Par. 1.  Material Transmitted and Purpose --Transmitted with this Manual Letter is revised Service Chapter 535-05, Medicaid State Plan – Personal Care Services. IMs 5015, 5019, and 5021 have been incorporated into the manual sections.

1.	Limitations and Non-covered Services 535-05-25 (Revised November 19 2007, IM #5021)

11.	The combination of personal care services and hospice service requires prior approval from the Department.

2.	Prior Authorization 535-05-30 (Revised September 12, 2007 #5019)

In addition, prior authorization from a State HCBS or DD Program Administrator is required to authorize units for meal prep, Llaundry, shopping, and housekeeping when performed by a live in provider or for a client who lives with other capable persons. Authorizations must be renewed annually.

3.	Instructions for Completing Personal Care Services Plan, SFN 662 535-05-70-01(Revised September 12, 2007, IM #5019)

Section II – Eligibility for Personal Care Service
If the individual chooses to receive services on a daily rate (T1020), the “Daily” check box must be checked.

If the individual chooses to receive services from a Basic Care Assistance provider, check PCS – Basic Care.

If the individual does not qualify for personal care services, check NONE and skip to Section V Signatures. 

Section III – Approved Services
If personal care services are to be provided by a basic care assistance provider, enter the provider name, and provider number.
•	If the basic care assistance provider is to be paid based on a daily rate, enter the units authorized on SFN 663 in the authorized units column, enter 4 in the procedure code column, and 31 in the billable units/days column. Eligibility for daily rate requires the client receives a daily services in at least one of the Task Categories listed on the SFN 663 of ADL, Meal Prep, Med Assistance or Other on a daily basis.
•	If the basic care assistance provider is to be paid based on a 15-minute increment rate enter the units authorized on SFN 663 in the authorized units column, T1019 in the procedure code column, and the authorized units in billable units/days column (units will be the same as the authorized units) to be provided on a monthly basis.  

4.	Instructions for Completing the Authorization to Provide Personal Care Services, SFN 663 535-05-70-05 (Revised August 1, 2007, IM #5015)

“Procedure Code for Billing Total Authorized Units” – enter 31 for Daily rate procedure code T1020 if the QSP is to be paid a daily rate, enter the total units authorized to be provided, this includes the total of the units approved in the Authorized Units per Task Category. if the provider(s) are to bill using a unit rate and procedure code T1019, or enter 31 for procedure code 4 if the service provider is a basic care provider.

(Revised September 12, 2007, IM #5019)
In addition, prior authorization from a State HCBS or DD Program Administrator is required to authorize units for meal prep, Llaundry, shopping, and housekeeping when performed by a live in provider or for a client who lives with other capable persons. Prior authorization must be renewed annually.

Par. 2.  Effective Date -- This manual letter is effective March 1, 2008.

This is the link for this chapter – go into Financial Help.

http://www.state.nd.us/humanservices/policymanuals/home/financialhelp.htm