Current through Register Vol.. 38, No. 17, April 11, 2022
Service description. Personal assistance
service may be provided either through an agency-directed or a
assistance service means direct support or supervision with (i) ADLs, (ii)
IADLs, (iii) access to the community, (iv) monitoring the self-administration
of medication or other medical needs, (v) monitoring health status and physical
condition, or (vi) work or postsecondary school-related personal assistance.
Personal assistance service substitutes for the absence, loss, diminution, or
impairment of a physical, behavioral, or cognitive function.
2. When specified in the plan for supports,
personal assistance service may include assistance with IADLs. Assistance with
IADLs shall be documented in the plan for supports as essential to the health
and welfare of the individual, rather than for the individual's
family/caregiver's comfort or convenience, or both. In order to be approved for
IADL support, the individual shall also require ADL supports.
3. An additional component to personal
assistance service is work personal assistance or postsecondary school-related
personal assistance that allows the personal assistance service provider to
provide assistance and supports to individuals in the workplace and
postsecondary educational institutions. Work-related personal assistance
service shall not duplicate supported employment service. Personal assistance
can be provided simultaneously with supported employment services and can be
assistance service shall be covered in the FIS and CL waivers.
Criteria and allowable
1. To qualify for personal
assistance service, the individual shall demonstrate a need for assistance with
ADLs, support with taking medication or other medical needs, or monitoring
health status or physical condition.
2. Individuals may receive both
agency-directed and consumer-directed personal assistance as long as the two
service models do not overlap the same days and times.
Individuals choosing the consumer-directed
option for personal assistance service may receive support from a services
facilitator and shall meet requirements for consumer direction as described in
assistance service, allowable activities shall include:
a. Support with ADLs;
b. Support with monitoring of health status
or physical condition;
with prescribed use of medication and other medical needs;
d. Support with preparation and eating of
e. Support with housekeeping
activities, such as bed-making, cleaning, or the individual's
f. Support with
participation in social, recreational, and community activities;
g. Assistance with bowel/bladder care needs,
range of motion activities, routine wound care that does not include the
sterile technique, and external catheter care when trained and supervised by an
h. Accompanying the individual
to appointments or meetings; and
Safety supports. For a child younger than 18 years of age the Request for
Supervision Hours in Personal Assistance form, DMAS P-257, shall be submitted
for service authorization purposes when supervision hours are requested to
address safety support needs.
Service units and limits.
1. The unit of service for personal
assistance service shall be one hour. The hours to be authorized shall be based
on the individual's assessed and documented need as reflected in the plan for
2. Any combination of
respite service, personal assistance service, and companion service in the
consumer-directed service model shall be limited to 40 hours per week for an
employer of record (EOR) by the same assistant. Assistants who live with the
individual, either full time or for substantial amounts of time, shall not be
restricted to only 40 hours per week for the EOR. CD services employees shall
work no more than 16 hours per day.
3. Individuals may receive a combination of
personal assistance service, respite service, companion, and in-home support
service as documented in their ISPs but shall not simultaneously receive
in-home supports service, personal assistance service, or respite
4. Individuals shall
require assistance with ADLs in order to receive IADL care through personal
5. An individual
shall be permitted to share personal assistance service hours with one other
individual who is also receiving waiver-covered personal assistance service and
who also lives in the same home, however, the number of hours billed shall not
exceed the number of hours the assistant worked.
Personal assistance service shall not
include skilled nursing (neither practical nor professional nursing) service
with the exception of skilled nursing tasks that are delegated in accordance
Skilled nursing services can be performed as allowed by §
31 of the Code of Virginia.
Persons rendering personal assistance service for reimbursement by DMAS shall
not be the individual's spouse. If the individual is a minor child, service
shall not be reimbursed if the service is provided by his parent or guardian.
a. Family members who are approved to be
reimbursed by DMAS to provide personal assistance service shall meet all of the
Personal assistance service shall not be provided by adult foster care
providers or any other paid caregivers for an individual residing in that
foster care home.
