10A NCAC 25O .0202. PERSONAL CARE SERVICES

(a)  The Division of Medical Assistance will cover personal care services in accordance with federal law.  The provision of personal care services must be physician authorized and must meet the following criteria:

(1)           The recipient of the service must have a medical diagnosis that warrants a physician's care and that recipient must be under the direct and ongoing care of the physician prescribing PCS.

(2)           The recipient's medical condition must be stable at maintenance level.

(3)           There must be a medical necessity for the provision of personal care services.

(b)  An enrolled provider must be a State licensed home care agency located within North Carolina that is approved in its license to provide in-home aide services.

(c)  Reimbursement is not available for personal care services exceeding 80 hours per recipient per calendar month.

(d)  Reimbursement for personal care services is not available to a given recipient on the same day another substantially equivalent service is provided.  Substantially equivalent services include home health aide services, and personal care services provided through In‑home Aide services at Level II and Level III ‑ Personal Care as defined in 10A NCAC 06A .0103(2) and 10A NCAC 06A .0103(4).

(e)  A member of the recipient's immediate family may not be employed by a provider agency to provide personal care services reimbursed by Medicaid.  Immediate family members are defined as spouses, children, parents, grandparents, grandchildren, siblings, including corresponding step‑ and in‑law relationships.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; S.L. 2002-126; S.L. 1985, c. 479, s. 86; 42 C.F.R. 440.170(f);

Eff. January 1, 1986;

Amended Eff. April 1, 1993; December 1, 1991;

Temporary Amendment Eff. December 27, 2002 (Paragraphs (c)-(e));

Temporary Amendment Expired October 12, 2003 (Paragraphs (c)-(e));

Paragraphs (a)-(b) transferred from 10A NCAC 22O .0120 Eff. May 1, 2012 (previously recodified from 10 NCAC 26B .0119 Eff. October 1, 1993 and recodified from 10 NCAC 26B .0120 Eff. January 1, 1998;

Paragraphs (c)-(e) transferred from 10A NCAC 22P .0410 Eff. May 1, 2012.