5005.1 Each Provider shall conduct an initial face-to-face visit with the beneficiary to develop a plan of care for delivering PCA services no later than seventy-two (72) hours after receiving the referral for services from DHCF or its designated agent.

5005.2 The plan of care shall:

1. (a) Be developed in consultation with the beneficiary or the beneficiary's representative;
2. (b) Specify how the beneficiary's need, as identified in the assessment conducted in accordance with Section 5003.3, will be met within the amount, duration, scope, and hours of services authorized by the PCA Service Authorization as set forth in Section 5003.4;
3. (c) Consider the beneficiary's preferences regarding the scheduling of PCA services;
4. (d) Specify the detailed services to be provided, their frequency, and duration, and expected outcome(s) of the services rendered consistent with the PCA Service Authorization; and
5. (e) Be approved and signed by the beneficiary's physician or an advanced practice registered nurse within thirty (30) days of the start of care, provided that the physician or advanced practice nurse 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 prescription of the personal care services.

5005.3 A registered nurse (R.N.) who is employed by the Provider shall review the beneficiary's plan of care at least once every sixty (60) days, and shall update or modify the plan of care as needed. The R.N. shall notify the beneficiary's physician of any significant change in the beneficiary's condition.

5005.4 If an update or modification to a beneficiary's plan of care requires any change in the frequency, duration or scope of PCA services provided to the beneficiary, the Provider must obtain an updated PCA Service Authorization from DHCF or its designated agent.

SOURCE: Final Rulemaking published at 50 DCR 3957 (May 23, 2003); as amended by Final Rulemaking published at 59 DCR 1760, 1770 (March 2, 2012); as amended by Final Rulemaking published at 60 DCR 15537 (November 8, 2013).