(Revised 10/01/2024 ML #3871)
The personal care service provider is responsible for keeping written records documenting the delivery of care to each individual. The written record must include the date, the tasks performed, and the time required to perform the tasks.
Electronic Visit Verification Requirements
Electronic Visit Verification (EVV) uses a mobile device application on a phone, tablet, or laptop that records the beginning and ending time of services provided to individuals by providers. Data may also be captured using a fixed object device (FOD) issued to the provider by HHS. This electronically verifies the service was provided at a particular location where the service is authorized, as required by the law. EVV is a federal requirement from the 21st Century Cures Act and became effective January 1, 2021, it is used for billing and payment of services you provide as a QSP.
All QSPs are required to participate in an EVV system if they enroll in at least one of the services subject to EVV. QSPs must have access to a FOB, phone, tablet, or laptop to utilize this system. This is necessary to check in and out when providing services, receiving service authorizations, and submitting claims electronically. Not all services require EVV to bill for services provided.
EVV programming under Therap includes the option to enter and store the documentation that is required for QSP services. This programming is called ISP Data and meets the standard for QSP documentation. ISP Data is only available to QSPs using Therap for EVV.
The approved services on the preauth must identify the procedure code the provider is to use to bill for services provided.
A personal care service provider who is enrolled as a QSP must use the Turnaround Document for Home and Community Based Care for the Elderly/Disabled (TAD), SFN 925, or the QSP online billing option to bill for services.
Basic Care Personal Care service provider
A personal care service provider enrolled as a basic care assistance provider must bill using the Basic Care Assistance billing process.
Unit Rate Personal Care Service Provider
Procedure code T1019 must be used be used to bill on a 15-minute increment basis.
Billing is limited to the time in performance of the authorized tasks provided. The provider must bill in 15-minute increments on a daily basis.
Providers must deliver at least 8 minutes of service before they can bill for the first 15-minute unit. Providers should not bill for services performed for less than 8 minutes.
The amount of time required to bill for a larger number of units is as follows:
2 units: at least 23 minutes 6 units: at least 83 minutes
3 units: at least 38 minutes 7 units: at least 98 minutes
4 units: at least 53 minutes 8 units: at least 113 minutes
5 units: at least 68 minutes
The pattern remains the same for allowable tasks performed in excess of 8 units (2 hours).
Daily Rate Service Rates.
Each 15-minute increment is one (1) unit and the number of units of service provided on each day of care must be shown on the billing document.
Procedure code T1020 must be used to bill a daily rate for a provider authorized to bill a daily rate. Only 1 unit per client may be billed per day for procedure code T1020. The provider may be paid the daily rate only for days on which personal care services were provided. The daily rate may not be paid for any days on which the individual was in the hospital or a health-care facility or on leave from the residence, except payment is allowed for the day the individual returns to the provider’s care. Payment may be claimed when personal care services are provided on the day of death.
Providers must provide one hour of service to bill for daily rate services.
Live-In Paid Family or Household Members/Qualified Service Providers
Reference policy Paid Family or Household Members/Qualified Service Provider (QSP) Service Agreement - Live in Paid Caregivers 525-05-40-50 (nd.gov)
When an individual is eligible and chooses live-in daily rate personal care funded under Medicaid State Plan - Personal Care (MSP-PC) the HCBS Case Manager must complete a person-centered plan of care and a service agreement with the eligible individual and their legal decision maker, when the live in paid care provider has a close personal relationship with the eligible individual in need of care.
A close personal relationship includes relative providers and individuals who had a close personal relationship with the eligible individual prior to paid care being established. Examples include but are not limited to relatives, significant other, or former spouse.
Case Managers should determine units in each of the categories of ADLs, Medication Assistance, Meal Preparation, Laundry/shopping/housekeeping, and Other. Some flexibility is anticipated in the provision of tasks amongst the categories of ADL, Other, and Medication Assistance and the provider is allowed to bill up to the total units approved; however, the provider may not bill for units in excess of the units authorized in the category of laundry, shopping and housekeeping and Meal Preparation.
Paid Family or Household Members/Qualified Service Provider (QSP) Service Agreement - Live in Paid Caregivers
The FLSA Final Rule recognizes the unique nature of programs in which the care provider and the eligible individual live together and have pre-existing family ties or a pre-existing shared household. There is both a familial or household relationship and an employment relationship.
Full Policy for Standards of Qualified Service Providers can be found at the following policy links:
Standards for Qualified Service Provider(s) 525-05-45
Qualified Service Provider Enrollment 525-05-45-10
Referrals for Qualified Service Providers 525-05-45-20
Qualified Service Provider (QSP) Complaints 525-05-45-30
Qualified Service Provider (QSP) Overtime 525-05-45-40
Agency Quality Service Provider (QSP) Quality Improvement Program 525-05-45-60