Or. Admin. Code § 410-172-0780 - Behavioral Health Personal Care Attendant Program
(1) The Behavioral Health Personal Care
Attendant (BH PCA) program ensures state plan personal care services support
and augment independence, empowerment, dignity and human potential through the
provision of flexible, efficient and suitable services to adults and children
eligible for State Plan personal care services. The BH PCA program is not
intended to supplement an individual's own personal abilities and resources,
including natural resources.
(2)
The BH PCA program provides essential personal care services that enable an
individual to move into or remain in their own home. Personal care services are
provided in accordance with an individual's authorized person-centered service
plan.
(a) Personal care services through the
BH PCA program are provided directly to an eligible individual and are not
meant to provide respite or other services to an individual's natural support
system. Personal care services may not be implemented for the purpose of
benefiting an individual's family members or the individual's
household;
(b) Personal care
services through the BH PCA program may not exceed 270 hours in a
person-centered service plan year from the date they were determined eligible
without an exception request approval from the Authority;
(c) When an individual's personal care
service needs are assessed as exceeding the annual maximum of 270 hours a year,
an exception request may be submitted in writing by the PCA Service Coordinator
and identify the following:
(A) The
exceptional personal care needs the individual is experiencing;
(B) The tasks that require hands on
assistance or direct supervision and cueing every time they occur;
and
(C) The date the additional
personal care services start and length of time to complete the
tasks.
(d) The Division
has up to 45 days upon receipt of an exception request to determine whether an
individual's assessed personal care needs warrant exceeding the 270-hour per
person-centered service plan year limitation and issue written notice to the
individual and the requesting provider;
(e) The PCA Service Coordinator will inform
the individual, through written notice, within 10 days of the Division's
decision including the individual's right to a hearing.
(3) Personal care services include:
(a) Activities of Daily Living (ADLs):
(A) Eating includes assisting the individual
in feeding or fluid intake by any means from a receptacle into the body.
Includes monitoring to prevent choking or aspiration.
(B) Bathing includes assisting the individual
with cleansing the body, washing hair, shaving, nail care, and using assistive
devices when necessary to get in and out of the bathtub or shower.
(C) Dressing includes assisting the
individual with putting on, fastening, and taking off all items of clothing,
braces, and artificial limbs, including obtaining and replacing items from
their storage area in the immediate environment.
(D) Toileting includes assisting the
individual in getting to and from, on and off, the toilet, commode or bedpan
for elimination of feces and urine. This includes cleansing after elimination
and adjusting clothing as necessary.
(E) Maintaining Continence includes assisting
the individual with external cleansing of Foley catheter, emptying catheter
drainage bag, maintenance bowel care, changing and replacing incontinence
products, including colostomy or ileostomy bags.
(F) Transferring includes assisting the
individual with mobility, transfers and repositioning by any means including
use of an assistive device and includes turning or adjusting padding for
physical comfort or pressure relief and encouraging or assisting with range of
motion exercises.
(b)
Instrumental Activities of Daily Living (IADLs)
(A) Personal Hygiene includes performing or
assisting the individual with activities required to keep one's desired
appearance, secure or fasten clothing, comb/brush hair, nail care, foot care,
skin care, mouth care and oral hygiene, etc.
(B) Light Housework includes performing or
assisting the individual with housekeeping tasks necessary to maintain the
individual in a healthy and safe living environment.
(C) Laundry includes performing or assisting
the individual with laundering or cleaning of clothing, bedding and other
linens.
(D) Meal preparation
includes performing or assisting the individual with healthy meal planning and
preparation, ensuring special diets are followed.
(E) Transportation includes assisting the
individual in getting to and from medically appropriate and necessary
appointments and community activities through available means of transportation
in accordance with the individual's authorized service plan, which may include:
(i) Scheduling non-emergent medical
transportation (NEMT) for their OHP covered medical service
appointments;
(ii) Scheduling
non-medical rides through public transportation or other modes of
transportation;
(iii) Accompanying
the individual to and from appointments or community activities;
(iv) Transporting the individual in the
personal care attendant's personal vehicle:
(I) The PCA Provider is required to submit
proof of current vehicle registration and insurance for the personal vehicle
used to transport the individual and a current valid driver's license to the
individual's PCA Service Coordinator prior to transporting client in the PCA's
personal vehicle.
(II) Mileage is
only reimbursed by the Authority when authorized in the individuals current
person-centered service plan and documentation requirements in OAR chapter 410
division 120 for billing and payment are met.
(III) Mileage reimbursement rate for a PCA is
described in the current Collective Bargaining Agreement (CBA).
(IV) Mileage is only reimbursed by Authority
for OHP covered medical appointments when there is documentation in the
individual's medical record, on the date of service, by the IQA of the barriers
preventing the individual's use of non-emergent medical transportation or
public transit.
(F) Shopping includes performing or assisting
the individual in planning for and purchasing of essential items including
clothing, groceries, prescribed medication, hygiene products and basic
household necessities.
(G) Using
the Telephone or other Electronic Communication Devices includes performing or
assisting the individual in arranging necessary appointments and making desired
phone calls using a telephone, smart phone, tablet or other similar electronic
device for communication purposes.
(H) Medication assistance includes helping
individual with oral medications prescribed for the individual by a licensed
medical professional, which are ordinarily self-administered described below:
(i) Administering medication;
(ii) Supervision or cueing to ensure the
individual is taking medication as prescribed;
(iii) Documenting and monitoring any notable
side effects;
(iv) Refilling
prescriptions; and
(v) Assisting
with use, maintenance, and cleaning of in-home medical equipment authorized by
a licensed medical professional, monitoring client's the individual's
condition, ordering and maintaining necessary supplies. Use, maintenance and
cleaning of in-home medical equipment must be performed by PCA in compliance
with manufacturers guidelines and PCA must have received prior training and
education from an RN, when applicable, in how to correctly perform these
tasks.
(I) Money
Management includes performing or assisting the individual with budgeting,
making payments for monthly expenses and use of personal funds for desired
items and activities.
(c) Delegated nursing includes nursing tasks
that are delegated by a Registered Nurse currently licensed and in good
standing with the Oregon Board of Nursing, to a licensed provider or other
non-licensed persons in accordance with OAR chapter 851, division 47. Skilled
services delegated by a Registered Nurse (RN) under Oregon's Nurse Practice Act
may be considered personal care services when the RN provides appropriate
training and delegation of the listed nursing tasks in accordance with the
Oregon Nurse Practice Act.
(d)
Personal care services may be required due to cognitive impairments that
prevent an individual from knowing when or how to carry out ADL/IADL tasks. In
such cases, personal assistance may include cueing along with supervision to
ensure the individual performs the task properly.
(4) Services outside the ADL/IADL in section
(3) above are not eligible for payment. Payment may not be made by the
Authority to a PCA for any of the following excluded services:
(a) Shopping for entertainment purposes or
non-essential items;
(b) Social
companionship;
(c) Day care,
partial hospitalization, respite or baby-sitting services;
(d) Care, grooming, or feeding of pets or
other animals; or
(e) Yard work,
gardening or home repair.
Notes
Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 413.042, 414.025, 414.065, 430.640, 430.705 & 430.715
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.