Extended Personal Care Service 525-05-30-27

(Revised 11/1/21 ML #3640)

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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 individual. Services provided by a licensed nurse include but are not limited to nurse assessments, care planning, training, periodic review of individual's care needs, medication set up, foot care, feeding tubes, changing, and flushing catheters, bowel programs that include manual removal of waste and bowel stimulation, or the provision of direct care that is too complicated to delegate to an extended personal care provider.

 

Per NDAC 54-05-01 and 54-05-02: 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.

 

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 that has the necessary skills and competence to accomplish safely.

 

Approval of the Nursing Plan of Care is required by the R.N. Program Administrator, before implementing the service.

 

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 administration of medications, or wound care.

 

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. Requires skilled or nursing care that requires training by a nurse licensed under ND Century Code chapter 43-12.1.
  5. Have an informal caregiver support system to provide contingency (back-up) care in case of absence of EPCS providers.
  6. Be competent to actively participate in the development and monitoring of their individual care plan or have a legally responsible party available to participate.


Service Location

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

üThe individual's home

ü Workplace

ü Other community service settings


Authorization for Service

  1. The initial Request for Extended Personal Care Services (written request by Case Manager), SPED/Ex-SPED Individual Care Plan (SFN 1467) and Authorization to Provide Services for SPED/Ex-SPED, or Medicaid Waiver Person Centered Plan of Care (SFN 404) and Authorization to Provide Medicaid Waiver Services and Nursing Plan of Care (NPOC) (including documentation of education provided for tasks, monitoring plan, and instructions for incident reporting) must be pre-approved by the Extended Personal Care Service (EPCS)Program Administrator, Aging Services Division. The case manager is responsible to send the completed documents to Aging Services/HCBS.

  2. The Authorization and NPOC must be updated and reviewed at the six-month level by the Extended Personal Care Service (EPCS)Program Administrator, Aging Services Division. The HCBS case manager is responsible to send the completed documents to Aging Services/HCBS.

  3. The Individual Care Plan, Authorization, and NPOC must be completed and reviewed every six-months by the Extended Personal Care Service (EPCS)Program Administrator, Aging Services Division. The HCBS case manager is responsible to send the completed documents to Aging Services/HCBS.

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 Individual Care 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.

 

Limits

  1. 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.
  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 if a provider is unavailable to provide the service.  
  3. The Nursing Plan of Care (NPOC) assessments must be done face to face to assure the health, welfare, and safety needs of the individual are met.

 

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.

üRelative within the definition of Family Home Care under subsection 4 of N.D.C.C. 50-06.2-02.

 

Per NDAC 54-05-01 and 54-05-02: 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.

 

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 that has the necessary skills and competence to accomplish safely.

 

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. A copy of the training documentation form is also given to the trained Extended Personal Care Provider listing the tasks to be completed. The Case Manager notes the units authorized.
  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 individual. Services provided by a licensed nurse include but are not limited to nurse assessments, care planning, training, periodic review of individual care needs, medication set up, foot care, feeding tubes, changing, and flushing catheters, bowel programs that include manual removal of waste and bowel stimulation, 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 individual’s needs every six months to determine if additional training and or tasks are required.