(Revised 06/01/2026 ML #3972)
Legal Authority
Purpose
The purpose of Extended Personal Care Services (EPCS) is to assist individuals in completing medical tasks specific to their needs. These services are designed for individuals who require support with tasks that are medical in nature to the extent permitted by state law under NDCC 43-12.1 and NDAC 54-05.
Nurse Education under extended personal care means, a nurse, licensed to practice in the state, will be reimbursed to provide training to the individual waiver participant and provider who will be reimbursed to perform the required care.
Services that must be provided by a Licensed Nurse:
Services that require a licensed nurse include, but are not limited to:
Comprehensive nursing assessments
Care planning
Medical care coordination
Training for unlicensed EPCS providers
Periodic reviews of the individual’s medical care needs
Medication set-up
Foot care/nail care
Feeding tube care
Catheter care (changing and flushing)
Bowel program management
Manual/digital removal of waste and bowel stimulation
Any direct care task deemed too complicated to train to an unlicensed provider
Registered Nurse: The initial or comprehensive nursing assessment shall be completed and implemented by an RN. The RN will develop a nursing plan of care based on that assessment and diagnoses and can provide education on nursing interventions for which that person has the necessary skills and competence to accomplish safely.
Licensed Practical Nurse: The LPN can participate in the development, evaluation, and modification of the nursing plan of care and can also conduct a focused nursing assessment and contribute that information to the nursing plan of care. The LPN can also provide education on nursing interventions for which that person has the necessary skills and competence to accomplish safely.
Service Eligibility; Criteria
To qualify for EPCS, an individual must meet the following criteria:
Eligibility: The individual must be eligible for the Medicaid Waiver for Home and Community-Based Services or Service Payments to the Elderly & Disabled
Competency: The individual must be able to participate in training provided by the Nurse Educator or have a legally responsible representative to assist in this process.
Need for Skilled Care: The individual must have a cognitive or physical impairment preventing them from performing extended personal care tasks independently.
Skilled Nursing Care: The individual must require skilled nursing care that necessitates training from a nurse licensed under NDCC 43-12.1.
Caregiver Support: The individual must have informal caregiver support or alternate plan to provide contingency (backup) care if the EPCS provider is unavailable.
Care Plan Participation: The individual must be able to actively participate in the development and monitoring of their individual care plan or have a legally responsible party to participate on their behalf.
Service Location
Services will be administered in the most integrated setting consistent with the Person-Centered Plan of Care, including (checked if allowable):
✓ The individual's home
✓ Workplace
✓ Other community service settings
Authorization for Service
Request and Documentation:
The HCBS Case Manager is responsible for submitting the written Request for EPCS to the EPCS Nurse Administrator
The Extended Personal Care Service (EPCS) RN Program Administrator must approve the initial preauthorization of Nurse Educator to complete the NPOC
Review and Update:
The HCBS Case Manager is responsible for submitting and uploading the documentation to the electronic record for review by EPCS RN Program Administrator.
The EPCS RN Program Administrator must review and approve the NPOC and Authorization at six-month intervals.
No preauthorizations for EPCS (S5115-TD or S5115) may be entered until RN Program Administrator approval of the NPOC has been obtained.
Upon receipt of approval from the EPCS RN Program Administrator for entry of Extended Personal Care – Nurse (S5115-TD) and Extended Personal Care (S5115) units into the NPOC, the HCBS Case Manager shall enter a preauthorization for Nurse Education (S5108) for the month in which the current approved NPOC is scheduled to expire.
For example, if the approved NPOC authorization period is 05/01/2026 through 10/31/2026, the HCBS Case Manager shall enter a Nurse Education (S5108) preauthorization for the period of 10/01/2026 through 10/31/2026 using the same number of previously authorized Nurse Education units.
If the Nurse Educator requests an increase in Nurse Education (S5108) units beyond the previously authorized amount, the HCBS Case Manager must obtain approval from the EPCS RN Program Administrator prior to entering preauthorization with the increased units.
Ongoing Review::
Following the initial approval, the NPOC must be reviewed, updated as needed, and approved every six (6) months by the EPCS RN Program Administrator.
The HCBS Case Manager is responsible for uploading the completed NPOC and all required supporting documentation into the electronic record for review.
No continued services requiring NPOC approval may proceed beyond the six-month review period without first obtaining approval.
Providers
Extended Personal Care Services may be provided by the following individual QSP's or employees of a QSP agency (checked if allowable):
□ Guardian
□ Legally Responsible Person - Legal spouse or parent of a minor child.
✓ Relative within the definition of Family Home Care under subsection 4 of N.D.C.C. 50-06.2-02.
Service Delivery
EPCS and Nurse Education are provided in accordance with the nursing plan of care (NPOC), developed by the individual and the Nurse Educator, to meet the identified needs of the individual. The Case Manager is responsible to complete the Person-Centered Plan and Authorization taking into consideration the needs identified in the NPOC.
