 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 29. PUBLIC WELFARE |
|
Chapter 29-50. MEDICAID REIMBURSEMENTS FOR PERSONAL CARE AIDE SERVICES |
Section 29-5006. PROGRAM REQUIREMENTS
-
5006.1PCA services shall be ordered, in writing, by a physician or APRN who is enrolled in the D.C. Medicaid program and has had a prior professional relationship with the beneficiary that included an examination(s) provided in a hospital, primary care physician’s office, nursing facility, or at the beneficiary’s home prior to the order for the PCA services. A written order for PCA services constitutes a certification that the beneficiary is unable to perform one (1) or more activities of daily living for which PCA services are needed.
5006.2A written order for PCA services issued in accordance with § 5006.1 shall be renewed every twelve (12) months.
5006.3Each written order for PCA services under this section shall include the prescriber’s NPI number obtained from NPPES.
5006.4A Provider has an on-going responsibility to verify that each beneficiary that receives PCA services from the Provider has current eligibility for the District of Columbia Medicaid program and is eligible for and authorized to receive PCA services.
5006.5An individual or family member other than a spouse, parent of a minor child, any other legally responsible relative, or court-appointed guardian may provide PCA services. Legally responsible relatives shall not include parents of adult children. Each family member providing PCA services shall comply with the requirements set forth in these rules.
5006.6The Provider shall initiate services no later than twenty-four (24) hours after completing the plan of care unless the beneficiary’s health or safety warrants the need for more immediate service initiation or the beneficiary or beneficiary's representatives agree to begin the services at a later date.
5006.7PCA services shall include the following:
(a)Cueing or hands-on assistance with performance of routine activities of daily living (such as, bathing, transferring, toileting, dressing, feeding, and maintaining bowel and bladder control);
(b)Assisting with incontinence, including bed pan use, changing urinary drainage bags, changing protective underwear, and monitoring urine input and output;
(c)Assisting beneficiaries with transfer, ambulation and range of motion exercises;
(d)Assisting beneficiaries with self-administered medications;
(e)Reading and recording temperature, pulse, blood pressure and respiration;
(f)Measuring and recording height and weight;
(g)Observing, documenting and reporting to the supervisory health professional, changes in the beneficiary's physical condition, behavior, and appearance and reporting all services provided on a daily basis;
(h)Preparing meals in accordance with dietary guidelines and assistance with eating;
(i)Performing tasks related to keeping areas occupied by the beneficiary in a condition that promotes the beneficiary's safety;
(j)Implementing universal precautions to ensure infection control;
(k)Accompanying the beneficiary to medical or dental appointments or place of employment and recreational activities if approved in the beneficiary’s plan of care;
(l)Shopping for items that are related to promoting a beneficiary’s nutritional status in accordance with dietary guidelines and other health needs; and
(m)Assistance with telephone use.
5006.8PCA services shall not include:
(a) Services that require the skills of a licensed professional as defined by the District of Columbia Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq.);
(b) Tasks usually performed by chore workers or homemakers, such as cleaning of areas not occupied by the beneficiary, shopping for items not related to promoting the beneficiary’s nutritional status and other health needs, and shopping for items not used by the beneficiary; and
(c) Money management.
5006.9PCA services shall not be provided in a hospital, nursing facility, intermediate care facility, or other living arrangement which includes personal care as part of the reimbursed service. However, persons residing in assisted living may receive PCA services upon prior authorization by DHCF or its agent.
5006.10PCA services may be provided at the beneficiary's place of employment.
5006.11A PCA is not authorized to make decisions on behalf of a beneficiary.
5006.12In accordance with Subsection 5006.7(g), a PCA shall immediately report to the R.N. any significant change in the beneficiary’s health status in the case of emergency, or within four (4) hours for other situations, unless indicated otherwise in the beneficiary’s plan of care.
5006.13 If the beneficiary seeks to change his or her Provider, the Provider shall assist the beneficiary in transferring to the new Provider. Until the beneficiary is transferred to a new PCA services Provider, the Provider shall continue providing PCA services to the beneficiary until the transfer has been completed successfully and the beneficiary is receiving PCA services from the new Provider.
5006.14Each Provider shall immediately terminate the services of a PCA and instruct the PCA to discontinue all services to the beneficiary, in any case where the Provider believes that the beneficiary’s physical or mental well-being is endangered by the care or lack of care provided by the PCA, or that the beneficiary’s property is at risk. The Provider is responsible for assigning a new PCA and ensuring that the beneficiary’s needs continue to be met.
5006.15 Each Provider shall conduct annual performance assessments of all PCAs who deliver services to beneficiaries served by the Provider, regardless of whether the PCA is an employee or is secured through another staffing agency. The initial performance assessment shall be conducted no later than three (3) months after the PCA first provides services to any beneficiary served by the Provider.
5006.16 Each Provider shall develop contingency staffing plans to provide coverage for each beneficiary in the event the assigned PCA cannot provide the services or is terminated.