Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. IV. Service Limits


A. Total Services Allowed Per Consumer

Personal care is rarely provided on a daily basis for SDSD clients. Most PCS consumers receive 4 to 7 hours of PAS per week. People with extensive needs will be placed into either the waiver programs or some sort of residential program.

The CSD has set maximum monthly hours for different types of services, i.e., 100 hours/month for ADL tasks, 100 hours/month for supervision, 15 hours/month for night-time care, 100 hours for delegation of nursing procedures, etc.

B. Type of Services Offered

1. Paramedical Services

Because of the Nurse Delegation Act and because CNAs are used to provide PCS with RN supervision, many paramedical services can be provided (including external Catheter and colostomy care, medications, and respiration). More skilled or invasive procedures are provided by home health aides. Service limits preclude daily provision of such tasks under PCS.

Extensive paramedical services are offered through CSD. Up to 100 hours of "delegation of nursing procedures" per month may be authorized by CSD caseworkers. The Oregon State Health Division has developed two Pediatric Nursing Procedure manuals, which detail the provision of the 30 clinical procedures which can be delegated.

2. Emergency and Respite Services

Because hours are so limited, PCS is not a viable source of respite services for SDSD clients. There is an emergency authorization process, so PCS may be used in emergencies by SDSD.

Emergency and respite services are not explicitly listed as reimbursable personal care by CSD, but "standby assistance/intensive behavioral supervision" could be made available for emergency or respite needs of children.

3. Homemaker Services

Basic housekeeping tasks necessary for consumer health and safety can be provided by PCS. In practice, personal care is too costly to provide ongoing housekeeping services. PCS can be supplemented by waiver funds, so independent providers can be used for housekeeping.

CSD reimburses for "household assistance essential to the child's health and comfort", which may cover some homemaker services.

4. Supervision

Supervision, specifically "care of confused, mentally or physically disabled clients" is defined as a personal care service by SDSD. Because PCS is generally not offered daily, it is not sufficient for people with higher supervision needs.

Up to 100 hours per month of "behavior management and supervision" as well as up to 15 hours of "intensive behavioral supervision" may be authorized by CSD caseworkers.

C. Location of Service Provision

PCS funding is not used by SDSD for adult foster care and other residential programs. PCS is limited to individual homes, and assistance "to and from necessary appointments."

For CSD, personal care is used for foster care placement of disabled children. Provision of services is not necessarily limited to the home: supportive services such as "travel and shopping to meet the child's health care, nutritional, educational, and recreational needs" are covered.

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