North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02 - Medical Services › Section 75-02-02-09.5 - Limitations on personal care services

Current through Supplement No. 393, July, 2024
1.
				No payment for personal care services may be made unless an assessment of the
				recipient is made by the department or the department's designee and the
				recipient is determined to be impaired in at least one of the activities of
				daily living of bathing, dressing, eating, incontinence, mobility, toileting,
				and transferring or in at least three of the instrumental activities of daily
				living of medication assistance, laundry, housekeeping, and meal
				preparation.
2. No payment may be
				made for personal care services unless prior authorization has been granted by
				the department.
3. Payment for
				personal care services may only be made to an enrolled qualified service
				provider who meets the standards described in
				chapter
				75-03-23 or to a basic
				care assistance provider that qualifies for a rate under
				75-02-07.1.
4. No payment may be made for personal care
				services provided in excess of the services, hours, or time frame authorized by
				the department in the recipient's approved service plan.
5. Personal care services may not include
				skilled health care services performed by individuals with professional
				training.
6. An inpatient or
				resident of a hospital, a nursing facility, an intermediate care facility for
				individuals with intellectual disabilities, a psychiatric residential treatment
				facility, or an institution for mental diseases may not receive personal care
				services.
7. Personal care services
				may not include home-delivered meals, services performed primarily as
				housekeeping tasks, transportation, social activities, or services or tasks not
				directly related to the needs of the recipient such as doing laundry for family
				members, cleaning of areas not occupied by the recipient, shopping for items
				not used by the recipient, or for tasks when they are completed for the benefit
				of both the recipient and the provider.
8. Payment for the tasks of laundry,
				shopping, meal preparation, money management, and communication may be made to
				a provider if the activity benefits the recipient. The department may pay a
				provider for housekeeping activities involving the recipient's personal private
				space and if the recipient is living with an adult, the recipient's share of
				common living space.
9. Meal
				preparation is limited to the maximum units set by the department. Laundry,
				shopping, and housekeeping tasks when provided as personal care services must
				be incidental to the provision of other personal care tasks and cannot exceed
				thirty percent of the total time authorized for the provision of all personal
				care tasks. Personal care service tasks of laundry, shopping, and housekeeping
				are limited to the maximum units set by the department, and the cap cannot be
				exceeded under other home and community-based services funding
				sources.
10. No payment may be made
				for personal care services provided to a recipient by the recipient's spouse,
				parent of a minor child, or legal guardian.
11. No payment may be made for care needs of
				a recipient which are outside the scope of personal care services.
12. Authorized personal care services may
				only be approved for:
a. Up to one hundred
				twenty hours per month;
b. Up to
				two hundred forty hours per month, if the recipient meets the medical necessity
				criteria for nursing facility level of care described in section
				75-02-02-09 or intermediate care
				facility for individuals with intellectual disabilities level of care;
				or
c. Up to three hundred hours per
				month if the recipient is determined to be impaired in at least five of the
				activities of daily living of bathing, dressing, eating, incontinence,
				mobility, toileting, and transferring; meets the medical necessity criteria for
				nursing facility level of care described in section
				75-02-02-09 or intermediate care
				facility for individuals with intellectual disabilities level of care; and none
				of the three hundred hours approved for personal care services are allocated to
				the tasks of laundry, shopping, or housekeeping.