
			 revise the number of minutes in Interchange.
B. Providers may not reduce a beneficiary's
			 services without prior authorization by DHS professional staff or contractor(s)
			 designated by DHS
C. The personal
			 care provider must document medical reasons for service plan
			 revisions.
D. The new beginning
			 date of service is the date authorized by DHS professional staff or
			 contractor(s) designated by DHS.
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.
215.351
Service Plan Requirements for
			 Multiple Providers 7-1-20
When a beneficiary receives services from more than one
				personal care provider, each provider must comply with the following
				requirements.
A. Each provider must
			 create an individualized service plan and collaborate with the beneficiary's
			 other personal care provider(s) to create a comprehensive service plan.
1. Each comprehensive service plan must
			 clearly state which provider provides which services, where and on which day(s)
			 they do so, which time(s) of day they furnish services and the maximum and
			 minimum amount of time per day and per week that the provider will take to
			 perform those services.
2. Each
			 comprehensive service plan must be authorized, signed and dated by the
			 provider.
B. Each time a
			 personal care provider intends to revise or renew a comprehensive service plan,
			 that provider must notify the beneficiary's other personal care provider(s) to
			 agree on the revision or renewal.
C. If the providers cannot agree on a
			 comprehensive service plan, plan revision or plan renewal, the providers shall
			 submit the various alternatives to DHS professional staff or contractor(s)
			 designated by DHS, who shall determine the terms of the final comprehensive
			 service plan.
D. Any Medicaid
			 provider having knowledge that another Medicaid provider has failed to comply
			 with a service plan, including a comprehensive service plan, shall notify the
			 DMS Director of such failure within ten (10) business days of the occurrence,
			 or sooner if the beneficiary's life or health is threatened
215.360
Changes of Condition
A. The individualized service plan must
			 identify individualized, beneficiary-specific standards, based on the
			 identified risk factors, for when a caregiver or supervisor must document and
			 report any significant change in the beneficiary's condition. A significant
			 change is one that exhibits a major decline or improvement in the physical or
			 mental health status of the beneficiary.
B. If a caregiver or supervisor observes a
			 significant change of condition, the caregiver or supervisor must document and
			 report the change of condition as required by the change-reporting standards
			 contained in the beneficiary's individualized service plan. Documentation must
			 include the time and date the change was identified by the caregiver and a full
			 description of the change.
C.
			 Within twenty-four (24) hours of a significant change of condition being
			 reported, a registered nurse must evaluate and document an assessment of the
			 beneficiary, including without limitation the reported change of
			 condition.
D. A change of condition
			 under this section may result in a change to the service plan or to the
			 frequency of supervisory visits, but it does not automatically result in a new
			 Independent Assessment by the DHS Independent Assessment Contractor.
			 Independent Assessments or Reassessments are governed by the provisions of the
			 Arkansas Independent Assessment Medicaid Provider Manual.
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, Level II assisted living facility,
			 intermediate care facility for persons with intellectual disabilities, or
			 institution for mental disease that are:
1.
			 Authorized for the individual by DHS professional staff or contractor(s)
			 designated by DHS 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 DHS professional staff or contractor(s) designated by
			 DHS
4. Provided by an individual
			 who is
a. Qualified to provide the
			 services;
b. Supervised by an
			 individual meeting the qualification set forth in Section 220.100;
			 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. Personal care services may be
			 provided in a beneficiary's home or while accompanying the beneficiary to other
			 locations, including without limitation for medical appointments or community
			 activities, subject to the restrictions on travel time in this
			 section.
C. Travel Time of Personal
			 Care Aide Accompanying Beneficiary:
1.
