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IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations
IdahoregulationIdaho Department of Health and Welfare· effective 2022-03-17
What this rule requires your agency to do
- 1Non-nasogastric gastrostomy tube feedings may be performed only if authorized by BLTC before implementation and only when a Licensed RN has assessed needs, written a standardized individualized procedure, named the delegatee(s), instructed and observed a return demonstration, documented strengths/weaknesses, and evaluates performance at least monthly. (Subsection 01.f)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 2Assisting with physician-ordered self-administered medications must be done in accordance with IDAPA 24.34.01 (Idaho Board of Nursing), Subsection 490.05. (Subsection 01.e)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 3PCS must consist of medically-oriented tasks related to the participant's physical or functional requirements (not housekeeping or skilled nursing), and the provider must deliver at least one of the enumerated basic personal-care/grooming, toileting, food/nutrition, active-treatment, medication-assistance, or authorized gastrostomy-feeding services. (Subsection 01)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 4The provider is prohibited from irrigation/suctioning of body cavities requiring sterile procedure, sterile dressing with prescription medication/aseptic technique, catheter insertion or sterile irrigation, injecting fluids, and administering medication. (Subsection 04)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 5Any change in the participant's status or problem related to the gastrostomy procedure must be reported immediately to the RN, and the procedure/supervision/evaluation must be documented in writing and readily available for review. (Subsection 01.f.iv-v)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 6Adults under the State Plan option are limited to 16 hours/week; the provider must not bill for more time than actually spent, and no provider home may serve more than two children authorized for eight or more hours of PCS per day. (Subsections 05.a, 06)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 7PCS may be provided only in the participant's own home/personal residence (which may be a Certified Family Home, Residential Assisted Living Facility, or PCS Family Alternate Care Home); nursing facilities, hospitals, ICFs/IID, and specialized/professional/group foster-care homes are excluded. (Subsection 03)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
- 8Non-medical tasks (incidental housekeeping, accompaniment to medical visits, health-related shopping) may be performed only in addition to at least one covered medical service and only if no natural supports are available; cleaning/laundry for other household occupants is excluded. (Subsection 02)(IDAPA 16.03.10.303 — Personal Care Services: Coverage and Limitations)
Applies to: personal care
Defines the scope of covered Idaho Medicaid Personal Care Services (PCS), the medical and non-medical tasks a provider may perform, allowable places of service, excluded/prohibited tasks, and hard hour limits (16 hours/week for adults under the State Plan option; up to 24 hours/day for qualifying EPSDT children). It also sets delegation and RN-supervision requirements for non-nasogastric gastrostomy tube feedings and prohibits billing for time not actually worked. Framework topic: Scope of Services / Service Coverage & Limitations.
Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.