Eligibility

Four categories of personal care assistance (PCA) services are eligible for payment from Medical Assistance:

1. Activities of daily living (ADLs)

2. Instrumental activities of daily living (IADLs)

3. Observation and redirection of behaviors

4. Health-related procedures and tasks.

A personal care assistance (PCA) worker may assist in these four categories of PCA services if the following criteria are met:

1. PCA care plan describes the person’s needed assistance

2. Training of the PCA worker is specific to the person’s needs and occurs in the first 14 days of PCA service for the person (unless person uses PCA Choice).

3. Documentation is in the agency’s file on the individualized training about the needs of the person

4. PCA worker documents services rendered on the timesheet and/or in another agency form.

PCA services may not meet all of the needs of the person. Referrals to other resources and services may be required.

PCA services require prior authorization for payment.

Covered Services

Activities of daily living (ADLs)

A PCA worker may assist the person with the following ADLs:

Dressing – Including application of clothing and special appliances or wraps

1. Grooming – Including basic hair care, oral care, shaving, basic nail care, applying cosmetics and deodorant, care of eyeglasses and hearing aids

2. Bathing – Including basic personal hygiene and skin care

3. Eating – Including completing the process of eating, including hand washing and application of orthotics required for eating, transfers and feeding

4. Transfers – Including assistance to transfer the person from one seating or reclining area to another

5. Mobility – Including assistance with ambulation, including use of a wheel chair; not including providing transportation

6. Positioning – Including assistance with positioning or turning a person for necessary care and comfort

7. Toileting – Including helping person with bowel or bladder elimination and care. This includes transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the perineal area, inspection of the skin and adjusting clothing.

Instrumental activities of daily living (IADLs)

A PCA worker may assist an adult with the following:

1. Accompany to medical appointments

2. Accompany to participate in the community

3. Assist with paying bills

4. Communicate by telephone and other media

5. Complete household tasks integral to the PCA services, such as planning and preparing meals and shopping for food, clothing and other essential items

A PCA worker may assist a child with IADLs when:

1. Immediate attention is needed for health and hygiene reasons integral to the personal care services

2. Assessor has indicated this need on the service plan.

Observation and redirection of behaviors

A PCA worker may observe and provide redirection to the recipient for episodes of behavior needing redirection as identified in the care plan.