(a) An individual PCA may be utilized to provide PC services when it is documented to be in the best interest of the member to have an individual personal care attendant (PCA) or when there are no qualified PC service agencies available in the member's local area. When an individual PCA is utilized, the OKDHS nurse explains OHCA form HCA-66, Authorization for Withholding of FICA Tax in Personal Care, to the member and obtains his/her signature. OHCA will check the list of providers that have been barred from Medicare/Medicaid participation to ensure that the individual provider is not listed.
(b) After PC services eligibility is established and prior to implementation of PC services using an individual PAC, the OKDHS nurse reviews the care plan with the member and individual PCA and notifies the member and PCA to begin PC services delivery. The OKDHS nurse maintains the original care plan and forwards a copy of the care plan to the chosen PCA within one working day of notice of approval.
(c) The OKDHS nurse monitors the care plan for members with an individual PCA. For any member receiving PC services utilizing an individual PCA, the OKDHS nurse makes a home visit at least every 180 days beginning within 90 days of the date of PC service initiation. OKDHS assesses the member's satisfaction with their PC services and evaluates the care plan for adequacy of goals and units allocated. Requests for changes in the units authorized in the care plan must be approved by the OKDHS area nurse, or designee, prior to implementation of the changed number of units.
(d) If a member requires an individual PCA and is also approved for ADvantage waiver, the ADvantage case manager develops and monitors PC service delivery as part of the ADvantage service plan. The ADvantage case manager reviews the care plan with the member and forwards a copy to the individual PCA. The ADvantage case manager contacts the member within five calendar days of service plan certification by the AA in order to make sure that services have been implemented. The ADvantage case manager contacts the member within 30 calendar days of service plan certification by the AA in order to make sure the needs of the member are being met. Requests for changes in authorized PC services units are submitted by the ADvantage case manager for approval or denial by the AA or designee, prior to implementation of the changes in units. The ADvantage case manager contacts the member monthly and makes a home visit at least every 90 days to evaluate the care plan for adequacy of goals and units allocated.
(e) With the exception of members served by the ADvantage or any other Home and Community Based Services (HCBS) Waiver, the OKDHS nurse is responsible for assessing and monitoring the provision of personal care for Individual Personal Care members. This function involves advocacy, service planning, coordination, monitoring and problem solving with service providers and with families in the provision of services.
(f) Under certain circumstances, the use of informal supports as individual PCAs may be the only available option for providing services to the member. The ADvantage Program consumer's interdisciplinary team authorizes the use of informal supports for the PC program.