The EPCS individual or their legally responsible person is required to identify and oversee their EPCS providers. The individual, with the assistance of the Case Manager must develop a contingency plan to assure health, welfare, and safety in the event the individual's care needs change or providers are not available.
Incidents
The Nurse Educator provides written documentation to the Department that shows he or she has provided instructions to the EPCS Provider that outlines the types of situations that are considered reportable incidents, and instructions on who should be contacted, and this may include contacting the individual's primary health care provider for instruction and then contacting the HCBS Case Manager. If the HCBS Case Manager and Nurse Educator determine that the incident is indicative of abuse, neglect, or exploitation, the HCBS Case Manager must immediately report the incident to the Department. The Case Manager must also follow the policy found in HCBS Case Management 525-05-30-05, Monitoring for Abuse, Neglect, or Exploitation. The incident plan needs to be updated on an annual basis and a copy provided to the Extended Personal Care Service (EPCS) Program Administrator.
Refer to the Critical Incident Reporting 525-05-42 policy for guidance on how to report incidents during service delivery.
Limits
Units for routine assessments for the health and welfare of the individual, incident reporting, assistance with activities of daily living (ADLs) and instrumental activities daily living are not part of this service.
Due to the complexity of the care provided to individuals receiving Extended Personal Care Services, contingency plans are required as a prerequisite to receive this service to assure that health welfare and safety are maintained if a provider is unavailable to provide the service.
Face-to-Face Assessments: Nursing assessments outlined in the NPOC must be conducted face-to-face by an RN to ensure the individual’s health, welfare, and safety. An LPN may assist with focused nursing assessments.
Authorized Service Activities and Limits
Nursing Assessments: The initial or comprehensive nursing assessment must be completed by an RN in accordance with NDAC 54-05-01 and 54-05-02.
Documentation of Tasks: The nurse must maintain documentation of the tasks for which they have trained the EPCS provider. A copy of this documentation will be provided to the HCBS Case Manager and the trained provider.
All authorized or approved EPCS tasks must be documented in accordance with established professional nursing documentation standards and regulatory requirements to ensure accuracy, consistency, accountability, and continuity of care.
At a minimum, documentation of EPCS tasks must include:
A description of the specific task or intervention performed
The date and exact time the task was completed
The individual's response to the intervention, when applicable
Any relevant observations, outcomes, or follow-up actions required
Documentation of communication with the nurse educator or other healthcare team members, when applicable
Six-Month Review: The Nurse Educator must conduct a review of the individual’s needs every six months to determine if additional training or tasks are required. The QSP Individual or Agency authorized for this service is responsible to complete the six month NPOC without reminders from the Department per preauthorization located within the Department’s electronic preauthorization system.
Failure to Provide Documentation: If the authorized QSP Individual or Agency fails to provide six-month service documents, the HCBS Case Manager and EPCS RN Program Administrator will re-educate the nurse. If the documents are still not provided, a complaint will be filed with the QSP Complaints Program Administrator.
Extended Personal Care may be provided in the form of Medical Care Coordination which includes escorting the participant to medical appointments and providing support to the individual in coordinating medical services.
Vital Signs: Authorization for vital signs may only be given if an order from an outside medical practitioner is obtained. The HCBS Case Manager must maintain a current order in the electronic record.
Non-Transferable Approvals: EPCS approvals cannot be transferred between QSP agencies or individual QSPs.
Virtual Supports Option Approval: Virtual Supports Option may only be used after approval from the EPCS RN Program Administrator, and the program administrator must document approval.
QSP Agency Responsibility:
When a QSP Agency accepts a preauthorization for providing Nurse Education (S5108), that agency must submit all required documentation to the Department so the EPCS can be authorized.
The authorized QSP Agency is responsible for making sure its employees complete all client-specific training for each approved EPCS medical task before working with that HCBS recipient.
If the employee providing the EPCS is a non-nurse employed by one QSP Agency, but the Nurse Educator works for a different agency or independent QSP: The agency employing the non-nurse staff member is still responsible for ensuring that employee has completed training for every authorized medical task for that specific HCBS recipient before services are provided.
Documentation of training must be completed on SFN 576.
The signatures of both the trained QSP and the registered nurse must coincide with the actual date of training for the specific HCBS recipient.
The completed SFN 576 must be submitted to the HCBS Case Manager within two (2) business days of completion and prior to a non-nurse performing any authorized EPCS medical task.
A QSP Agency shall not assign any medical task authorized under EPCS to an untrained QSP provider or agency employee.
If a QSP Agency employee provides any EPCS-approved medical task to an HCBS participant without documented client-specific training on file with the department, a QSP Complaint shall be filed against the QSP Agency by any individual with knowledge of the critical incident reportable event.
EPCS Individual or QSP Agency Responsibility:
All documentation must be sent to the HCBS Case Manager as soon as possible following completion and no longer than two (2) days
Billing:
An individual or agency QSP may not bill for more units in a twenty-four (24) hour period than the number of units authorized for that day.
