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

12/01/1991

A. Total Services Allowed Per Consumer

Services are limited to 30 hours per week in the Primary Home Care program. This service limit is a controversial program feature, especially among disability groups like United Cerebral Palsy (UCP).

B. Type of Services Offered

1. Paramedical Services

Attendants are not allowed to do invasive procedures such as irrigate internal catheters, give injections, or give medications. They may change ostomy bags, tampons, or external catheters. Disability advocates have successfully lobbied for revision of regulations promulgated by the state Board of Nurse Examiners. These revisions theoretically allow nurses to delegate paramedical tasks to paid attendants, but these changes have not impacted state programs at this point. In a few state-funded programs, the doctor may delegate tasks directly to an attendant. There is concern among state administrators and industry representatives that provision of such services constitutes a liability risk. A DHS administrator also observes that since all provider agencies also have certified home health divisions which can bill at a much higher rate, there is an economic disincentive to modify service delivery practices.

2. Emergency and Respite Services

Both advocates and state administrators identify "service gaps" as a major problem. Currently, agencies may take up to 14 days to provide an attendant once the consumer is deemed eligible, or when consumers change agencies and/or attendants. This can be disruptive or dangerous for consumers with a high level of need. Both private agencies and DHS workers claim that high need cases receive an immediate or expedited response. However, disability advocates know of clients who, because an attendant fails to show up and they have no informal support for backup, have become enmeshed in the Adult Protective Services system and ultimately are forced back into an institutional settings. Administrators are meeting with advocates and vendors about the service gap issue, and plan to submit a recommendations to the DHS board by August of 1991.

3. Homemaker Services

Basic homemaker services for the consumer are part of many consumer service plans.

4. Supervision

Supervision is not provided as a regular service in Primary Home Care.

C. Location of Service Provision

Service is limited to the home and to medical visits.

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