Extended Personal Care Service 525-05-30-27

(Revised 04/15/2025 ML #3912)

View Archives

 

Legal Authority

N.D. Admin. Code 54-05-01

N.D. Admin. Code 54-05-02

 

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.

  1. Services Provided by a Licensed Nurse:

    1. Services that require a licensed nurse include, but are not limited to:

      1. Comprehensive nursing assessments

      2. Care planning

      3. Medical care coordination

      4. Training for unlicensed EPCS providers

      5. Periodic reviews of the individual’s medical care needs

      6. Medication set-up

      7. Foot care/nail care

      8. Feeding tube care

      9. Catheter care (changing and flushing)

      10. Bowel program management

      11. Manual/digital removal of waste and bowel stimulation

      12. Any direct care task deemed too complicated to train to an unlicensed provider

Service Eligibility; Criteria

 

  1. To qualify for EPCS, an individual must meet the following criteria:

    1. Eligibility: The individual must be eligible for the Medicaid Waiver for Home and Community-Based Services or Service Payments to the Elderly & Disabled

    2. 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.

    3. Need for Skilled Care: The individual must have a cognitive or physical impairment preventing them from performing extended personal care tasks independently.

    4. Skilled Nursing Care: The individual must require skilled nursing care that necessitates training from a nurse licensed under NDCC 43-12.1.

    5. Caregiver Support: The individual must have informal caregiver support or alternate plan to provide contingency (backup) care if the EPCS provider is unavailable.

    6. 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.

 

Authorization for Service

 

  1. Request and Documentation:

    1. The HCBS Case Manager is responsible for submitting the written Request for EPCS to the EPCS Nurse Administrator

    2. The Extended Personal Care Service (EPCS) RN Program Administrator must approve the initial preauthorization of Nurse Educator to complete the NPOC

  1. Review and Update:

    1. The HCBS Case Manager is responsible for submitting and uploading the documentation to the electronic record for review by EPCS RN Program Administrator.

    2. The EPCS RN Program Administrator must review and approve the NPOC and Authorization at six-month intervals.

    3. The NPOC must be approved before any pre-authorizations for services (S5115-TD or S5115) are entered into the electronic preauthorization system.

  1. Ongoing Review::

    1. The NPOC must be reviewed and updated every six months by the EPCS Program Administrator.

    2. The HCBS Case Manager is responsible for uploading the completed documents for review by the EPCS RN Program Administrator.

 

Providers

 

  1. EPCS can be provided by the following individuals or their employees:

    1. QSP Providers: Qualified Service Providers (QSPs), including individual providers and employees of QSP agencies, are eligible to deliver EPCS services.

    2. Legally Responsible Persons: A legal spouse or a parent of a minor child may act as the EPCS provider.

    3. Family Members: A relative, as defined under NDCC 50-06.2-02, may also serve as the EPCS provider.

 

Service Locations

  1. Services must be delivered in the most integrated setting based on the individual’s needs, which may include:

 

Incidents

  1. Refer to the Critical Incident Reporting 525-05-42 policy for guidance on how to report incidents during service delivery.

 

Limits

  1. Face-to-Face Assessments: Nursing assessments outlined in the NPOC must be conducted face-to-face to ensure the individual’s health, welfare, and safety.

  2. 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.

  3. Non-Transferable Approvals: EPCS approvals cannot be transferred between QSP agencies or individual QSPs.

  4. 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.

 

Authorized Service Activities and Limits

  1. Nursing Assessments: The initial or comprehensive nursing assessment must be completed by an RN per NDAC 54-05-01 and NDAC 54-05-02.

  2. 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.

  3. 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.

  4. Failure to Provide Documentation: If the Nurse Educator 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.

  5. Extended Personal Care may be provided in the form of Medical Care Coordination which includes escorting the waiver participant to medical appointments and providing support to the individual in coordinating medical services.

 

Virtual Supports Option in Nurse Education.

 

Virtual Supports Option may be used for certain aspects of nurse education, provided they meet the following criteria:

  1. Tasks Suitable for Virtual Supports Option, this list is not all-inclusive:

    1. Toenail Care

    2. Vital sign monitoring (with physician order)

    3. Bowel program assistance

    4. Compression wraps

    5. Nebulizer use

    6. Topical prescriptions

  1. Tasks NOT Suitable for Virtual Supports Option, this list is not all-inclusive:

    1. Medication set-up

    2. Wound care, tube care, and suctioning tasks

    3. Lab work

    4. Colostomy care

    5. Injections

  1. Requirements for Virtual Supports Option:

    1. Virtual Supports Option must be incorporated into the initial NPOC, which must be completed in person.

    2. The Virtual Supports Option Checklist will be completed by the Nurse Educator and the team to ensure that virtual support is appropriate.

    3. The risk assessment will include plans for health, safety, and behavioral needs during Virtual Supports Option service delivery.

  1. Privacy and Compliance:

    1. Virtual Supports Option must comply with HIPAA and respect the participant's privacy and dignity.

    2. Virtual Supports Option must be voluntary, and the participant must always have the option to request in-person services.