			 Personal care only covers personal care aide travel time when all of the
			 following apply:
a. The personal care aide
			 accompanies the beneficiary in the same vehicle as the beneficiary travels to
			 and returns from a community location for medical appointment or community
			 activity;
b. The travel time billed
			 is solely for necessary time in transit from the beneficiary's home to the
			 community location and the return travel from the community location to the
			 beneficiary's home;
c. The
			 beneficiary's participation in the local community activity is for the benefit
			 of the beneficiary and to meet the beneficiary's goals for independent living
			 in the community, and the travel, including stops, is not for the benefit or
			 convenience of any other person (including the personal care aide, a family
			 member, the driver, or other passengers);
d. The traveling activity itself is for
			 practical transit within the community and not for diversional or recreational
			 purposes of any kind;
e. The
			 beneficiary's Individualized Service Plan includes Personal Care service hours
			 for one or both of the following activities of daily living (ADLs): toileting
			 and mobility / ambulating;
f. While
			 in transit to and from the community location, the beneficiary requires, or is
			 likely to need given assessed functional limitations, hands-on assistance with
			 the ADL task of toileting or the ADL task of mobility/ambulating; and
g. The travel time is reasonable given
			 driving distances, traffic conditions, and weather, with time and locations
			 documented.
2. Travel
			 time is not reimbursable if any other adult person accompanying (or driving)
			 the beneficiary is a family member and is reasonably able to assist the
			 beneficiary in transit if needed.
3. Travel time accompanying a beneficiary
			 will count against the total number of Personal Care hours per month authorized
			 in the participant's Individualized Service Plan and prior
			 authorization.
4. Requesting Hours
			 for Travel Time of Attendant Accompanying Participant:
Beneficiaries vary in their medical appointments, participation
				in community activities, the availability of family or other assistance they
				may need while traveling, and the time involved when traveling to medical
				appointments and local community activities. When covered, travel time of a
				personal care aide accompanying a beneficiary is incident to but itself not the
				ADL task of toileting or the ADL task of mobility/ambulating. Therefore, the
				Task and Hour Standards are not currently used to help determine the number of
				Personal Care hours, if any, associated solely with travel time of a personal
				care aide accompanying a beneficiary to a medical visit or community
				activity.
For an ARChoices beneficiary, the number of hours allowed for
				travel time of a personal care aide will be determined by the DHS nurse in the
				beneficiary's Person-Centered Service Plan.
For other beneficiaries, the provider may include in the prior
				authorization request justification for travel time, based on the beneficiary's
				community activities, need for a personal care aide to accompany them, and the
				distances and roundtrip travel times typically involved. Based on this
				information and consistent with the above requirements, the contractor
				designated by DHS to process prior authorization requests, or if there is no
				contractor designated by DHS, DHS professional staff, may increase the number
				of Personal Care hours per month covered in the Individualized Service Plan and
				prior authorization to reasonably accommodate the travel time of a personal
				care aide accompanying the beneficiary.
220.100
Service Supervision
A. The provider must assure that the delivery
			 of personal care services by personal care aides is supervised.
1. A supervisor must be a licensed nurse or
			 have completed two (2) years of full-time study at an accredited institution of
			 higher learning. An individual who has a high school diploma or general
			 equivalency diploma may substitute one (1) year of fulltime employment in a
			 supervisory capacity in a healthcare facility or community-based agency for one
			 (1) year at an institution of higher education.
2. Alternatively, a Qualified Intellectual
			 Disabilities Professional (QIDP) may fulfill the supervision requirement for
			 personal care services to beneficiaries residing in alternative living
			 situations or alternative family homes, licensed and certified by DPSQA as
			 personal care providers.
3. An
			 individual who personally provides personal care services to a beneficiary may
			 not supervise another personal care aide providing personal care services to
			 that same beneficiary.
B.
			 The supervisor has the following responsibilities.
1. The supervisor must instruct the personal
			 care aide in
a. Which routines, activities and
			 tasks to perform in executing a beneficiary's service plan;
b. The minimum frequency of each routine or
			 activity; and
c. The maximum number
			 of hours per month of personal care service delivery, as authorized in the
			 service plan.
2. At least
			 once a month, the supervisor must
a. Review
			 the aide's records;
b. Document the
			 record review; and
c. If necessary,
			 further instruct the aide and document the nature of and the reasons for
			 further instructions.
3.
