5005

PROGRAM SERVICES

5005.1 Personal care aide services shall be prescribed by a primary care physician or advanced practice registered nurse who has had a relationship with the beneficiary that extended to an examination(s) provided in a hospital, primary care physician's office, nursing facility, or at the beneficiary's home prior to the prescription of the personal care services.

5005.2 Each prescription for PCA services under this section shall include the prescriber's NPI number obtained from NPPES;

5005.3 PCA services shall be initiated no later than forty-eight (48) hours after completion of the initial assessment unless the beneficiary or the beneficiary's representatives agree to begin the services at a later date.

5005.4 An individual or family member other than a spouse, parent of a minor beneficiary, or any other legally responsible relative may provide personal care services. Each family member providing personal care services shall meet the requirements of these rules.

5005.5 Personal care services shall include, but not be limited to, the following:

(a) Performance of or assistance in performing routine activities of daily living (such as, bathing, transferring, toileting, dressing, eating and feeding self, maintaining bowel and bladder control [continence]);

(b) Assistance with bed pan use or changing urinary drainage bags;

(c) Assisting beneficiaries with a range of motion exercises;

(d) Assisting beneficiaries with self-administered medications;

(e) Reading and recording temperature, pulse, and respiration;

(f) Observing and documenting the beneficiary's status and reporting all services provided;

(g) Meal preparation in accordance with dietary guidelines and assistance with eating;

(h) Tasks related to keeping areas occupied by the beneficiary in a condition that promotes the beneficiary's safety;

(i) Accompanying the beneficiary to medically-related appointments or place of employment;

(j) Providing assistance at the beneficiary's place of employment;

(k) Shopping for items related to promoting the beneficiary's nutritional status and other health needs;

(l) Recording and reporting to the supervisory health professional, changes in the beneficiary's physical condition, behavior or appearance;

(m) Infection control; and

(n) Accompanying the beneficiary to recreational activities prescribed by the beneficiary's primary care physician or advanced practice registered nurse.

5005.6 PCA services shall not include:

(a) Services that require the skills of a licensed professional as defined by the Health Professional Licensing Administration (HPLA); and

(b) Tasks usually performed by chore workers, such as cleaning of areas not occupied by the beneficiary and shopping for items not used by the beneficiary.

5005.7 PCA services shall be made available seven (7) days per week.

5005.8 Personal care services shall not be provided in a hospital, nursing facility, intermediate care facility for persons with intellectual and developmental disabilities (ICF/IDD), or any institutional setting.

SOURCE: Final Rulemaking published at 50 DCR 3957 (May 23, 2003); as amended by Notice of Final Rulemaking published at 59 DCR 1760, 1770 (March 2, 2012).