Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services)

What this rule requires your agency to do

• 1PCS agencies must immediately report abuse, neglect, or exploitation pursuant to NMSA 1978 §27-7-30 (Adult Protective Services Act) by fax within 24 hours, and submit written incident reports to Medicaid/its designee and the MCO within 24 hours of an incident being reported, covering death, environmental hazard, law enforcement intervention, emergency services, and any reports to APS (Sec. 8.14, Approved PCS agency responsibilities; Reportable incidents).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 2An approved PCS agency must perform the nationwide caregiver criminal history screening (per 7.1.9 NMAC [now 8.370.5] and NMSA 1978 §29-17-2 et seq.) on all potential personal care attendants, ensure paperwork is submitted within the first 20 calendar days of hire, may conditionally employ pending results, and may not continue employing an attendant who fails the screening; the agency bears the cost of the first screening (Sec. 8.14, Approved PCS agency responsibilities).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 3PCS providers must use the HCA-approved EVV system to record date and time for provided PCS, must establish employment policies and oversight to ensure required EVV use as mandated by the 21st Century Cures Act, and must complete required EVV system training within 30 days of contracting with the MCOs (Sec. 8.14, Scope of Services).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 4PCS agencies must verify monthly that consumers are eligible for full Medicaid coverage and PCS before furnishing services; maintain audit-ready records disclosing extent and nature of services; use an electronic check-in/check-out system that verifies time/type of services and consumer verification; and pass random and targeted audits, with recoupment for insufficiently documented claims (Sec. 8.14, Approved PCS agency responsibilities).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 5For the consumer-delegated model the agency must have, upon request, an approved written competency test for attendants addressing communication skills; patient/member rights and cultural diversity; recordkeeping; nutrition and meal preparation; housekeeping; care of the ill and disabled including special-needs populations; emergency response (CPR and first aid); universal precautions and basic infection control and home/oxygen/fire safety; incident management and reporting; and confidentiality (Sec. 8.14, Agency Provider Requirements).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 6To be certified, an agency must submit a completed Medicaid PPA (MAD 335); copies of successfully passed nationwide caregivers criminal history screenings on employees meeting the "caregiver"/"care provider" definition (per 7.1.9 NMAC [now 8.370.5] and NMSA 1978 §29-17-2 et seq.); a current business license or non-profit documentation; proof of liability and workers' compensation insurance (submitted annually); and written policies/procedures covering PCS rules, personnel policies, office details, and quality improvement (Sec. 8.14, Agency Provider Requirements).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 7PCS agencies electing to participate must obtain agency certification and may only serve members in counties approved by HCA; each must maintain an official office with published phone number and hours, provide services in all areas of the county, and may elect to serve any county within 100 miles of the main office (Sec. 8.14, Agency Provider Requirements).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))
• 8Under the consumer-directed model the agency (as agency-with-choice legal employer or as fiscal employer agent) must maintain at least quarterly in-person contact with the consumer, obtain signed drug/alcohol agreements, obtain a signed agreement accepting responsibility for training (CPR, first aid, competency testing, TB testing, Hepatitis B immunizations, or waiver), and verify attendants are not on the employee abuse registry (Consolidated Online Registry) prior to employment and annually per 8.11.6 NMAC and the Employee Abuse Registry Act, NMSA §27-7A-1 et seq. (Sec. 8.14, Consumer/Agency responsibilities, consumer-directed model).(Managed Care Policy Manual, Section 8 — Agency-Based Community Benefits (Personal Care Services))