Limitations and Non-covered Services 535-05-25

(Revised 10/01/2024 ML #3871)

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  1. Personal care services may not include skilled services performed by persons with professional training.
  2. An individual receiving personal care services may not be an inpatient or resident of a hospital, a nursing facility, an intermediate care facility for individuals with intellectual disabilities, a psychiatric residential treatment facility, or an institution for mental disease.
  3. Personal care services may not include home delivered meals; services performed primarily as housekeeping tasks; transportation; social activities; or services or tasks not directly related to the needs of the individual such as doing laundry for family members, cleaning of areas not occupied by the individual, or shopping for items not used by the individual.
  4. Meal preparation is limited to the maximum units set by the department. Laundry, shopping, and housework tasks when provided must be incidental to the provision of other personal care tasks and cannot exceed 30% of the total time authorized for the provision of all personal care tasks. Personal care service tasks of laundry, shopping, and housekeeping are limited to the maximum units set by the department, and the cap cannot be exceeded under other home and community-based services funding sources.
  5. Services provided by a spouse, parent of a minor child, or legal guardian are not covered.
  6. The tasks of laundry, shopping, housekeeping, meal preparation, money management and communication may be assessed for individuals whose provider is a relative listed under the definition of family home care under subsection 4 of the North Dakota Century Code section 50-06.2 02 or who is a former spouse beginning at the first required contact after 1/1/2021. Conditions that would benefit the consumer would include, but are not limited to, maintenance of the home environment, such as shared spaces as assigned by the case manager and individual's laundry.
  7. Care needs of the individual that are outside the scope of personal care services are not covered.
  8. Services provided in excess of the services or hours authorized by the case manager in the individual’s approved care plan are not covered.
  9. Authorized personal care services may not exceed 120 hours (480 units) per month for Level A Personal Care Services or 240 hours (960 units) per month for Level B Personal Care Services, and 300 hours (1200 units) per month for Level C Personal Care Services.
  10. Personal care services may be provided to a recipient who has natural supports. For purposes of this subsection, "natural supports" means an informal, unpaid caregiver that provides care to an applicant or recipient.
  11. Personal care services may not be provided for tasks that are otherwise age appropriate or generally needed by an individual within the normal stages of development.
  12. Per guidance given by the Centers for Medicare and Medicaid Services in the following 2001 HHS Survey and Certification memo, personal cares can be offered in conjunction with Hospice services.

    https://www.cms.gov/Medicare/Provider-Enrollment-and Certification/SurveyCertificationGenInfo/downloads/SCLetter01-013.pdf

  13. The combination of personal care services and hospice service requires approval from the Department. The request must outline the individual's needs, the services that will be provided through Hospice, and the services being requested through MSP PC. The request must also contain an assurance that there is not a duplication of services.
  14. The Hospice plan of care must include the need for personal care services and a copy must be maintained in the individual’s file.