Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 15 - Division of Senior and Disability Services › Chapter 8 - Consumer-Directed Services › Section 19 CSR 15-8.100 - Definitions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule defines terms used in establishing
				  procedures for the provision of consumer-directed services under the Department
				  of Health and Senior Services to eligible consumers through eligible vendors,
				  subject to legislative appropriations.
(1) As used in this rule and other rules
				established for consumer-directed services (CDS), except as otherwise required
				for the context, the following terms shall have the meanings ascribed:
(A) Adjusted gross income. The amount
				reported to the Internal Revenue Service (IRS) as adjusted gross income on the
				previous calendar year's income tax return for the consumer and the consumer's
				spouse;
(B) Assets. Any tangible,
				real, or personal property as would be reported to the Department of Social
				Services (DSS), Family Support Division (FSD) for the purpose of determining
				eligibility for Medicaid;
(C)
				Consumer. A physically disabled person determined by the Department of Health
				and Senior Services (DHSS) to be eligible to receive consumer-directed services
				(CDS). Consumer does not include any individual with a legal limitation of his
				or her ability to make decisions, including the appointment of a guardian or
				conservator, or who has an effective power of attorney that authorizes another
				person to act as the agent or on behalf of the individual for any of the duties
				required by the CDS program;
(D)
				Consumer-directed. The hiring, training, supervising, and directing of the
				personal care attendant (attendant) by the physically disabled
				person;
(E) Consumer-directed
				services (CDS). All services that are required or may be provided as part of
				the CDS program;
(F)
				Disability-related medical expenses. Any medical expense, as defined and
				approved by the IRS, that is directly related to the consumer's
				disability;
(G) Health care
				coverage. Any insurance policy that provides personal care assistance
				benefits;
(H) Income. Any income as
				would be reported to DSS/FSD for the purpose of determining eligibility for
				Medicaid;
(I) Live independently.
				To reside and perform routine tasks of daily living and activities of daily
				living and activities in the community in a noninstitutional or unsupervised
				residential setting;
(J)
				Non-Medicaid eligible (NME). Has been found by DSS/FSD not to be eligible to
				participate under guidelines established by the Medicaid state plan;
(K) Non-Medicaid eligible (NME) program.
				Financial assistance for CDS through eligible vendors for individuals who are
				NME consumers;
(L) Personal care
				assistance (PCA) services. Those routine tasks provided to meet the unmet needs
				required by a physically disabled person to enable him or her to live
				independently;
(M) Personal care
				attendant (attendant). A person, other than the consumer's spouse, who performs
				PCA services for a physically disabled person;
(N) Physically disabled. Loss of, or loss of
				use of, all or part of the neurological, muscular or skeletal functions of the
				body to the extent that person requires the assistance of another person to
				accomplish routine tasks;
(O)
				Routine tasks. Routine tasks and instrumental activities of daily living
				include, but are not limited to, the following:
1. Bowel and bladder elimination;
2. Dressing and undressing;
3. Moving into and out of bed;
4. Preparation and consumption of food and
				drink;
5. Bathing and
				grooming;
6.
				Shopping/transportation;
7.
				Maintenance and use of prostheses, aids, equipment and other similar devices;
				and/or
8. Ambulation, housekeeping,
				or other functions of daily living based on an independent living philosophy as
				specified in state law and regulation;
(P) Undue hardship. The result of a
				significantly difficult circumstance experienced by the disabled consumer that
				creates a situation of burden, risk or harm to the consumer. Undue hardship
				includes, but is not limited to, the following:
1. Loss of consumer's income;
2. Overall disintegration of the
				family;
3. Abuse and
				neglect;
4. Misuse of child labor;
				and/or
5. Presence of physical
				contraindication(s);
(Q)
				Unit of service. One unit equals fifteen (15) minutes;
(R) Unmet needs. Routine tasks and activities
				of daily living which cannot be reasonably met by members of the consumer's
				household or other current support systems without causing undue hardship;
				and
(S) Vendor. Any person, firm or
				corporation having a written agreement with DHSS to provide services, including
				monitoring and oversight of the attendant, orientation and training of the
				consumer, and fiscal conduit services necessary for delivery of CDS to
				physically disabled persons.