37.40.1135    AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: REIMBURSEMENT

(1) Personal Assistance Services (PAS) may be provided up to, but not more than, 80 hours of attendant service per two-week time period per person as defined by the service profile. The department may, within its discretion, authorize additional hours in excess of this limit. Any services exceeding this limit must be prior authorized by the department. Prior authorization for excess hours may be authorized if additional assistance is required for:

(a) a period of time not to exceed three months and as the result of an acute medical episode;

(b) a period of time not to exceed three months and to prevent institutionalization during the absence of the normal caregiver; or

(c) a period of time not to exceed three months and during a post-hospitalization period.

(2) Add-on payments for direct-care wage, bonus, and health care for health care workers are subject to the requirements in ARM 37.40.1027 and 37.40.1030.

(3) PAS include the following:

(a) personal care attendant service is a 15-minute unit and means an onsite visit specific to a member. Personal care attendant services include the performance of activities of daily living, instrumental activities of daily living, and health maintenance activities. The personal care attendant service rate is an all-inclusive rate and includes the provider agency's administrative, person-centered planning, supervision, and oversight duties;

(b) medical escort is a 15-minute unit and means transportation time and appointment time so the person can access an approved medical appointment; and

(c) mileage is a unit of one mile and means reimbursement for mileage when an attendant uses their vehicle to transport a person on an approved shopping, or medical escort trip.

(4) The department will not reimburse a member for in-home services delivered by a privately retained attendant.

(5) Reimbursement is not available for PAS provided by immediate family members as described in ARM 37.40.1111.

(6) Reimbursement fees for agency-based and self-directed PAS are stated in the department's fee schedule adopted at ARM 37.85.105(4).

History: 53-2-201, 53-6-101, MCA; IMP, 53-2-201, 53-6-113, MCA; NEW, 2014 MAR p. 3086, Eff. 12/25/14; AMD, 2015 MAR p. 822, Eff. 7/1/15.