SPED Personal Care Service 525-05-30-45

(Revised 10/01/2025 ML #3950)

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Purpose

The philosophy of the Department is that SPED personal care should be provided so as to assist the eligible individual with as many activities of daily living and instrumental activities of daily living as needed and as permitted in order to maintain independence and self-reliance to the greatest degree possible. The individual or legally responsible person must direct the care provided and should be involved in training and monitoring the SPED personal care QSP as much as possible and when appropriate.

  1. SPED Personal Care differs from adult foster care in that personal care is provided in the individual's home, and adult foster care is provided in the service provider's home. If a non-relative is caring for the individual on a 24-hr live in basis in the provider’s home, the service must be Adult Foster Care. It cannot be SPED Personal Care service.  
  2. Live-in personal cares (daily care) are all inclusive with the exception of Respite Care.
  3. Personal care differs from respite care in that respite care is provided to relieve the primary, live-in caregiver, whereas the primary purpose of personal care is to provide the care a individual needs and not to relieve the caregiver.

Service Eligibility, Criteria for

The individual receiving SPED Personal Care service will meet the following criteria:

  1. Must be eligible for the SPED program and not eligible to receive Personal Cares under the Medicaid State Plan, Waiver Personal Care, Family Personal Care or Family Home Care;

    1. Individuals who require less than an average of 1 hours of care per day are not eligible for SPED personal care live-in.

  2. Be at least age 18;
  3. The care needs of the individual must fall within the scope of personal care service as described in this service chapter. The care needs may include a combination of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Either the individual must have the ADLs and IADLs needs performed for him/her OR an individual with cognitive impairment may be able to complete the activity ONLY with supervision, guidance, or prompting.
  1. The task of supervision is allowed between other personal care tasks, if the individual requires supervision/oversight due to physical or cognitive impairment, up to the SPED program cap. Under SPED, the tasks of cog/supervision is considered a personal care and is billed at the same rate/code as the other personal cares authorized. While supervision is an allowable task within SPED personal care, it cannot be the sole reason for the care.
  2. The tasks that may be included in SPED unit personal cares are as follows: bathing, dressing/undressing, eye care, feeding/eating, hair care/shaving, incontinence, medication assistance, mobility, fingernail care, skin care, teeth/mouth care, toileting, transferring/turning/positioning, cog/supervision, exercises, hoyer lift/mechanized bath chairs, indwelling catheter, medical gases, prosthesis/orthotics, suppository/bowel program, TED socks, temp/bp/pulse/respiration rate, apnea monitor, jobst stockings, ostomy care, postural/bronchial drainage, and RIK bed care. The identified tasks for the individual are listed on the service authorization.
  1. SPED Daily Personal Cares live-in must be authorized if the non-relative provider and the individual live in the same residence and personal care is needed on a daily basis under SPED. See section on "Limits" for further details.
  1. SPED Daily Personal Care is an all-inclusive service and can only be combined with Respite Care. For unusual or unique circumstances, prior approval from the HCBS Program Administrator must be obtained. The tasks that may be included in SPED daily personal cares live in are as follows: bathing, communication, dressing/undressing, eye care, feeding/eating, hair care/shaving, housework, incontinence, laundry, meal preparation, medication assistance, mobility, money management, fingernail care, shopping, skin care, teeth/mouth care, toileting, transferring/turning/positioning, cog/supervision, exercises, hoyer lift/mechanized bath chairs, indwelling catheter, medical gases, prosthesis/orthotics, suppository/bowel program, TED socks, temp/bp/pulse/respiration rate, apnea monitor, jobst stockings, ostomy care, postural/bronchial drainage, and RIK bed care. The identified tasks for the individual are listed on the service authorization.
  2. Qualified Service Provider (QSP) Service Agreement - Live In Paid Caregiver, SFN 1654, is required for all live in SPED Daily Personal Care Providers.

Service Location

Services will be administered in the most integrated setting consistent with the Person-Centered Plan of Care, including (checked if allowable):

ü The individual's residence

ü Workplace

ü Other community service settings


Provider Need Not be Present in the Home on a 24-Hour Basis

The provision of SPED Daily Personal Cares live-in is appropriate ONLY for individuals who can be left alone for routine temporary periods of time (e.g. part-time employment) without adverse impact to the individual’s welfare and safety. The individual must agree to be left alone.

 

Individuals with Cognitive Impairments

For individuals who cannot be safely left alone due to cognitive impairment or high physical needs, the person-centered plan of care must include a plan to ensure continued health and safety of the individual. The plan must identify needs, including personal care assistance, guidance, cueing, prompting, and supervision and how those needs will be met. This information must be documented under the Supervision/Structured Environment section within the functional assessment component of the participant assessment.

 

Providers

SPED Personal Care Services may be provided by the following individual QSP's or employees of a QSP agency (checked if allowable):

ü Guardian

ü Legally Responsible Person - Legal spouse or parent of a minor child.