Work personal assistance or postsecondary school-related personal assistance
shall not be provided if they should be provided by DARS or under IDEA, or if
they are an employer's responsibility under the Americans with Disabilities Act
42 USC §
et seq.), the Virginians with
Disabilities Act (Title 51.5 (§
seq.) of the Code of Virginia), or § 504 of the Rehabilitation Act (
9. Personal assistance shall not be
reimbursed by DMAS for individuals who receive group home residential service,
sponsored residential service, or supported living residential service; who
live in assisted living facilities; or who receive comparable services from
another program, service, or payment source, except as noted in subdivision A 3
of this section.
agency-directed personal assistance service, the provider shall be licensed by
DBHDS as either a group home provider, residential provider, or supportive
in-home residential provider or shall meet the VDH licensing requirements or
have accreditation from a CMS-recognized organization to be a personal care or
respite care provider.
of personal assistance service shall have a current, signed participation
agreement with DMAS. Providers as designated on this agreement shall render
this service directly and shall bill DMAS directly for Medicaid
requirements for agency-directed personal assistance service.
a. A supervisor shall provide ongoing
supervision of all personal assistants.
For personal assistance service providers
that are licensed by DBHDS, a supervisor meeting the requirements of
shall provide supervision of direct support professional staff.
c. For personal assistance service providers
that are licensed by the Virginia Department of Health (VDH), the provider
shall employ or subcontract with and directly supervise an RN or an LPN who
shall provide ongoing supervision of all assistants. The supervising RN or LPN
shall have at least one year of related clinical nursing experience that may
include work in an acute care hospital, public health clinic, home health
agency, ICF/IID, or nursing facility.
d. The supervisor shall make a home visit to
conduct an initial assessment prior to the start of service for all individuals
enrolled in the waiver requesting and who have been approved to receive
personal assistance. The supervisor shall also perform any subsequent
reassessments or changes to the plan for supports. All changes that are
indicated for an individual's plan for supports shall be reviewed with and
agreed to by the individual and, if appropriate, the individual's
e. The supervisor
shall make supervisory home visits as often as needed to ensure both quality
and appropriateness of the service. The minimum frequency of these visits shall
be every 30 to 90 days under the agency-directed model, depending on the
f. Based on
continuing evaluations of the assistant's performance and the individual's
needs, the supervisor shall identify any gaps in the assistant's ability to
function competently and shall provide training as indicated.
requirements for the personal assistance service shall be the same as those set
forth in 12VAC30-122-150
individuals shall have a backup plan prior to initiating services in cases of
emergency or should the provider be unable to render services as needed. This
backup plan shall be shared with the provider and support coordinator at the
onset of services and updated with the provider and support coordinator as
shall ensure that staff providing the personal assistance service meet provider
training and competency requirements as specified in 12VAC30-122-180
Assistants employed by personal assistance
agencies licensed by VDH shall have completed an educational curriculum of at
least 40 hours of study related to the needs of individuals who have
disabilities, including intellectual and developmental disabilities. The
provider shall ensure, prior to assigning assistants to support an individual,
that the assistants have the required skills and training to perform the
service as specified in the individual's plan for supports and related
supporting documentation. Assistants' required training shall be met in one of
the following ways:
(1) Registration with the
Board of Nursing as a certified nurse aide;
(2) Graduation from an approved educational
curriculum as listed by the Board of Nursing; or
(3) Completion of the provider's educational
curriculum, as conducted by a licensed RN who shall have at least one year of
related clinical nursing experience that may include work in an acute care
hospital, public health clinic, home health agency, ICF/IID, or nursing
shall have a satisfactory work record, as evidenced by two references from
prior job experiences, if applicable, including no evidence of possible abuse,
neglect, or exploitation of elderly persons, children, or adults with
to render the service and substitution of assistants. When assistants are
absent or otherwise unable to render scheduled supports to individuals enrolled
in the waiver, the provider shall be responsible for ensuring that the service
continues to be provided to the affected individuals.
