PURPOSE: This rule revises an existing program, known as Personal Care Assistance, administered by the Division of Vocational Rehabilitation to permit Medicaid reimbursement for PCA services to persons who are Medicaid eligible and also meet PCA eligibility. This program will be administered according to this rule and 5 CSR 90-7.010.

1. (1) Persons eligible for Personal Care Assistance (PCA) under Medicaid must—

   1. (A) Be eligible for PCA according to criteria defined in 178.662, RSMo; and
   2. (B) Be determined eligible for Title XIX (Medicaid) by the Division of Family Services.
2. (2) Medicaid-eligible persons who do not meet criteria for PCA as defined in 178.662, RSMo shall be referred to the Division of Aging for assessment for personal care under 13 CSR 70-91.010.

3. (3) Criteria for Providers: Providers of PCA must—

   1. (A) Have a valid participation agreement with the state Medicaid agency; and

   2. (B) Have a valid contract with the Division of Vocational Rehabilitation (DVR) as an independent living center. The contract with DVR certifies the center is capable of providing the following services:

      1. 1. Client assessment and evaluation by a

team which includes an independent living specialist, physical or occupational therapist, and a registered nurse;

1. 2. The personal care assistance plan

developed by the assessment team will be made available for review by the client’s physician;

1. 3. Maintenance of a list of qualified per-

sonal care attendants available for selection by the client; and

1. 4. Training the client in recruitment and

training of attendants as specified in 5 CSR 90-9.010.

1. (4) Reimbursement.

   1. (A) The Division of Vocational Rehabilitation shall set maximum fees to be paid for personal care assistance services.
   2. (B) The total monthly payment for personal care assistance as defined in section (3) of this rule made in behalf of an individual cannot exceed one hundred percent (100%) of the average statewide monthly cost for care in a nursing facility as defined in 13 CSR 70- 10.010(4)(Q) (excluding intermediate care facility/mentally retarded (ICF/MR)).
   3. (C) The average monthly cost to the state for care in a nursing facility, as defined in 13 CSR 70-10.010(4)(Q) (excluding ICF/MR), will be established in the month of May of each state fiscal year by the Division of Medical Services which will become effective on July 1 of the following state fiscal year.
   4. (D) One (1) hour of service equals one (1) unit.
   5. (E) Payment will be made on the lower of the established rate per service unit or the provider’s billed charges.

AUTHORITY: sections 208.153 and 208.201, RSMo 1994.* Emergency rule filed Oct. 3, 1994, effective Nov. 1, 1994, expired Jan. 29, 1995. Original rule filed Oct. 28, 1994, effective June 30, 1995. Amended: Filed March 2, 1998, effective Sept. 30, 1998. *Original authority: 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991 and 208.201, RSMo 1987.