Utah Medicaid Provider Manual – Personal Care Services

What this rule requires your agency to do

• 1Providers must report any breach or loss of PHI/PII to the EPAS specialist in the Division of Integrated Healthcare not more than 24 hours after the provider knows or should have reasonably known about the breach, and must also submit a written/email report to DFHP within 5 business days of the breach (Part 2, Ch. 11-2).(Utah Medicaid Provider Manual – Personal Care Services)
• 2The RN must make a supervisory visit to the member's residence at least once every 60 days to ensure adequate care is provided according to the written plan of care (Part 1, Ch. 8-2.3).(Utah Medicaid Provider Manual – Personal Care Services)
• 3Providers' EVV systems must be compliant with 21st Century Cures Act requirements, capturing type of service, individual receiving the service, date, location of service delivery, individual providing the service, time the service begins and ends, and date of creation of the electronic record; providers must make EVV records available to Medicaid for review (Part 1, Ch. 3-1).(Utah Medicaid Provider Manual – Personal Care Services)
• 4The certification period for each plan of care is 60 days; an RN must perform a new nursing assessment and the agency must review and revise the plan of care every 60 days, and the care plan must be signed by an RN and included in the agency's permanent record for the member (Part 1, Ch. 8-2.2).(Utah Medicaid Provider Manual – Personal Care Services)
• 5Personal care aide services are limited to 60 hours per month, and nursing assessments are limited to one every 60 days (performable 3 days before or 2 days after the 60-day mark; outside that window prior authorization is required) (Part 1, Ch. 9).(Utah Medicaid Provider Manual – Personal Care Services)
• 6Any person who has reason to believe that a vulnerable adult is being abused, neglected, or exploited must immediately notify adult protective services or the nearest law enforcement office, per Utah law 62A-3-305 (Part 2, Ch. 9).(Utah Medicaid Provider Manual – Personal Care Services)
• 7Personal care services reported under HCPCS code T1019 require prior authorization; failure to obtain PA results in denial of payment, and the PA request with supporting medical documentation must be completed through PRISM within 10 business days of the nursing assessment (Part 1, Ch. 10).(Utah Medicaid Provider Manual – Personal Care Services)
• 8An RN must supervise the provision of PCS, a physician must prescribe the necessary PCS, and only a qualified personal care aide, CNA, HHA, LPN, or RN (performing only personal care level tasks) may provide PCS (Part 1, Ch. 8-2.1).(Utah Medicaid Provider Manual – Personal Care Services)