			 At least annually, the supervisor must visit the beneficiary at the service
			 delivery location to conduct on-site evaluation.
a. Medicaid requires that at least one of
			 these supervisory visits annually must be when the aide is not
			 present.
b. If the frequency of
			 in-home supervisory visits for a beneficiary is greater than one annually, at
			 least one visit must be while the aide is present and furnishing
			 services.
4. When the
			 aide is present during the visit the supervising RN or QIDP must
a. Observe and document;
(1). The condition of the
			 beneficiary;
(2). The type and
			 quality of the personal care aide's service provision;
(3). The interaction and relationship between
			 the beneficiary and the aide; and
(4). Any changes or additions to any risk
			 factors relevant to the needed frequency of in-person supervisory
			 visits.
b. Consult with
			 the agency-designated registered nurse regarding modifications to the service
			 plan, if necessary, based on the observations and findings from the visit and
			 document the consultation in the beneficiary's records; and,
c. If necessary, further instruct the aide
			 and document the nature of and the reasons for further instructions.
5. When the aide is not present
			 during the visit, the supervisor must
a.
			 Observe and document the condition of the beneficiary;
b. Observe and document, from available
			 evidence, the type and quality of the personal care aide's service
			 provision;
c. Observe, document,
			 and report any changes or additions to any risk factors relevant to the needed
			 frequency of in-person supervisory visits;
d. Query the beneficiary or the beneficiary's
			 representative and document pertinent information regarding the beneficiary's
			 opinion of:
(1). The type and quality of the
			 aide's service;
(2). The aide's
			 conduct; and
(3). The adequacy of
			 the working relationship of the beneficiary and the aide.
e. Consult with the agency-designated
			 registered nurse regarding modifications to the service plan, if necessary,
			 based on observations and findings from the visit and document the consultation
			 in the beneficiary's records; and
f. Further instruct the aide, if necessary,
			 and document the nature of and the reasons for further instructions.
C. The provider must
			 review the service plan and the aide's records as necessary. The review will
			 ensure that the daily aggregate time estimate in the service plan accurately
			 reflects the actual average time the aide spends delivering personal care aide
			 services to a beneficiary.
221.000
Documentation
NOTE: This section is not applicable to the
				IndependentChoices program.
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
				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 supervisor or, Qualified Intellectual Disabilities
			 Professional (QIDP), or agency-designated registered nurse including without
			 limitation:
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 DHS
			 professional staff or contractor(s) designated by DHS.
3. Notes arising from a 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;
c.
			 Documentation of prior or post approval of unscheduled tasks; and
d. Recommendation or justification for the
			 frequency needed for in-person supervisory visits.
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 agency-designated registered
			 nurse, the supervisor or QIDP, the aide and the beneficiary or the
			 beneficiary's representative; as those activities affect delivering personal
			 care services.
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;
			 and
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 twenty-four (24) hours.
2. Minimum time for supervised practical
			 training is sixteen (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 sixteen
			 (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 twenty-four (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 supervisor or QIDP
			 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 two (2) years of nursing experience, at least one (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 7-1-20
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; and
4. Reporting and documenting, when pertinent,
			 the beneficiary's observations regarding their own status.
E. Recognizing and reporting, to the
			 supervisor or Qualified Intellectual Disabilities Professional (QIDP), 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 as designated by the Arkansas State Board of
			 Nursing.
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; and
13. Laundry
			 skills.
N. Early
			 recognition and reporting of changes in client condition.
244.000
Duration of PA
Personal Care PAs are generally assigned for twelve (12) months
				from the date of the last independent assessment or for the life of the service
				plan, whichever is shorter, unless the beneficiary has a change in
				condition.
204.000
Participation Requirements for Providers of Targeted Case Management for
			 Beneficiaries Ages Sixty (60) and Older Including ARChoices in Homecare Waiver
			 Participants
Providers of targeted case management who are restricted to
				serving persons sixty (60) years of age and older or serving persons ages
				twenty-one (21) and older with a physical disability and those sixty-five (65)
				and older who participate in the ARChoices in Homecare (ARChoices) 1915(c)
				waiver must be certified by the Division of Provider Services and Quality
				Assurance (DPSQA) as an organization qualified to provide targeted case
				management services.
