Personal Care ServicesMedicaid In The Schools Dana Bennett, RN Health Services Nurse
Introduction • Personal Care is medically necessary services authorized by a physician. • It is IEP driven. • Reimbursement is available. • It is designed to assist a student with their physical dependency needs related to activities of daily living.
Activities Of Daily Living • Bathing • Bladder and bowel requirements • Dressing • Eating • Incidental housekeeping • Personal hygiene • Shopping • Laundry • Mobility/Ambulation
Services That Are Covered • The student must have a physical dependency need preventing or substantially impairing their ability to do these things for themselves.
Tasks associated with ADL’s • Eating • Example: puree food for student , cut food up, hand over hand assistance. • Mobility and Ambulation • Example: assist student form sitting to standing position, assist with walking, assist with ROM.
Cont.’d • Personal hygiene • Example: assist with brushing teeth, assist with hand and face washing. • Bladder and bowel • Example: assist student to restroom, assist with clothing. • Bathing • Example: assist student with holding wash cloth.
Cont.’d • Dressing • Example: assist student with buttons, assist with putting on coat. • Incidental Housekeeping means cleaning of the floor and furniture only in the area of the service delivery location occupied by that student. • Laundry means laundering only items incidental to the care of that student. • Example: cleaning soiled clothing.
Cont.’d • Shopping means services to address the student’s physical dependency need by assisting the student with shopping or by shopping for the student.
Acting as a Medicaid Provider • Personal Care requires a separate provider number. • Paraprofessionals must complete a 40 hour curriculum, take a test, and receive the ADE certification. • The district must employ an RN.
Cont.’d • The RN is responsible for the services that are provided by the personal care aide, thus supervision is a requirement. • Documentation requirements
General Certification Requirements • Minimum classroom training is 24 hours. • Paraprofessional Modules through the ADE, special education unit. • Minimum for practical training is 16 hours. • Training curriculum provided on website • RN must train • Certified Nursing Assistants, Certified Home Health Aides with current valid credentials are deemed qualified.
Delegation • Nurse Practice Act • Delegation Chart
Student Privacy Requirements • The Family Educational Rights and Privacy Act of 1973(FERPA) • The Health Insurance Portability and Accountability Act of 1996(HIPAA) • Confidentiality of student records. • Need to know basis.
Documentation Log • Essential for calculating time • Documentation of specific services rendered • Can be coded for services, where services are provided • Cumulative daily minutes provided calculate into billable units.
Billing • Billed by 15 minute increments from documentation log) • Based on prior authorized hours: • AFMC review • Quarterly match requirement for district • EDS • FFS Electronic Medicaid Billing • $3.46 per 15 minute unit
Documentation • Service Log • Prior Authorization • Supervision Notes
Prior Authorization • Goes along with the student’s service plan • Service plan is included in the Prior Authorization.
Supervision • RN is required to make supervised visits with aide and student at a minimum of 2 times per 183 days. • RN is required to review the aide’s records, document the review, and if necessary make changes to the plan which may include further instruction)
Contact Information • Medicaid In The Schools • 2402 Wildwood, Suite 172 • Sherwood, AR. 72120 • 1-866-280-8300 • Dana Bennett-Health Services Nurse • 501-681-6087 • email@example.com • http://arksped.k12.ar.us/sections/medicaid.html