39-5603. STANDARDS FOR PROVISION OF PERSONAL ASSISTANCE SERVICES. The director shall have the power and it shall be his duty to promulgate and adopt appropriate rules necessary to implement and enforce standards for provision of personal assistance services.

The following standards for provision of personal assistance services and other provisions contained throughout this chapter and rules shall apply to participants and providers receiving or providing personal assistance services either as a medicaid option service or a waivered service, unless prohibited by federal law or contents of the federal waiver agreement.

(1) Personal care services shall be included in the medicaid services described in section 56-255(3) and (4), Idaho Code.

(2) Attendant care shall be included as a service under medicaid home and community-based waiver(s).

(3) All attendant care services must be authorized by the department or its designee.

(4) The department will establish by rule maximum hours per month of personal care services available to the individual participant under the state medicaid plan.

(5) The department shall enter into agreements with providers for the provision of personal assistance services. A single provider may operate as both a personal assistance agency and a fiscal intermediary agency. However, the agency must clearly document whether it is operating as a personal assistance agency or as a fiscal intermediary for each participant. The department may deny provider status or revoke that status when a provider is found to endanger the health, person or property of the participant, or is in violation of rules promulgated by the department or the provider agreement.

(6) A personal assistance agency shall have the responsibility for the following:

(a) Recruitment, hiring, firing, training, supervision, scheduling, payroll, and the assurance of quality of service, of its personal assistants;

(b) Complying with state and federal labor and tax laws, rules and regulations;

(c) Maintaining liability insurance coverage;

(d) Provision of an appropriately qualified nurse when required;

(e) Assignment of a qualified personal assistant to each authorized participant after consultation with and prior approval of that participant;

(f) Assuring all personal assistants providing services meet the standards and qualifications of this chapter;

(g) Billing medicaid for services approved and authorized;

(h) Collecting any participant contribution due;

(i) Referring participants to the department for service coordination services based on established criteria;

(j) Providing for care by a qualified replacement when the regular personal assistant is unable to provide the services, and providing for unanticipated services approved on the individual service plan when requested by the participant; and

(k) Conducting, at least annually, participant satisfaction/quality control reviews available to the department and general public.

(7) A fiscal intermediary agency shall have the responsibility for the following:

(a) To assure compliance with legal requirements related to the employment of participant/family directed personal assistants;

(b) To offer services to enable participants or families to perform required employer tasks themselves;

(c) To bill the medicaid program for services approved and authorized by the department;

(d) To collect any participant contribution due;

(e) To pay personal assistants for services;

(f) To perform all necessary withholding as required by state and federal labor and tax laws, rules and regulations;

(g) To assure that all personal assistants providing services meet the standards and qualifications of this chapter;

(h) To refer participants to service coordination services based on established criteria;

(i) To maintain liability insurance coverage;

(j) To conduct, at least annually, participant satisfaction and quality control reviews which shall be available to the department and to the general public; and

(k) To maintain documentation that the participant or his legal representative agrees in writing that he takes responsibility for and accepts potential risks, and any resulting consequences, for his choice to manage his own personal assistance services.

(8) Personal assistants are not employees of the state.

(9) Service coordination shall be made available to personal assistance participants where and when appropriate. In order to avoid a conflict of interest, service coordination shall not be provided by the same agency that provides personal assistance services to the participant.

(10) The department’s regional medicaid staff shall review and approve the individual service plan, authorize personal assistance services, the hours of service, and make appropriate referrals for service coordination for eligible individuals.

(11) The department shall establish and maintain a community awareness program that will educate Idaho citizens regarding the purpose and function of all long-term care alternatives including, but not limited to, personal assistance services and individual participant rights. This program will be developed in cooperation with other state agencies including, but not limited to, the commission on aging and the state independent living council.

(12) It shall be the responsibility of the participant or his designee or legal representative, when appropriate, to select the provider of personal assistance services.

(13) The department shall provide the participant, his designee or legal representative, with a list of available providers of personal assistance services; however, this does not relieve the participant or his designee or legal representative of the responsibility of provider selection.

(14) In those cases where the participant or his designee or legal representative cannot arrange for personal assistance services or asks for help in making arrangements, a representative of the department may arrange for or help arrange for personal assistance services on behalf of the participant.

History:

[(39-5603) 39-A4703, added 1981, ch. 65, sec. 1, p. 93; am. & redesig. 1990, ch. 326, sec. 3, p. 890; am. 1997, ch. 316, sec. 2, p. 934; am. 1998, ch. 224, sec. 2, p. 771; am. 2000, ch. 274, sec. 124, p. 861; am. 2006, ch. 283, sec. 1, p. 869; am. 2007, ch. 222, sec. 3, p. 666; am. 2010, ch. 347, sec. 3, p. 906.]