Family Personal Care 525-05-30-32

(Revised 12/01/2024 ML #3885)

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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 by allowing individuals who want to choose their spouse or one of the following family members as defined under N.D.C.C. 50.06.2-02; parent, grandparent, adult child, adult sibling, adult grandchild, adult niece, or adult nephew, as their family personal care service provider.

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. The provider indicates their agreement with the care plan by signing the Person-Centered Plan of Care.

   1. In addition to the FPC providers signature on the care plan the Qualified Service Provider (QSP) Service Agreement - Live In Paid Caregiver, SFN 1654, is required for all Family Personal Care Providers.

5. The individual must have a daily personal care and/or supervision need that is provided by the family personal care provider.

   1. When determining whether the individual has a daily personal care or supervision need, do not include homemaker tasks such as assistance with meal prep, laundry, shopping, housework, money management, or communication as part of the daily need.

6. The provider for FPC must provide a minimum total of three (3) hours of care to the eligible individual per day. The three (3) hours per day includes the daily personal care or supervision need and any other allowable task under FPC.

   1. The three hour of care per day may include homemaker tasks within the limits allowable under Medicaid Waiver.

   2. If family member is providing less than 3 hours of care per day, (including homemaker tasks allowable under the service cap) live-in care is to be provided under MSP-PC, T1020 with a provider agreement as long as the provider is eligible for MSP-PC.

      1. Three (3) hours per day may be calculated by taking the total number of units required per month x 12, divided by 365.

7. The number of reimbursable hours of care for this service cannot exceed 10 hours per day.
8. The need for services must fall within the scope of tasks identified on the Authorization to Provide Services, otherwise known as the Preauth.
9. Individuals with Live in Providers (except for Spouses or legal Guardians) may choose to have their services Under Medicaid State Plan Personal Care – Daily Rate (T1020). MSP-PC Note that T1020 does not include reimbursement for the task of supervision, but does reimburse for personal cares.

Service Tasks/Activities

The service tasks/activities within the scope of this service chapter are all inclusive, including personal care, cog/supervision, and homemaker.

1. Family personal care tasks include 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, 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. The FPC provider must have global endorsements in order to be authorized for supervision, exercises, hoyer lift/mechanized bath chairs, indwelling catheter, medical gases, prosthesis/orthotics, suppository/bowel program, TED socks, and temp/bp/pulse/respiration rate.

   2. The FPC provider must have client specific endorsements in order to be authorized for apnea monitor, jobst stockings, ostomy care, postural/bronchial drainage, and RIK bed care.

   3. The FPC provider may be authorized for medication administration even if the individual is not able to self-direct their medications.

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

   1. The service of family personal care is not intended to be used primarily for environmental tasks. The individual must have a daily personal care and/or supervision need to qualify for this service.

   2. 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.  

1. For care out of state, prior approval must be granted by the HCBS Program Administrator for each instance of out of state care.

2. No payment is allowed for care provided outside of the United States.

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, and transitional living.

1. The number of reimbursable hours of care cannot exceed 10 hours per day.

   • The provider may provide more care than 10 hours, but the State is not obligated to pay because that care is being provided because of their close personal relationship and that they share a household with the eligible individual.

2. Under FPC, the tasks of housework, laundry, meal prep, shopping, money management, and community are considered homemaker tasks and are limited to the maximum monthly amount set by the Department.

Providers

Family Personal Care may be provided by the following individuals (checked if allowable):

ü Guardian

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

ü Relative within the definition of Family Home Care under subsection 4 of N.D.C.C. 50-06.2-02. (Required)

Note: A provider who is on Medicaid is not allowed to request a lower rate than what is calculated based on the service recipient’s needs. Per Medicaid guidelines: if a provider is on Medicaid, all income available to that provider must be considered and counted.

• If a provider on Medicaid has questions about how payment will affect their eligibility, they should refer to their eligibility worker.

• If a provider receiving other financial assistance such as TANF, SNAP, housing assistance, SSI, etc. has questions about how payment with affect their eligibility, they should refer to the authorizing entity.

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.
3. For some situations, it may be appropriate for two Family Personal Care providers to be authorized to provide care to one individual if both providers meet the Family Personal Care definition. However, both Family Personal providers cannot bill for the service on the same day. Pre-approval by program administration is required for services authorized in this manner. 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 for these instances.
4. 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 Family Personal Care provider has been pre-approved to provide daily live-in care to more than one individual.
5. Under unusual or unique circumstances other HCBS service combinations may be appropriate. In such cases, contact the HCBS Program Administrator in writing to obtain approval.

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.

• Example: an individual’s provider is authorized for T1019 but becomes approved for Family Personal Care. The case manager ends T1019 the last day of the month and starts Family Personal Care 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.

• Example: An individual’s provider is authorized for Family Home Care but becomes approved for Family Personal Care. The case manager ends Family Home Care the last day of the month and starts Family Personal Care the first day of the next month.