Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1110 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Activities of
				daily living" (ADL) means basic personal everyday activities limited to
				bathing, personal hygiene, transferring, positioning, eating, dressing,
				toileting, assistance with exercise routine performed in home,
				self-administered medication, including medication reminders, and meal
				preparation.
(2) "Agency-based
				services" means services provided by a qualified personal care provider agency.
				The agency works with the member to establish the schedule for service
				provision and provides the trained staff necessary for the delivery of
				care.
(3) "Annual review" means a
				member review conducted by a licensed nurse from the designated quality
				improvement organization once every 365 days. The review of the member's health
				status includes the completion of a functional assessment and service
				profile.
(4) "Case manager" means a
				nurse or social worker who is responsible for managing services provided to
				eligible members under the Home and Community Based Services (HCBS Waiver)
				Program. These case managers plan, implement, and monitor the delivery of
				services available through the program to the member.
(5) "Department" means the Montana Department
				of Public Health and Human Services.
(6) "Direct-Care Wage" means funding which is
				a supplemental payment made to Personal Assistance Services (PAS) providers for
				the purpose of providing direct-care wage increases, benefits, or lump-sum
				payments to workers that provide direct services. These funds are distributed
				proportionately based on a pro rata share of appropriated funding to
				participating providers of PAS. The distribution is based on the number of
				units of Medicaid PAS provided by each provider agency for the distribution
				year relative to the total number of units provided statewide by all providers
				of PAS.
(7) "Functional assessment"
				means an assessment that is performed by the designated quality improvement
				organization licensed nurse to determine if the member qualifies for PAS and
				requires assistance with activities of daily living, instrumental activities of
				daily living, and health maintenance activities.
(8) "Health Care for Health Care Workers"
				means funding which is designated for the purpose of Medicaid provider rate
				increases when health insurance is provided for direct-care workers in the
				personal assistance, personal assistance services, and private duty nursing
				programs. The funds must be used to cover premiums for health insurance that
				meet defined benchmark criteria established by the department. These funds are
				distributed proportionately based on a pro rata share of appropriated funding
				to participating providers of PAS based on the number of units of Medicaid PAS
				provided by each provider for the distribution year relative to the total
				number of units provided statewide by all providers of service.
(9) "Health care professional" means a
				medical doctor, certified physician assistant, nurse practitioner or registered
				nurse, occupational therapist or a medical social worker, who is familiar with
				the member's activities of daily living. The health care professional may not
				be a paid employee of the PAS provider agency.
(10) "Health maintenance activities" means
				health-related tasks that may be reimbursed through the Nurse Practice Act
				exemption in accordance with ARM
				24.159.1616 and
				37-8-103,
				MCA. These tasks are limited to bowel programs, wound care, urinary system
				management, and administration of medication. These activities are delivered by
				the member's personal care attendant when the activities, in the opinion of the
				physician or other health care professional, can be performed by the person if
				the person were physically capable and if the procedure could be safely
				performed in the home. A member is only able to receive these services from a
				personal care attendant using the self-direct model.
(11) "Instrumental activities of daily
				living" means activities which are limited to activities provided in accordance
				with the service plan, which are directly related to the member's
				person-centered needs. These activities are limited to the following:
(a) household tasks which are limited to
				cleaning the area used by the member, changing the member's bed linens, and
				doing the member's laundry; and
(b)
				shopping.