PURPOSE: This rule establishes the criteria and procedures for determining an applicant eligible to receive personal care assistance program services.

1. (1) Subject to legislative appropriations, the Division of Vocational Rehabilitation (DVR) shall provide financial assistance for the personal care assistance (PCA) program services through eligible providers to each client/consumer selected to participate and meeting the criteria:

   1. (A) All clients/consumers must meet the following general criteria for eligibility under the PCA program:

      1. 1. Be at least eighteen (18) years of age;
      2. 2. Able to direct their own care (partic-

ipant directed);

1. 3. Employed, ready for employment, or

capable of living independently with PCA; and

1. 4. Physically disabled;

2. (B) In addition to the above general criteria, persons eligible for non-Medicaid eligible (NME) PCA services shall meet the following:

   1. 1. Document need for a minimum of

seven (7) or maximum of forty-two (42) hours per week of PCA. If more than fortytwo (42) hours per week are required, substantial documentation may be used to support a request for additional time;

1. 2. Demonstrate financial need based

upon the client/consumer adjusted gross income level of the most recent tax records less living expenses as approved by DVR and compared to three hundred percent (300%) of the U.S. Department of Health and Human Services poverty level for Missouri and the Consumer Price Index as updated on an annual basis; and

1. 3. Participate in an evaluation conducted

by the assessment team to assess the individual’s qualifications to be eligible for PCA services:

1. A. The initial evaluation shall be con-

ducted in the individual’s home or current place of residence at the time of application. If the individual is in the process of relocation, the assessment shall be conducted at the new residence; and

1. (C) In addition to the above general criteria, persons eligible for Medicaid PCA services shall meet the following:

   1. 1. Document proof of Medicaid eligibil-

ity under Title XIX of the Social Security Act pursuant to federal/state laws and regulations; and

1. 2. Participate in an assessment with the

assessment team or the Department of Health and Senior Services, Division of Senior Services (Division of Senior Services) that utilizes a level of care evaluation tool that is approved by the state Medicaid agency and assigns a point value pursuant to federal/state laws and regulations.

1. A. The initial assessment shall be

conducted in the individual’s home or current place of residence at the time of application. If the individual is in the process of relocation, the assessment shall be conducted at the new residence.

1. (2) Individuals eligible for Medicaid under Title XIX of the Social Security Act who do not meet the above criteria for PCA shall be referred to the Division of Senior Services or other agencies as appropriate, to determine eligibility for PCA services pursuant to state laws and regulations.

2. (3) The assessment team must consist of an independent living specialist, rehabilitation counselor, and a medical professional from physical therapy, occupational therapy, or a registered nurse. Other team members may include additional service providers, including Division of Senior Services personnel. When a client/consumer is currently receiving PCA services from another agency and wishes to transfer PCA services to DVR, the other agency’s case manager should be consulted for planning purposes:

   1. (A) The independent living specialist will serve as a team member, consultant on independent living, and must be qualified as follows:

      1. 1. Understand basic principles of case

management;

1. 2. Possess previous experience in an

independent living program or a related field (that is, case services, peer counseling, etc.);

1. 3. Possess the ability to communicate

effectively;

1. 4. Possess skills in training others to live

independently; and

1. 5. Participate in assessment and evalua-

tion training provided by DVR;

1. (B) The medical professional will be contracted by DVR, serve as team leader, conduct the assessment, and must be qualified as follows:

   1. 1. If a physical therapist, the individual

shall possess a valid and unencumbered license as a registered physical therapist, in accordance with state law and regulation, and be approved as a contractor with DVR;

1. 2. If an occupational therapist, the indi-

vidual shall possess a valid and unencumbered license as a registered occupational therapist, in accordance with state law and regulation, and be approved as a contractor with DVR; or

1. 3. If a registered nurse, the individual

shall possess a valid and unencumbered license as a registered nurse in accordance with state law and regulation, and be approved as a contractor with DVR; and

1. (C) The rehabilitation counselor will serve as a team member, reviews and approves all assessments.