If an individual is approved for 12 units of EPCS per day, the QSP may bill no more than 12 units in a single 24-hour period.
A QSP may not:
Bill 360 units (30 days × 12 units), or
Bill thirty (30) days of authorized units on one (1) day.
Billing must reflect the actual services delivered within each 24-hour period and must not exceed the daily authorized amount.
An individual or agency QSP is required to bill all EPCS tasks using the appropriate EPCS billing codes:
S5108 – Nurse Education only This code may only be billed by a nurse. A non-nurse QSP may not bill this code.
S5115-TD – Nurse providing EPCS medical tasks This code is used when a nurse completes EPCS medical tasks with the HCBS recipient. A non-nurse QSP may not bill this code.
S5115 – Non-nurse providing EPCS medical tasks This code may be billed by a non-nurse QSP who has received the required training, and whose training documentation is on file with the department, for EPCS medical tasks provided to the specific HCBS recipient.
An individual or agency QSP is required to bill all EPCS tasks under EPCS billing codes:
S5108 – Nurse Education only, a non-nurse QSP may not bill this code
S5115-TD – A nurse completing the EPCS medical tasks with the HCBS recipient, a non-nurse QSP may not bill this code
S5115 – A non-nurse QSP that has been trained and documentation is on file with the department may bill this code for EPCS medical tasks provided to the HCBS recipient.
If an EPCS is not rendered:
Documentation must be completed and include reason the service was not rendered
Examples of situation where services may not be rendered for the HCBS recipient and the reason requires documentation:
Recipient is an appointment or out of home with friends/family
A natural support completed the EPCS task for the recipient
Recipient refused the service
Virtual Supports Option in Nurse Education.
Virtual Supports require the initial NPOC has been completed in person with the provider, individual and other team members during the person-centered planning process.
The NPOC will ensure that the planning process has considered service needs and if these needs can be met by using a virtual supports method of service delivery.
The NPOC includes a Virtual Support Checklist will be required to be completed by the Nurse Educator and the team during the personcentered planning process.
This checklist will act as a safeguard to ensure virtual support can help meet the needs of the participant in a way that protects the right to privacy, dignity, respect, and freedom from coercion.
Any issues will be addressed prior to the implementation of remote supports. The checklist will ensure that the planning process has considered service needs and if these needs can be met by using a virtual supports method of service delivery.
The Virtual Support Checklist will include consideration of the estimated hours/visits that virtual supports delivery will be utilized.
The risk assessment and service plan requires the team to develop a plan to address health, safety, and behavioral needs while remote supports are utilized so appropriate assistance can be provided.
In virtual support, the use of cameras in bathrooms or bedrooms impacting the participant's dignity and privacy is not permitted.
Virtual support reinforces community integration by encouraging the participant to engage in community life as independently as possible and to be able to safely engage in activities in his or her home or in the community without relying on the physical presence of staff to accomplish those activities.
The participant's services may not be delivered via virtual support 100% of the time.
The participant must always have the option to request in-person services. The amount of time chosen shall be determined during the person-centered planning process and outlined in the Individual Program Plan (IPP).
Participant will be given education and support on the use of virtual supports by their chosen provider.
Virtual supports are not a system to provide surveillance or for staff convenience.
Virtual Supports Option may be used for certain aspects of nurse education, provided they meet the following criteria:
Tasks Suitable for Virtual Supports Option, this list is not all-inclusive:
Vital sign monitoring (with physician order)
Bowel program assistance (without digital/manual stimulation use)
Compression wraps
Nebulizer use
Topical prescriptions (without skin integrity problem)
Tasks NOT Suitable for Virtual Supports Option, this list is not all-inclusive:
Medication set-up
Wound care, tube care, and suctioning tasks
Lab work
Colostomy care
Injections
Complex medical compression garments, wraps or devices
Diabetic management (e.g., insulin, blood glucose monitoring, diabetic foot cares)
Preauthorization contains monthly nursing tasks under code S5115-TD
Nurse Educator Requirements for Virtual Supports Option:
Virtual Supports Option must be incorporated into the initial NPOC, which must be completed in person face-to-face.
The Virtual Supports Option Checklist will be completed by the Nurse Educator and the team to ensure that virtual support is appropriate.
The risk assessment will include plans for health, safety, and behavioral needs during Virtual Supports Option service delivery.
The request to utilize the Virtual Supports Option must come from the HCBS participant. Virtual Supports Option shall not be approved for QSP convenience or employment status of the RN.
Privacy and Compliance: Provider must use a HIPAA compliant service delivery method (e.g. Microsoft Teams, Zoom for Healthcare). HIPAA rules apply to all covered entities regarding HIPAA Privacy and Security.
Virtual Supports Option must be voluntary, and the participant must always have the option to request in-person services.
The use of cameras in bathrooms or bedrooms impacting the participant's dignity and privacy is not permitted.