üRelative within the definition of Family Home Care under subsection 4 of N.D.C.C. 50-06.2.02.

 

Limits:  

  1. Individuals who have a daily personal care and or/supervision need and require an average of at least 1 hour of care per day whose daily live-in providers meet the definition of Family Home care must utilize Family Home Care instead of SPED personal care. See N.D.C.C. 50-06.2-02(4) for the definition of family member.
  2. In order to qualify for SPED Daily Personal Cares live-in, the individual must require an average of at least 1 hour of care each day. If the individual requires less than 1 hour of daily care, unit-based SPED personal care and/or SPED homemaker may be considered.
  3. If personal care is not needed on a daily basis, SPED Daily Personal Cares live-in should not be authorized. Instead, unit-based SPED personal care and/or SPED homemaker may be considered.
  4. If there are multiple personal care providers necessary to meet the individual's need, it is allowable for unit-based personal care to be authorized instead of SPED Daily Personal Cares live-in.
  5. Under SPED Personal Care Service, payment can be made for time performing authorized personal care tasks even if performed outside the individual's home as long as the cares are provided in the local trade area. The hours remain based on the care necessary in the individual's home. The care provided outside the home must be within the defined scope (allowable tasks as authorized) of the service.  
  1. Exception:  When the individual is required to seek essential services outside of the local trade area, contact the HCBS Program Administrator for prior approval.

 

Assisted Living Facility

A daily rate is calculated for an individual to receive daily SPED personal care services in an assisted living facility when the individual lives in a licensed assisted living facility and the provider has been approved to use the assisted living billing code.

 

The following criteria have been established for recipients in an "assisted living facility":

  1. Individuals meeting one of the following criteria may have a self-employed QSP as a live-in-attendant.
  1. The provider is a family member as defined in State law for Family Home Care.
  2. The intensity of care needs cannot be met under "assisted living" (e.g. need for continuous on-site care).
  3. The assisted living personal care provider is not identified in the tenant’s rental agreement.
  1. For those individuals unable to do their own meal preparation, it will be included in the "assisted living" provider's daily rate.  The provider may prepare the meal in the recipient's individual apartment or offer congregate dining.  The recipient is responsible for payment of food costs.

The HCBS Case Manager must determine what services are being provided by the Assisted Living facility as a component of their base rate which includes room and board. For those services included within the base rate, the tasks would not be recorded and calculated within the daily rate. The daily rate for SPED Personal Care Assisted Living applies to all individuals who receive assisted living SPED personal care services. Tasks that may be included in the daily rate calculation are as follows: bathing, communication, dressing/undressing, eye care, feeding/eating, hair care/shaving, housework, incontinence, laundry, meal preparation, medication assistance, mobility, money management, fingernail care, shopping, skin care, teeth/mouth care, toileting, transferring/turning/positioning, cog/supervision, exercises, hoyer lift/mechanized bath chairs, indwelling catheter, medical gases, prosthesis/orthotics, suppository/bowel program, TED socks, temp/bp/pulse/respiration rate, apnea monitor, jobst stockings, ostomy care, postural/bronchial drainage, and RIK bed care. The identified tasks for the individual are listed on the service authorization.

 

Service Activities, Authorized and Limits

  1. The service tasks/activities within the scope of this service chapter are identified on the service authorization.
  2. For SPED Personal Care unit rate, housework, laundry, communication, money management, shopping, and meal preparation are considered homemaker tasks and cannot be authorized as SPED personal care tasks.
  3. For SPED Personal Care unit rate, Community Integration, Social Appropriateness, and Transportation are tasks which cannot be authorized.
  4. SPED Daily Personal Cares live-in and SPED Personal Care Assisted Living daily rate are limited to those tasks identified within this service chapter. Homemaker units (including housework, laundry, communication, money management, shopping, and meal preparation) are limited to the max monthly amount set by the department.
  5. Qualified Service Provider (QSP) Service Agreement - Live In Paid Caregiver, SFN 1654, is required for live in care providers who are a relative or had a close personal relationship with the eligible individual prior to paid care being established.
  6. For individuals who require two-person assist with SPED personal cares, approval is required from a HCBS Program Administrator.
  7. In order to qualify for SPED Personal Care Assisted Living daily rate, the individual must require a daily personal care, and an average of at least 1 hour of care each day. If the individual requires less than 1 hour of daily care, unit-based SPED personal care and/or SPED homemaker may be considered.

 

Authorization

 

When an individual’s live-in provider changes from a unit rate service to daily rate service, the case manager ends the unit-rate service the last day of the month and authorizes the daily rate service the first day of the next month.

When an individual’s live-in provider changes from one daily rate service to another daily rate service, the case manager ends the first service the last day of the month and authorizes the new service the first day of the next month.

See Paid Family or Household Members/Qualified Service Provider (QSP) Service Agreement - Live in Paid Caregivers 525-05-45-50 for instructions on how the QSP Service Agreements are completed if one SPED T1020 provider has been pre-approved to provide daily live-in care to more than one individual.