PURPOSE: This rule establishes the standards and procedures for the provision of state-funded participant-directed personal care assistance services to eligible clients subject to legislative appropriations through eligible vendors under guidelines established by the Division of Vocational Rehabilitation.

1. (1) Definitions. As used in this rule, except as otherwise required for the context, the following terms shall have the meanings ascribed:

   1. (A) After-tax income. The sum of all income from all sources to an individual including, but not limited to, salary, wages, tips, interest, dividends, annuities, pensions and disability payments, less the sum of all federal, state and local taxes on this income;
   2. (B) Client/consumer. A physically disabled person determined by the Division of Vocational Rehabilitation (DVR) to be eligible to receive personal care assistance (PCA) services;
   3. (C) Counselor. An employee of DVR responsible for determining eligibility for PCA services and for developing and implementing a PCA services plan (plan of care);
   4. (D) Employment. A minimum of sixteen

2. (16) hours per week for which an individual receives remuneration;

   1. (E) Live independently. To reside and perform routine tasks of daily living and activities of daily living and activities in the community in a noninstitutional or unsupervised residential setting;

   2. (F) Participant-directed. Hiring, training, supervising and directing of the personal care attendant by the physically disabled person; excluding, but not limited to, the following:

      1. 1. Any individual with a legal designa-

tion, including guardianship, conservator, power of attorney, etc., that involves the authorization of another person to act as the agent for any of the duties required by the participant-directed program;

1. (G) Personal care assistance services. Those services required by a physically disabled person to enable him/her to perform those routine tasks and activities of daily living necessary to enter and maintain employment or to live independently;
2. (H) Personal care attendant. A person who performs PCA tasks for a physically disabled person;
3. (I) Physically disabled. Loss of, or loss use of, all or part of the neurological, muscular or skeletal functions of the body to the extent that person requires the assistance of another person to accomplish routine tasks;

4. (J) Routine tasks. Routine tasks and instrumental activities of daily living include, but are not limited to, the following:

   1. 1. Bowel and bladder elimination;
   2. 2. Dressing and undressing;
   3. 3. Moving into and out of bed;
   4. 4. Preparation and consumption of food

and drink;

1. 5. Bathing and grooming;
2. 6. Shopping/transportation;
3. 7. Maintenance and use of prostheses,

aids, equipment and other similar devices; and/or

1. 8. Ambulation or other functions of

daily living based on an independent living philosophy as specified in state law and regulation;

1. (K) Vendor. Any person, firm or corporation certified by DVR as eligible to provide evaluation, training and administrative services to physically disabled persons. For purposes of this rule, the term “provider” is used synonymously with the term “vendor”;
2. (L) Unmet need. Unmet needs are those routine tasks and activities of daily living as allowable by Medicaid but not adequately met by current support systems without causing undue hardships to the client/consumer and/or caregiver;

3. (M) Undue hardship. An undue hardship is the result of a significantly difficult circumstance experienced by the caregiver who is currently meeting the needs of the person with a disability that creates a situation of burden, risk or harm to the caregiver or client/consumer. Undue hardship includes, but is not limited to, the following:

   1. 1. Loss of income;
   2. 2. Overall disintegration of the family;
   3. 3. Abuse and neglect;
   4. 4. Misuse of child labor;
   5. 5. Inadequacy of training; and/or
   6. 6. Physically contraindicated;
4. (N) Non-Medicaid eligible (NME) program. The NME program provides PCA services through state funding sources for the NME clients/consumers and serves clients/consumers with physical disabilities who are “employed or ready for employment” to maintain or seek such employment or “live independently”;
5. (O) Medicaid state plan (MSP) program. The MSP program provides PCA services, through a combination of federal and state 5 CSR 90-7

funding sources, for the Medicaid-eligible client/consumers with physical disabilities who are “employed or ready for employment” to maintain or seek such employment or “live independently”; and/or

1. (P) Cost Neutral. Overall cost of services to receiving agency should not exceed cost of services from transferring agency.

AUTHORITY: sections 161.092, RSMo Supp. 2003, 178.661 and 178.673, RSMo 2000.* Original rule filed Jan. 10, 1985, effective May 13, 1985. Amended: Filed Aug. 1, 1988, effective Nov. 25, 1988. Emergency amendment filed Aug. 31, 1992, effective Sept. 10, 1992, expired Jan. 9, 1993. Amended: Filed Aug. 31, 1992, effective April 8, 1993. Amended: Filed May 31, 1994, effective Dec. 30, 1994. Amended: Filed Oct. 31, 1996, effective June 30, 1997. Amended: Filed June 28, 2001, effective Jan. 30, 2002. Amended: Filed Sept. 12, 2003, effective April 30, 2004.

*Original authority: 161.092, RSMo 1963, amended 1973, 2002, 2003; 178.661, RSMo 1984; and 178.673, RSMo 1984, amended 1993.