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Personal Assistance

Personal Assistance shall mean the provision of direct assistance with activities of daily living (e.g., bathing, dressing, personal hygiene, feeding/assistance with eating, meal preparation excluding cost of food, toileting and incontinence care, assistance with transfer and mobility), household chores essential to the health and safety of the person (e.g., washing dishes; personal laundry; general housecleaning in areas of the residence used by the waiver participant); budget management, supervising and accompanying the person to medical appointments if needed, and on personal errands such as grocery shopping, picking up prescriptions, paying bills; and trips to the post office.  It also may include medication administration as permitted under Tennessee's Nurse Practice Act.  Personal Assistance shall be provided in accordance with therapeutic goals and objectives as specified in the plan of care. 

Personal Assistance is a service that is provided for the direct benefit of the person.  It is not a service that provides assistance to other members of the household (e.g., preparation of meals for the family, family laundry) who are not persons supported through the waiver.  Personal Assistance staff shall not provide any personal assistance services to family members of the person, unless such family members are also supported through the waiver  residing in the same home (e.g., when 2 siblings in the home are both waiver participants). 

When Personal Assistance is provided as a shared service for 2 or more family members who are waiver participants residing in the same home, the total number of units of shared Personal Assistance shall be apportioned based on an assessment of individual need and the apportioned amount included in the plan of care for each waiver participant, as applicable.

Personal Assistance is often delivered in the person place of residence; however, it may be provided outside the person home in community-based settings where the Personal Assistance provider accompanies the person to perform tasks and functions in accordance with the approved service definition and as specified in the plan of care.  Personal Assistance does not include routine provision of Personal Assistance services in an area outside the person’s waiver participant's local community of residence. On an infrequent and exceptional basis and in accordance with the approved plan of care, Personal Assistance services may be provided in an area outside the person’s waiver participant’s local community of residence.

Personal Assistance may be provided in the home or community; however, it shall not be provided in schools for school-age children, to replace personal assistance or similar services required to be covered by schools, to transport or otherwise take children to or from school, or to replace services available through the Medicaid State Plan/TennCare Program. 

Personal Assistance services shall not be provided in the home of the Personal Assistant, except (1) when the waiver participant lives in the home with the Personal Assistant or (2) on an infrequent and exceptional basis when the person is attending a special event (e.g., a party) that is held in the home of the Personal Assistant.  Services provided in the Personal Assistant’s home must be specified and in accordance with the approved ISP.
Personal Assistance may be provided during the day or night, as specified in the plan of care.  A person who is receiving a residential service (e.g., Supported Living, Residential Habilitation, Medical Residential Services, or Family Model Residential Support) shall not be eligible to receive Personal Assistance. 

Personal Assistant Services shall not be provided during the same time period that the person is receiving Day Services, Respite Services, services under a 504 Plan or Individual Education Program (IEP), is being homeschooled, or any combination thereof or as a substitute for education services which are available pursuant to IDEA, but which the person or his representative has elected to forego. 

This service shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).  Personal Assistance shall not be provided in a licensed facility (e.g., a group home, boarding home, or assisted living home) when the facility's licensure category requires the provision of personal assistance or personal care services.

Family members who provide Personal Assistance must meet the same standards as providers who are unrelated to the person. The Personal Assistant shall not be the spouse of a person and shall not be the parent or custodial grandparent of a person under age 18 years, whether the relationship is by blood, by marriage, or by adoption; and reimbursement shall not include payment for Personal Assistance provided by such individuals.  Reimbursement shall not be made to any other individual who is a conservator unless so permitted in the Order for Conservatorship.

Family members are required to implement services as specified in the individual support plan (ISP). Reimbursement to family members shall be limited to forty hours per week per family member for self-directed services as well as those delivered by contracted provider agencies. The person’s Circle of Support is responsible for determining if the use of family members to deliver paid care is the best choice for the person and shall ensure that paid services do not supplant natural supports that would otherwise be provided at no cost to the Medicaid program.

The unit of reimbursement for Personal Assistance services shall be 15 minutes.

The Personal Assistance provider is not obligated to provide transportation for the person as part of the Personal Assistance service; however, a Personal Assistance provider who is also an Individual Transportation Services provider may bill for Individual Transportation Services for transport of the person into the community.

Personal Assistance may be provided out-of-state under the following circumstances:

a. Out-of-state services shall be for the purpose of visiting relatives or for vacations and shall be included in the person's plan of care.  (Trips to casinos or other gambling establishments shall be excluded.)

b. Out-of-state services shall be subject to the same monthly limitation as Personal Assistance services provided in-state and in addition, are limited to a maximum of 14 days per person supported per waiver program year.

c. The waiver service provider agency must be able to assure the health and safety of the person supported during the period when services will be provided out-of-state and must be willing to assume the additional risk and liability of provision of services out-of-state (i.e., provision of out-of-state services is at the discretion of the service provider).

d. During the period when out-of-state services are being provided, the waiver service provider agency must maintain an adequate amount of staffing (including services of a nurse if applicable) to meet the needs of the person supported and must ensure that staff meet waiver provider qualifications.

e. The waiver service provider agency shall not receive any additional reimbursement for provision of services out-of-state.  The costs of travel, lodging, food, and other expenses incurred by staff during the provision of out-of-state services shall not be reimbursed through the waiver.  The costs of travel, lodging, food, and other expenses incurred by the person supported while receiving out-of-state services shall be the responsibility of the person supported and shall not be reimbursed through the waiver.

Applicable limits, if any, on the amount, frequency, or duration of this service:
Personal Assistance services shall be limited to a maximum of 860 units (215 hours) per waiver participant per month.  Out of state Personal Assistance services are subject to the same monthly limitation, and in addition, are limited to a maximum of 14 days per waiver participant per waiver program year.

 

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