Extended Personal Care Service 525-05-30-27

(Revised 1/1/14 ML #3399)

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Purpose

The purpose of Extended Personal Care Services (EPCS) is to complete tasks that are medical in nature and specific to the needs of an eligible individual. Approval to complete these tasks is provided by the Nurse Educator who has provided training to the EPCS Provider and is enrolled with the Department to provide Nurse Education. Or, if a necessary medical task is too complex to be taught to an unlicensed provider the nurse may provide the service directly to the client. Services provided by a licensed nurse include but are not limited to nurse assessments, care planning, training, medication set up and periodic review of client care needs or the provision of direct care that is too complicated to delegate to an extended personal care provider.

 

This service may include nursing care to the extent permitted by state law that will maintain the health and well-being of the individual and allow the individual to remain in the community. EPCS are services that an individual without a functional disability would customarily and personally perform without the assistance of a licensed health care provider, such as catheter irrigation, administration of medications, or wound care. Activities of daily living and instrumental activities daily living are not part of this service.

 

Service Eligibility, Criteria for

The individual receiving EPCS must be:

  1. Eligible for the Medicaid  Waiver for Home and Community Based Services or Service Payments to the Elderly & Disabled.
  2. Competent to participate in the education of the Extended Personal Care Service Provider by the Nurse Educator or have a legally responsible representative directly participate in the process.
  3. The need for EPCS is limited to individuals who have a cognitive or physical impairment that prevents them from performing extended personal care service activities.
  4. Have an informal caregiver support system to provide contingency (back-up) care in case of absence of EPCS providers
  5. Be competent to actively participate in the development and monitoring of their individual care plan or have a legally responsible party available to participate.

 

Authorization for Service

  1. The initial Request for Extended Personal Care Services (written request by Case Manager), ICP, SFN 1467, Authorization to Provide Services, SFN 1699, and NPOC (including documentation of education provided for tasks, monitoring plan, and instructions for incident reporting) must be pre-approved by the Assistant Medicaid Director of the Long Term Care Continuum, Medical Services Division. The case manager is responsible to send the completed documents to Medical Services/HCBS.
  2. The ICP, SFN 1467, Authorization to Provide Services, SFN 1699, and NPOC must be updated and reviewed at the six month level by the Assistant Medicaid Director of the Long Term Care Continuum, Medical Services Division. The case manager is responsible to send the completed documents to Medical Services/HCBS.
  3. The ICP, SFN 1467, Authorization to Provide Services, SFN 1699, and NPOC must be completed and reviewed every six months by the Assistant Medicaid Director of the Long Term Care Continuum, Medical Services Division. The case manager is responsible to send the completed documents to Medical Services/HCBS.

 

Service Delivery

EPCS and Nurse Education are provided in accordance with the nursing plan of care (NPOC), developed by the client and the Nurse Educator, to meet the identified needs of the client. The Case Manager is responsible to complete an Individual Plan of Care, SFN 1467, and Authorization to Provide Services, SFN 1699, taking into consideration the needs identified in the NPOC.

 

The EPCS client or their legally responsible person is required to identify and oversee their EPCS providers. The client, with the assistance of the Case Manager must develop a contingency plan to assure health, welfare, and safety in the event the client’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 client’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 Assistant Medical Director.

 

Limits

  1. Assistance with activities of daily living and instrumental activities daily living are not part of this service.
  2. 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 in the event that a provider is unavailable to provide the service.  

 

Service Activities, Authorized and Limits

  1. Documentation outlining the tasks the nurse has trained  the Extended Personal Care Service Provider on are maintained by the Nurse and a copy is sent to the Case Manager. The Case Manager notes on the SFN 1699 in Section II “Other," the tasks the nurse has trained the Extended Personal Care Service Provider to complete.
  2. If a necessary medical task is too complex to be taught to an unlicensed provider the nurse may be paid to provide the service directly to the client. Services provided by a licensed nurse include but are not limited to nurse assessments, care planning, training, medication set up and periodic review of client care needs or the provision of direct care that is too complicated to delegate to an extended personal care provider.
  3. The nurse educator will provide at a minimum, a review of the client’s needs every six months to determine if additional training and or tasks are required.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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