HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model)

What this rule requires your agency to do

• 1Dietary units for a specialized diet may be authorized only after DSDS reviews the physician-ordered diet, and no meal-prep/cleanup units may be authorized unless facility staff exceeds licensure requirements.(HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model))
• 2Participants must be at least 18 years of age, in active Medicaid status, and meet nursing facility level of care.(HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model))
• 3Basic PC and APC services in an RCF/ALF must be authorized in 15-minute units.(HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model))
• 4PC services shall not exceed 60% of the cost maximum (exceedable by APC and RN visit costs up to 100%), and all combined PC services shall not exceed 100% of the average statewide monthly nursing-facility cost.(HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model))
• 5APC tasks (e.g., aseptic dressings, non-injectable medication assistance) must be performed only as directed/set up by a licensed nurse where specified.(HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model))
• 6RCF/ALF PC services may be authorized only when the resident's needs exceed the facility's minimum licensure obligations, and reimbursement cannot duplicate services already covered in facility reimbursement (e.g., routine linen changes, meal preparation).(HCBS Policy Manual 3.20 — RCF/ALF Personal Care – State Plan (Agency Model))