(1) The provider may either obtain a
substitute assistant from another provider if the lapse in coverage is to be
less than two weeks in duration or transfer the individual's services to
another personal assistance service provider.
(2) If no other provider is available who can
supply a substitute assistant, the provider shall notify the individual and the
individual's family/caregiver, as appropriate, and the support coordinator so
that the support coordinator may find another available provider of the
temporary, short-term lapses in coverage that are not expected to exceed
approximately two weeks in duration, the following procedures shall apply:
(a) The service-authorized provider shall
provide the supervision for the substitute assistant;
(b) The provider of the substitute assistant
shall send a copy of the assistant's daily documentation signed by the
assistant, the individual, and the individual's family/caregiver, as
appropriate, to the provider having the service authorization; and
(c) The service authorized provider shall
bill DMAS for service rendered by the substitute assistant.
e. If a provider secures
a substitute assistant, the provider agency shall be responsible for ensuring
that all DMAS requirements continue to be met including documentation of
service rendered by the substitute assistant and documentation that the
substitute assistant's qualifications meet DMAS requirements. The two providers
involved shall be responsible for negotiating the financial arrangements of
paying the substitute assistant.
Persons functioning as assistants shall
meet the following requirements:
a. Be at
least 18 years of age;
b. Be able
to read and write English to the degree required to function in this capacity
and create and maintain the required documentation to support billing and
possess basic math skills;
capable of following a plan for supports with minimal supervision and
physically able to perform the required work;
d. Possess a valid Social Security Number
that has been issued by the Social Security Administration to the person who is
to function as the assistant;
capable of aiding in IADLs;
Receive a tuberculosis screening according to the requirements of the Virginia
Department of Health; and
consumer directed assistants, be willing to attend training at the individual's
or family/caregiver's request.
Agency-directed service documentation and
The record for
agency-directed providers shall at a minimum contain all of the following:
a. The most recently updated plan for
supports and supporting documentation, and all provider documentation.
A copy of the most recently
updated age-appropriate assessment form as set out in 12VAC30-122-200
initial assessment by the DBHDS-licensed agency supervisor or RN supervisory
nurse completed prior to or on the date the service is initiated, subsequent
reassessments, and changes to the supporting documentation by the RN
summarizing notes recorded and dated during any contacts with the personal
assistant during supervisory visits to the individual's home.
d. The specific service delivered to the
individual enrolled in the waiver by the personal assistant dated the day of
service delivery, and the individual's unique, specific responses.
e. The personal assistant's arrival and
f. The personal
assistant's weekly comments or observations about the individual enrolled in
the waiver to include individual-specific observations of the individual's
physical and emotional condition, daily activities, and responses to the
g. The personal
assistant's, individual's and the individual's family/caregiver's, as
appropriate, weekly signatures recorded on the last day of service delivery for
any given week to verify that the personal assistance service during that week
has been rendered.
h. A written
review supported by documentation in the individuals' record that is submitted
to the support coordinator at least quarterly with the plan for supports, if
modified. For the annual review and every time supporting documentation is
updated, the supporting documentation shall be reviewed with the individual or
family/caregiver, as appropriate, and such review shall be documented.
i. All correspondence to the
individual and the individual's family/caregiver, as appropriate, the support
coordinator, DMAS, and DBHDS.
Written documentation of all contacts with the individual's family/caregiver,
physicians, providers, and all professionals regarding the
assistant service records shall be separated from those of other nonwaiver
services, such as home health service.
Provider progress notes shall meet the
standards contained in 12VAC30-122-120
4. Provider documentation shall support all
claims submitted for DMAS reimbursement. Claims for payment that are not
supported by supporting documentation shall be subject to recovery by DMAS or
its designee as a result of utilization reviews or audits.
requirements are set forth in 12VAC30-122-500