1. (4) The PCA services plan (plan of care) is based on the assessment/evaluation performed by the assessment team or Division of Senior Services and determines the appropriateness and adequacy of services, ensures the services furnished are consistent with the nature and severity of the individual’s disability. If a client/consumer transfers from or is shared with the Division of Senior Services, a new evaluation and PCA services plan (POC) is required but must maintain cost neutrality through the next regularly scheduled assessment date, unless undue hardship is documented. The plan of care will be available for review upon proper release by the client’s/consumer’s physician:

   1. (A) The evaluation and re-evaluation shall be conducted in the client’s/consumer’s home or place of residence and include, but not be limited to, the following:

      1. 1. The functions of daily living;
      2. 2. The frequency and duration of the

routine task or activity required to live independently; and

1. 3. A description of met and/or unmet

need;

1. (B) The NME plan of care shall include, but not be limited to, the following:

   1. 1. The maximum number of hours of

PCA to be provided;

1. 2. The maximum amount of financial

assistance to be provided by DVR for PCA services;

1. 3. The date of evaluation, initiation of,

and re-evaluation of the PCA services; and

1. 4. Signatures of the client/consumer,

rehabilitation counselor, and provider; and

1. (C) The Medicaid PCA services plan of care, subject to DVR’s approval, shall include, but not be limited to, the following:

   1. 1. The maximum number of hours of

PCA to be provided based on a client’s/consumer’s unmet need;

1. 2. The description and frequency of ser-

vices provided as documented on the assessment and evaluation;

1. 3. The type of provider who will furnish

each service;

1. 4. The starting date for PCA services;
2. 5. The date for re-evaluation of PCA

services;

1. 6. Consent signatures by the client/con-

sumer and assessment team members and the approval signature by DVR; and

1. 7. If a client/consumer is receiving ser-

vices or transferring from another service provider or agency, the provider is responsible for collaborating and coordinating services through the plan of care.

1. (5) The individual shall be notified by the provider of DVR decision within thirty (30) days of the date of application for eligibility for PCA services.

2. (6) PCA services are participant directed and the client/consumer shall be responsible, at a minimum, for the following:

   1. (A) Selection, hiring, training, and supervision of the client’s/consumer’s PCA attendant;
   2. (B) Preparation of biweekly time sheets, signed by both the client/consumer and PCA which shall be submitted to the provider in a timely manner;
   3. (C) Prompt notification to DVR of any changes in need for PCA services, that affect the amount of PCA received, financial status, and/or place of residence;
   4. (D) Prompt notification of the provider regarding any problems resulting from the quality of services rendered by the PCA attendant; and
   5. (E) Ensure that hours submitted for reimbursement do not exceed the amounts authorized by the plan of care.
3. (7) The client/consumer shall be reassessed and/or re-evaluated for Medicaid eligibility, at least annually, for continued need of PCA services including financial need.

4. (8) A client’s/consumer’s PCA services may be discontinued by a provider in certain circumstances:

   1. (A) The provider may request discontinuation of PCA services in the following situations:

      1. 1. If the provider learns of circum-

stances that require the closure of a client’s/consumer’s case, including but not limited to, death, entry into a nursing home, no longer needing service, and/or the inability to participant direct PCA service;

1. 2. If the client/consumer has falsified

records or committed fraud;

1. 3. If the client/consumer is noncompli-

ant with the plan of care. Noncompliance requires persistent actions by the client/consumer or family/representative which negate the services provided in the plan of care;

1. 4. If the client/consumer or client’s/con-

sumer’s family/representative threatens and/or abuses the PCA attendant and/or provider to the point where the staff’s welfare is in jeopardy and corrective action has failed; and/or

1. 5. If a provider is unable to continue to

meet the maintenance needs of a client/consumer whose plan of care hours exceed availability;

1. (B) The provider shall confer with DVR, the client/consumer and/or their representative prior to requesting termination of PCA services in writing. This may include discussion of alternatives, including but not limited to, a transfer to another agency, institutional placement, or other appropriate care;
2. (C) Prior to termination of PCA services, the provider must notify DVR and client/consumer, in writing, listing the specific reasons, and requesting discontinuation of services; and
3. (D) The client/consumer may request under the rules promulgated by the State Board of Education, informal review and/or a hearing. The provider shall not suspend, reduce or terminate services provided to a client/consumer during this time period, unless the client/consumer or their representative requests in writing that services be suspended, reduced or terminated.

