Family Personal Care 525-05-30-32

(Revised 2/1/22 ML #3663)

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Purpose

The purpose of family personal care (FPC) is to assist individuals to remain with their family members and in their own communities. It provides for the provision of extraordinary care payments to the legal spouse or other qualified family member of a recipient for the provision of personal care or similar services.

Service Eligibility, Criteria for

The individual receiving Family Personal Care will meet the following criteria:

1. Must be eligible for the HCBS Medicaid Waiver program.
   
   
2. The individual and qualified provider (who is a qualified family member and is enrolled as a personal care provider) must reside in the same residence.
   1. The qualified family member must be one of the relatives as defined in Family Home Care N.D.C.C 50-06.2-02(4), and must be the provider performing the care to the individual. Family Personal Care can be provided by the "spouse or by one of the following relatives, or the current or former spouse of one of the following relatives, of the elderly or disabled person: parent, grandparent, adult child, adult sibling, adult grandchild, adult niece, or adult nephew."
      
      
3. Before a legally responsible individual who has decision making authority over an individual can be enrolled as a qualified service provider for Family Personal Care, the Case manager must approve the choice of provider. The case manager is responsible to forward to the HCBS Program Administrator a copy of the narrative that explains why the legally responsible person acting as the family personal care provider is in the best interest of the individual. A legally responsible individual would include a Legal Spouse or Guardian.
   
   
4. The individual and qualified provider must mutually agree to the arrangement.
   
   
5. The need for services must fall within the scope of tasks identified on the SFN 1012, Monthly Rate Worksheet - Live-In Care (MRW), and Authorization to Provider Waivered Services.
   
   
6. The individual must have a daily need that is included in the Monthly Rate Worksheet.

Service Tasks/Activities

The service tasks/activities within the scope of this service chapter are identified on the Authorization to Provide Medicaid Waiver Services form, and only those listed on the SFN 1012, Monthly Rate Worksheet, can be approved and authorized.

Tasks of laundry, shopping, housekeeping, meal preparation, money management, and communication are allowed only when the service activity benefits the individual.

The department may pay a provider for homemaker tasks that would otherwise be considered the individual’s share of the responsibility to complete the task. An example of this would be authorizing housekeeping for the individual’s personal private space OR their shared responsibility of cleaning the common living space.

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 home

□ Workplace

ü Other community service settings

Out-of-Home Care

Payment can be made for days the individual is receiving the SAME care from the SAME caregiver-QSP although not in the home they otherwise mutually share.  No payment is allowed for individuals out-of-state with the exception of individuals seeking medical care out of state unless prior approval has been given by an HCBS Program Administrator.

For care out of state, prior approval must be granted from the HCBS Program Administrator.

Provider need not be Present in the Home on a 24-Hour Basis

This provision within the Family Personal Care service is appropriate for individuals who can be left alone for routine temporary periods of time (e.g. part-time employment of the qualified family member) without adverse impact to the individual’s welfare and safety. The individual must agree to be left alone.

• This provision does NOT allow for the qualified family member to hire a provider to provide care for the individual during routine absences from the home.

Limitations

Family Personal Care cannot be combined with adult residential care, adult foster care, extended personal care, and transitional living.

Providers

Family Personal Care is provided by the live-in qualified family member. The family member may also have the following relationship to the eligible individual (checked if allowable):

ü Guardian

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

Service Combinations

Family Personal Care is an all-inclusive 24-hour service. Therefore, respite care service and Emergency Response System (ERS) along with Family Personal Care is acceptable only as described under the following circumstances:

1. The individual meets the eligibility criteria for Respite Care Services or when the qualified family member provides less than 24-hour per day care on a routine basis, and the individual can be left alone safely for brief periods of time, respite care is appropriate only when the qualified family member will be gone for an extended period of time, for example, to attend a wedding.

If individual cannot be safely left alone or supervision is an authorized task on the MRW respite care must be authorized so the qualified family member can take necessary breaks away from their caregiving responsibilities.

• Respite care must be authorized because FPC providers cannot delegate their care to another individual if an individual cannot be safely left alone.
• If informal respite is in place and of benefit to the individual, the case manager must document that formal respite care was offered and declined.

2. Emergency response is acceptable if a safety risk (i.e. potential fall risk or sudden illness) has been identified during the FPC provider’s short term absence. ERS is not acceptable for individuals who require supervision for cognitive or health related reasons. Contact the HCBS Program Administrator in writing to obtain approval for the combination of FPC and ERS service.