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. (1) Providers of personal care assistance

2. (PCA) must be certified by the Division of Vocational Rehabilitation (DVR). To be certified, the provider shall meet the following criteria:

   1. (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. 1. At least fifty-one percent (51%) of the

board membership must be persons with disabilities;

1. 2. At least fifty-one percent (51%) of the

staff of the corporation must be persons with disabilities;

1. 3. Must manifest and promote an inde-

pendent living philosophy in accordance with state law and regulation;

1. 4. Demonstrate sound fiscal manage-

ment through the submission of quarterly financial reports and annual audit to DVR;

1. 5. Have available for clients/consumers,

at a minimum, the following independent living services:

1. A. Advocacy;
2. B. Independent living skills training;
3. C. Peer counseling; and
4. D. Information and referral;
5. 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

1. 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;

1. (B) Demonstrate to DVR that the community-based, not-for-profit corporation shall provide, either directly or through contract, the following:

   1. 1. Assessment and evaluation of the

extent of a client’s/consumer’s need for PCA; 19 CSR 15-8

1. 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;

1. 3. Maintain a list of persons interested

in being personal care attendants; and

1. 4. Processing of clients/consumers

and/or personal care attendants inquiries and/or problems; and

1. (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.

1. (2) DVR will monitor the certified PCA providers’ responsibilities. In addition, DVR will administer the following fiscal services:

   1. (A) Mail the individual payment directly to the employee;
   2. (B) DVR shall set maximum fees to be paid for PCA services;
   3. (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);
   4. (D) One (1) hour of PCA service equals four (4) units; and
   5. (E) DVR’s payment will be made on the lower of the established rate per service unit or the provider’s billed charges.

2. (3) Certified PCA providers shall be responsible for the following:

   1. (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;
   2. (B) Assisting clients/consumers in the general orientation of attendants as requested by clients/consumers;

   3. (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. 1. Be at least eighteen (18) years of age;
      2. 2. Meet the physical and mental

demands required to perform specific tasks required by a particular client/consumer;

1. 3. Agree to maintain confidentiality;
2. 4. Be emotionally mature and depend-

able;

1. 5. Be able to handle emergency type sit-

uations;

1. 6. Not be the client’s spouse; and
2. 7. Register with the Family Care Safety

Registry pursuant to applicable state laws and regulations;

1. (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. 1. PCA providers shall not solicit any

person to become a client/consumer;

1. (E) Coordination with other PCA providers in developing the plan of care to assure comprehensive delivery of services and reduce duplication;
2. (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;
3. (G) Operation of programs, services, and/or activities in such a manner as to be readily accessible to and usable by persons with disabilities;
4. (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;
5. (I) Maintain confidentiality of client/consumer records and eligibility information from DVR pursuant to applicable federal/state laws and regulations;
6. (J) Conduct assessments and re-evaluations for determining eligibility and the need for continued attendant care based on unmet need;
7. (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;
8. (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;

9. (M) Ensure that the client’s/consumer’s case file contains at a minimum, the following:

   1. 1. Written plan of care that documents

the type of services and quantity of units to be provided;

1. 2. The client’s/consumer’s service time

sheets contain the following information:

1. A. Attendant’s name;
2. B. Client’s/consumer’s name;
3. C. Dates of service delivery;
4. D. Time spent;
5. E. Types of activities performed on

each date;

1. F. Attendant’s signature each day; and
2. G. Client’s/consumer’s verifying sig-

nature;

1. 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;

1. 4. Signed documentation that indicates

the client/consumer has been informed of their rights concerning background checks, advanced directives, hearings and participant responsibilities:

1. A. Hearing rights and participant

choice and responsibilities forms must comply with Medicaid and/or DVR requirements;

1. 5. Documentation of training provided

to client/consumer in the skills need to understand and perform the essential functions of an employer;

1. 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;

1. 7. Evaluations and/or assessments;
2. 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

1. 9. Any pertinent documentation regard-

ing the client/consumer;

1. (N) Perform duties necessary to coordinate accounting processing requirements, including the following but not limited to:

   1. 1. Utilize DVR approved time sheets,

accumulate time sheets, certify accuracy and forward a copy to DVR for processing;

1. 2. File original time sheet in

client’s/consumer’s case file;

1. 3. Maintain required client/consumer

payroll information on a computer system compatible with DVR’s PCA computer system;

1. 4. Monitor utilization of hours by the

client/consumer at least monthly;

1. 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

1. 6. Provide as requested by DVR, the

information necessary to conduct state or federal audits or both;

1. (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;
2. (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;
3. (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
4. (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.

1. (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.