AUTHORITY: sections 161.092, RSMo Supp. 2003, 178.662, 178.666 and 178.673, RSMo 2000.* This rule originally filed as 5 CSR 90-7.100. Original rule filed June 28, 2001, effective Jan. 30, 2002. Amended: Filed Sept. 12, 2003, effective April 30, 2004. Moved to 19 CSR 15-8.200, effective Aug. 29, 2005. *Original authority: 161.092, RSMo 1963, amended 1973, 2002, 2003; 178.662, RSMo 1984, amended 1987, 1992; 178.666, RSMo 1984, amended 1992; and 178.673, RSMo 1984, amended 1993. 19 CSR 15-7.400 Providers PURPOSE: This rule establishes the criteria and procedures for certifying a provider eligible to provide personal care assistance program services and the responsibilities of the certified provider. (1) Providers of personal care assistance (PCA) must be certified by the Division of Vocational Rehabilitation (DVR). To be certified, the provider shall meet the following criteria: (A) Be a community-based, not-for-profit corporation pursuant to state laws and regulations, in existence for twenty-four (24) consecutive months, with the following: 1. At least fifty-one percent (51%) of the board membership must be persons with disabilities; 2. At least fifty-one percent (51%) of the staff of the corporation must be persons with disabilities; 3. Must manifest and promote an inde- pendent living philosophy in accordance with state law and regulation; 4. Demonstrate sound fiscal manage- ment through the submission of quarterly financial reports and annual audit to DVR; 5. Have available for clients/consumers, at a minimum, the following independent living services: A. Advocacy; B. Independent living skills training; C. Peer counseling; and D. Information and referral; 6. Meet or exceed program standards for approval by the Commission on Accreditation of Rehabilitation Facilities (CARF) or a certification process accepted by DVR; and 7. Demonstrate a positive impact on consumer outcomes regarding the provision of these services through the submission of quarterly service reports and an annual service report to DVR; (B) Demonstrate to DVR that the community-based, not-for-profit corporation shall provide, either directly or through contract, the following: 1. Assessment and evaluation of the extent of a client’s/consumer’s need for PCA; 19 CSR 15-8 2. Orientation and training of clients/consumers concerning the recruitment, training and supervision of personal care attendants including but not limited to the preparation of time sheets; 3. Maintain a list of persons interested in being personal care attendants; and 4. Processing of clients/consumers and/or personal care attendants inquiries and/or problems; and (C) The provider of PCA services to clients/consumers who are Medicaid eligible must have a valid participation agreement with Medicaid pursuant to state laws and regulations. (2) DVR will monitor the certified PCA providers’ responsibilities. In addition, DVR will administer the following fiscal services: (A) Mail the individual payment directly to the employee; (B) DVR shall set maximum fees to be paid for PCA services; (C) The total monthly payment for PCA services made on behalf of client/consumer cannot exceed one hundred percent (100%) of the average statewide monthly cost for care in a nursing facility as defined in state laws and regulations (excluding intermediate care facility/mentally retarded); (D) One (1) hour of PCA service equals four (4) units; and (E) DVR’s payment will be made on the lower of the established rate per service unit or the provider’s billed charges. (3) Certified PCA providers shall be responsible for the following: (A) Training and orientation of clients/consumers in skills needed to recruit, employ, instruct, supervise and maintain the services of attendants including but not limited to the preparation of time sheets; (B) Assisting clients/consumers in the general orientation of attendants as requested by clients/consumers; (C) Maintaining a list of personal care attendants available for selection by the client/consumer. The attendants are employees of the client/consumer only for the time period subsidized with PCA funds, but are never employees of DVR or the state of Missouri. The attendants must meet the following qualifications: 1. Be at least eighteen (18) years of age; 2. Meet the physical and mental demands required to perform specific tasks required by a particular client/consumer; 3. Agree to maintain confidentiality; 4. Be emotionally mature and depend- able; 5. Be able to handle emergency type sit- uations; 6. Not be the client’s spouse; and 7. Register with the Family Care Safety Registry pursuant to applicable state laws and regulations; (D) Public information, outreach and education activities to ensure that persons with disabilities are informed of the services available and have maximum opportunity for participation: 1. PCA providers shall not solicit any person to become a client/consumer; (E) Coordination with other PCA providers in developing the plan of care to assure comprehensive delivery of services and reduce duplication; (F) Assuring that federal funds shall not be used to replace funds from nonfederal sources and that the provider shall continue or initiate efforts to obtain support from private sources or other public organizations; (G) Operation of programs, services, and/or