In order to be certified by DPSQA, the provider must meet the
				following qualifications:
A. Be
			 located in the state of Arkansas;
B. Be licensed as a Class A or Class B Home
			 Health Agency or Private Care Agency by the Arkansas Department of Health or a
			 unit of state government or be a private or public incorporated agency whose
			 stated purpose is to provide case management to the elderly or adults with
			 physical disabilities;
C. Be able
			 to demonstrate one year of experience in performing case management services.
			 (Experience must be within the past three (3) years);
D. Be able to demonstrate one year of
			 experience in working specifically with individuals in the targeted group.
			 (Experience must be within the past three (3) years);
E. Have an administrative capacity to ensure
			 quality of services in accordance with state and federal
			 requirements;
F. Have the financial
			 management capacity and system that provides documentation of services and
			 costs;
G. Have the capacity to
			 document and maintain individual case records in accordance with state and
			 federal requirements;
H. Be able to
			 demonstrate that the provider has current liability coverage; and
I. Employ qualified case managers who reside
			 in or near the area of responsibility and who meet at least one of the
			 following qualifications:
1. Licensed in the
			 state of Arkansas as a social worker (Licensed Master Social Worker or Licensed
			 Certified Social Worker), a registered nurse or a licensed practical
			 nurse;
2. Have a bachelor's degree
			 from an accredited institution in a health and human services or related field;
			 or
3. Have two years' experience in
			 the delivery of human services, including without limitation having performed
			 satisfactorily as a case manager for a period of two (2) years (experience must
			 be within the past three (3) years).
A copy of the current certification must accompany the provider
				application and Medicaid contract.
218.300
Service Monitoring/Service Plan
			 Updating 7-1-20
This component includes activities and contacts that are
				necessary to ensure the TCM care plan is effectively implemented and adequately
				addressing the needs of the Medicaid-eligible beneficiary.
The maximum units allowed for this service may not exceed
				six (6) units per monitoring visit when providers are dealing with
				beneficiaries ages twenty-one (21) and older.
A. The activities and contacts may be with
			 the Medicaid-eligible beneficiary, family members, providers or other
			 entities.
B. They may be as
			 frequent as necessary, within established Medicaid maximum allowable
			 limitations, to help determine such things as:
1. Whether services are being furnished in
			 accordance with a Medicaid eligible beneficiary's plan of care;
2. The adequacy of the services in the plan
			 of care; and
3. Changes in the
			 needs or status of the Medicaid-eligible beneficiary
C. Monitoring is allowed through regular
			 contacts with service providers at least every month to verify that appropriate
			 services are provided in a manner that is in accordance with the service plan
			 and assuring through contacts with the beneficiary, at least every other month,
			 that the beneficiary continues to participate in the service plan and is
			 satisfied with services.
1. A face-to-face
			 monitoring contact with the beneficiary must be completed once every three (3)
			 months. Required contacts with the service providers may be conducted through
			 face-to-face contact or by telephone. Communication with service providers by
			 email or fax are allowed as described in Section 213.000, F.1.
2. A face-to-face contact is not considered a
			 covered monitoring contact unless the required monitoring form is completed
			 according to instructions, dated, signed by the targeted case manager, and
			 filed in the beneficiary's case record.
D. Updating includes:
1. Reexamining the beneficiary's
			 needs;
2. Identifying changes that
			 have occurred since the previous assessment;
3. Identifying hospitalizations or other
			 extended absences from the home;
4.
			 Altering the TCM service plan; and
5. Measuring the beneficiary's progress
			 toward service plan goals. Service plans should not be updated more than
			 quarterly unless there is a significant change in the beneficiary's needs.
Monitoring and follow-up activities include making necessary
				adjustments in the TCM care plan and service arrangements with providers,
				according to established program guidelines.
