Personal Care Services

Effective July 1, 2008, districts may be reimbursed by Medicaid for personal care services. In Wayne County, the recording of personal care services is mandatory for Act 18 programs. Reporting for non-Act 18 programs is at the district's discretion. Note that if a paraprofessional is federally funded, they cannot record personal care services.

I. PERSONAL CARE POLICY:

Definition of Personal Care Services: Personal Care Services are a range of human assistance services provided to persons with disabilities and chronic conditions which enables them to accomplish tasks that they would normally do for themselves if they did not have a disability. Assistance may be in the form of hands-on assistance or cueing so that the person performs the task by him/her self.

Billing Requirements:

• Personal care services must be authorized by a physician or other licensed practitioner operating within their scope of practice. The "other licensed practitioner" could be of the same discipline as the service in question. For instance, a licensed occupational therapist could authorize the provision of services, as long as doing so is within their scope of practice.  
• The need for personal care services must be documented in the student's IEP. In order to facilitate this documentation, page 3 of the Wayne RESA IEP form includes wording similar to the following:
  
  "Is the severity of the student's impairment such that it requires a licensed practitioner's authorization for personal care services?" Yes or No 
• In addition to the checkbox on the IEP, a Personal Care Authorization form must be completed and placed in the student's file.

    Personal Care Authorization Form (WORD)

• The service must be medically necessary

Personal Care Services:

Services may include, but are not limited to, assisting with the following:

• Eating/feeding;
• Respiratory assistance;
• Toileting;
• Grooming;
• Dressing;
• Transferring;
• Ambulation;
• Personal hygiene;
• Mobility/Positioning;
• Meal preparation;
• Skin care;
• Bathing;
• Maintaining continence;
• Assistance with self administered medications;
• Redirection and intervention for behavior; and
• Health related functions through hands-on assistance, supervision and cueing.

Personal Care Paraprofessional Provider Qualifications:

The personal care paraprofessional personnel shall be qualified under the requirements established by their respective ISD plan. Providers must be trained in the skills needed to perform covered services, and must be under the direction of a qualified professional as designated in the IEP/IFSP. Paraprofessional personnel include:

• Teacher Aides
• Health Care Aides
• Instructional Aides
• Bilingual Aides
• Program Assistants
• Trainable Aides

Documentation:

Personal care services must be medically necessary and the need for the service documented in the student's IEP/IFSP. Each child's school clinical record must contain a completed, signed and dated monthly activity checklist.
All Medicaid documentation must be kept on file for seven years.

Procedure Code:

The following procedure code may be used to bill for personal care services:
T1020 - Personal care services, per diem

II. PROCESS FOR TRACKING AND REPORTING SERVICES

Personal Care Checklist:

A completed, signed and dated activity checklist must be completed for each student for whom personal care services will be reported.  Below are a monthly and a weekly version of the Personal Care checklist.  Districts have the option to use either of these lists or may create their own. 

Personal Care Monthly Checklist (EXCEL)

Personal Care Weekly Checklist (EXCEL) 

The checklist process should works as follows:

1. The district will add the names of the students receiving personal care services to each paraprofessional's checklist so that each para-pro has their own checklist for logging encounters.

2. Each para-pro will record the services they render to each student on their checklist on a daily basis.

3. At the end of the week (or month), the para-pro will turn in their signed and dated checklists to the designated person/location in the district.

4. The checklists will be forwarded to the data entry person/department. Each district will determine who will receive these checklists.

Data Entry:

5. The data entry person will transcribe the data from the checklists onto a monthly Excel spreadsheet. District Special Education staff and Medicaid Office staff will work together to populate the student information on these spreadsheets. Initially, the Medicaid Office will send the Special Education Directors a list of the Medicaid eligible students in their district by building. The Special Education office will edit the list to include only those students who receive billable personal care services.

Personal Care Data Entry Spreadsheet (EXCEL)

6. An "X" will be used to denote that the student received at least one billable service on a given day of the month.

7. When all services have been transcribed onto the spreadsheet, the monthly file is to be saved and emailed to the Medicaid office as an email attachment.

8. Designated personnel will request updates/checks as new students enter district.

RESA staff will upload the data from the spreadsheets into Service Tracker at the county site, similar to the way transportation data is currently loaded. Personal care data will not be visible in Service Tracker at the district sites.

The checklists must be filed and kept by the district for seven years in case of an audit.