activities in such a manner as to be readily accessible to and usable by persons with disabilities; (H) Assurance of compliance with Title VI of the Civil Rights Act of 1964, Section 504, The Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972, and the Age Discrimination Act of 1975; (I) Maintain confidentiality of client/consumer records and eligibility information from DVR pursuant to applicable federal/state laws and regulations; (J) Conduct assessments and re-evaluations for determining eligibility and the need for continued attendant care based on unmet need; (K) Document that a valid written plan of care was developed by the assessment team, Department of Health and Senior Services, Division of Senior Services and/or qualified individuals for each client/consumer prior to the provision of PCA services; (L) Perform case management activities with the consumer at least monthly, to provide ongoing monitoring of the provision of services in the plan of care and other services as needed to live independently; (M) Ensure that the client’s/consumer’s case file contains at a minimum, the following: 1. Written plan of care that documents the type of services and quantity of units to be provided; 2. The client’s/consumer’s service time sheets contain the following information: A. Attendant’s name; B. Client’s/consumer’s name; C. Dates of service delivery; D. Time spent; E. Types of activities performed on each date; F. Attendant’s signature each day; and G. Client’s/consumer’s verifying sig- nature; 3. Copies of all correspondence with DVR, the client’s/consumer’s physician or other service providers, including but not limited to other administrative agencies; 4. Signed documentation that indicates the client/consumer has been informed of their rights concerning background checks, advanced directives, hearings and participant responsibilities: A. Hearing rights and participant choice and responsibilities forms must comply with Medicaid and/or DVR requirements; 5. Documentation of training provided to client/consumer in the skills need to understand and perform the essential functions of an employer; 6. For clients/consumers eligible for services under Title XIX of the Social Security Act, the assessment shall be available for review upon proper release by a physician possessing a valid license pursuant to state laws and regulations; 7. Evaluations and/or assessments; 8. Annual financial documentation for the non-Medicaid eligible (NME) program to include the financial application or documentation of Medicaid eligibility for the Medicaid state plan program; and 9. Any pertinent documentation regard- ing the client/consumer; (N) Perform duties necessary to coordinate accounting processing requirements, including the following but not limited to: 1. Utilize DVR approved time sheets, accumulate time sheets, certify accuracy and forward a copy to DVR for processing; 2. File original time sheet in client’s/consumer’s case file; 3. Maintain required client/consumer payroll information on a computer system compatible with DVR’s PCA computer system; 4. Monitor utilization of hours by the client/consumer at least monthly; 5. Be responsible for any federal and/or state funds for attendant services that are deferred or ultimately disallowed arising from a failure to comply with a federal and/or state requirement; and 6. Provide as requested by DVR, the information necessary to conduct state or federal audits or both; (O) Ensure that a copy of the plan of care, assessment, and evaluation are in the client’s/consumer’s home and accessible to all attendants at all times; (P) Submit quarterly financial reports to DVR one (1) day after the end of the quarter or as soon as practicable thereafter, but no later than fifteen (15) days after the end of the quarter. Quarterly service reports will be submitted to DVR thirty (30) days after the end of the quarter. If required reports are not submitted on a timely basis, future funding will be withheld by DVR until the provider submits the required documentation; (Q) Maintain PCA financial records separately from any other financial records and make all client/consumer and PCA financial records, documents, reports and data available to DVR; and (R) Submit an annual audit by a properly licensed independent practitioner (certified public accountant licensed in the state of Missouri) pursuant to applicable federal/state laws and regulations, including any audit parameters as established by DVR. The audit report must be submitted to DVR within ninety (90) days after the end of the provider’s fiscal year. (4) Providers not meeting the above-stated responsibilities may have their funds and/or certification as a PCA provider suspended or terminated by DVR. AUTHORITY: sections 161.092, RSMo Supp. 2003 and 178.662, 178.664, 178.666, 178.669 and 178.673, RSMo 2000.* This rule originally filed as 5 CSR 90-7.200. Original rule filed June 28, 2001, effective Jan. 30, 2002. Amended: Filed Sept. 12, 2003, effective April 30, 2004. Moved to 19 CSR 15-8.400, effective Aug. 29, 2005. *Original authority: 161.092, RSMo 1963, amended 1973, 2002, 2003; 178.662, RSMo 1984, amended 1987, 1992; 178.664, RSMo 1984, amended 1987; 178.666, RSMo 1984, amended 1992; 178.669, RSMo 1984; and 178.673, RSMo 1984, amended 1993.