Face-to-face monitoring contacts must be completed as often as
				deemed necessary, based on the professional judgment of the TCM, but no less
				frequent than established in Medicaid TCM program policy.
E. Non-Covered Services include:
1. The updating of a tickler
			 system;
2. A case management agency
			 is not allowed to monitor or update an activity when the service being
			 monitored or updated is provided to the beneficiary by the same
			 agency;
3. However, the same agency
			 is allowed to be both the TCM agency and the agency providing a direct service,
			 such as personal care, home delivered meals, or PERS;
4. However, the agency is not allowed to bill
			 for a TCM monitoring contact when monitoring the
quality of care or the
			 quality of the service
provided by the same agency or when the purpose
			 of the contact is to monitor the progress of a service being in place,
			 delivered, having started, effective date, etc.;
5. In addition, TCM is not allowed when
			 monitoring is required through the direct service policy, such as with PERS
			 providers; and
6. Monitoring the
			 PERS service is a part of the certification policy for all PERS providers.
			 Additional monitoring of the PERS service by a TCM is not a covered TCM
			 service.
F. Examples of
			 case monitoring and service plan updating are shown below:
1. Example # 1
Provider "A" has been chosen by the beneficiary to provide home
				delivered meals. The beneficiary has also chosen provider "A" for case
				management services. Case management by provider "A" may not be billed for any
				activity associated with the provision of home delivered meals. It is the
				responsibility of the direct service provider to ensure quality services are
				provided. In this example, the home delivered meal provider is responsible for
				ensuring meals are delivered timely and to the beneficiary's satisfaction. Case
				management activity does not include monitoring the provision of home delivered
				meals by the same agency.
This same policy applies to any service where the case
				management agency is the same agency providing the in-home service.
2. Example # 2
Provider "B" has been chosen by the beneficiary to provide
				personal care. The beneficiary has also chosen provider "B" for targeted case
				management services. Case management by provider "B" may not be billed for any
				activity associated with the quality of the personal care services being
				provided by the same agency. It is the responsibility of the direct service
				provider to ensure quality services are provided.
In this example, the personal care provider is responsible for
				ensuring personal care services are provided to the satisfaction of the
				beneficiary and according to the plan of care (POC) that includes the personal
				care service. This includes whether or not the aide performs the duties
				assigned, arrives timely, stays the assigned period of time, is courteous, and
				meets the requirements established for the Personal Care Program by the
				Arkansas Medicaid Program.
G. A TCM provider is allowed to bill a
			 monitoring contact when the monitoring is for the purpose of verifying the
			 services included on the POC are sufficient based on the beneficiary's current
			 condition. This is also true when the case manager is contacted by the
			 beneficiary.
1. If the monitoring contact is
			 billed, based on this purpose, documentation must support the reason for the
			 contact, the results of the contact, and any changes requested to the POC.
a.
NOTE:
This type activity,
			 when based on the beneficiary's condition and the sufficiency of the services
			 in place, may be billed regardless of whether or not the case manager and the
			 direct service provider are the same agency.
b. If the monitoring contact, whether
			 initiated by the case manager or the beneficiary, is not addressing
quality of care
, the monitoring contact
			 is billable, if it meets the definition described in this manual.
2. The same policy applies to the
			 personal emergency response system (PERS) service. The TCM provider may test
			 the PERS unit when completing a monitoring visit, if the PERS unit is not
			 provided by the same agency as the TCM service.
a. Since the PERS providers are required to
			 test their units monthly, if they choose to meet that requirement by having
			 their targeted case managers test the units while in the home, this is not
			 considered a covered TCM service.
b. It does, however, meet the requirement
			 established for the PERS providers, if results of the testing are documented by
			 the PERS provider and available for audit.
H. All requests from case managers to
			 increase or decrease services or change service providers will be verified by
			 the DHS RN and justified by the DHS RN prior to any changes being made to the
			 waiver plan of care. This applies when the beneficiary is a participant in a
			 home and community-based waiver program.
See Section 262.100 for the appropriate procedure code and
				modifier.