Or. Admin. Code § 410-172-0780

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-172-0780 - Behavioral Health Personal Care Attendant Program

(1) The Behavioral Health Personal Care Attendant (BH PCA) program ensures state plan personal care services support and augment independence, empowerment, dignity and human potential through the provision of flexible, efficient and suitable services to adults and children eligible for State Plan personal care services. The BH PCA program is not intended to supplement an individual's own personal abilities and resources, including natural resources.

(2) The BH PCA program provides essential personal care services that enable an individual to move into or remain in their own home. Personal care services are provided in accordance with an individual's authorized person-centered service plan.

(a) Personal care services through the BH PCA program are provided directly to an eligible individual and are not meant to provide respite or other services to an individual's natural support system. Personal care services may not be implemented for the purpose of benefiting an individual's family members or the individual's household;

(b) Personal care services through the BH PCA program may not exceed 270 hours in a person-centered service plan year from the date they were determined eligible without an exception request approval from the Authority;

(c) When an individual's personal care service needs are assessed as exceeding the annual maximum of 270 hours a year, an exception request may be submitted in writing by the PCA Service Coordinator and identify the following:

(A) The exceptional personal care needs the individual is experiencing;

(B) The tasks that require hands on assistance or direct supervision and cueing every time they occur; and

(C) The date the additional personal care services start and length of time to complete the tasks.

(d) The Division has up to 45 days upon receipt of an exception request to determine whether an individual's assessed personal care needs warrant exceeding the 270-hour per person-centered service plan year limitation and issue written notice to the individual and the requesting provider;

(e) The PCA Service Coordinator will inform the individual, through written notice, within 10 days of the Division's decision including the individual's right to a hearing.

(3) Personal care services include:

(a) Activities of Daily Living (ADLs):

(A) Eating includes assisting the individual in feeding or fluid intake by any means from a receptacle into the body. Includes monitoring to prevent choking or aspiration.

(B) Bathing includes assisting the individual with cleansing the body, washing hair, shaving, nail care, and using assistive devices when necessary to get in and out of the bathtub or shower.

(C) Dressing includes assisting the individual with putting on, fastening, and taking off all items of clothing, braces, and artificial limbs, including obtaining and replacing items from their storage area in the immediate environment.

(D) Toileting includes assisting the individual in getting to and from, on and off, the toilet, commode or bedpan for elimination of feces and urine. This includes cleansing after elimination and adjusting clothing as necessary.

(E) Maintaining Continence includes assisting the individual with external cleansing of Foley catheter, emptying catheter drainage bag, maintenance bowel care, changing and replacing incontinence products, including colostomy or ileostomy bags.

(F) Transferring includes assisting the individual with mobility, transfers and repositioning by any means including use of an assistive device and includes turning or adjusting padding for physical comfort or pressure relief and encouraging or assisting with range of motion exercises.

(b) Instrumental Activities of Daily Living (IADLs)

(A) Personal Hygiene includes performing or assisting the individual with activities required to keep one's desired appearance, secure or fasten clothing, comb/brush hair, nail care, foot care, skin care, mouth care and oral hygiene, etc.

(B) Light Housework includes performing or assisting the individual with housekeeping tasks necessary to maintain the individual in a healthy and safe living environment.

(C) Laundry includes performing or assisting the individual with laundering or cleaning of clothing, bedding and other linens.

(D) Meal preparation includes performing or assisting the individual with healthy meal planning and preparation, ensuring special diets are followed.

(E) Transportation includes assisting the individual in getting to and from medically appropriate and necessary appointments and community activities through available means of transportation in accordance with the individual's authorized service plan, which may include:

(i) Scheduling non-emergent medical transportation (NEMT) for their OHP covered medical service appointments;

(ii) Scheduling non-medical rides through public transportation or other modes of transportation;

(iii) Accompanying the individual to and from appointments or community activities;

(iv) Transporting the individual in the personal care attendant's personal vehicle:

(I) The PCA Provider is required to submit proof of current vehicle registration and insurance for the personal vehicle used to transport the individual and a current valid driver's license to the individual's PCA Service Coordinator prior to transporting client in the PCA's personal vehicle.

(II) Mileage is only reimbursed by the Authority when authorized in the individuals current person-centered service plan and documentation requirements in OAR chapter 410 division 120 for billing and payment are met.

(III) Mileage reimbursement rate for a PCA is described in the current Collective Bargaining Agreement (CBA).

(IV) Mileage is only reimbursed by Authority for OHP covered medical appointments when there is documentation in the individual's medical record, on the date of service, by the IQA of the barriers preventing the individual's use of non-emergent medical transportation or public transit.

(F) Shopping includes performing or assisting the individual in planning for and purchasing of essential items including clothing, groceries, prescribed medication, hygiene products and basic household necessities.

(G) Using the Telephone or other Electronic Communication Devices includes performing or assisting the individual in arranging necessary appointments and making desired phone calls using a telephone, smart phone, tablet or other similar electronic device for communication purposes.

(H) Medication assistance includes helping individual with oral medications prescribed for the individual by a licensed medical professional, which are ordinarily self-administered described below:

(i) Administering medication;

(ii) Supervision or cueing to ensure the individual is taking medication as prescribed;

(iii) Documenting and monitoring any notable side effects;

(iv) Refilling prescriptions; and

(v) Assisting with use, maintenance, and cleaning of in-home medical equipment authorized by a licensed medical professional, monitoring client's the individual's condition, ordering and maintaining necessary supplies. Use, maintenance and cleaning of in-home medical equipment must be performed by PCA in compliance with manufacturers guidelines and PCA must have received prior training and education from an RN, when applicable, in how to correctly perform these tasks.

(I) Money Management includes performing or assisting the individual with budgeting, making payments for monthly expenses and use of personal funds for desired items and activities.

(c) Delegated nursing includes nursing tasks that are delegated by a Registered Nurse currently licensed and in good standing with the Oregon Board of Nursing, to a licensed provider or other non-licensed persons in accordance with OAR chapter 851, division 47. Skilled services delegated by a Registered Nurse (RN) under Oregon's Nurse Practice Act may be considered personal care services when the RN provides appropriate training and delegation of the listed nursing tasks in accordance with the Oregon Nurse Practice Act.

(d) Personal care services may be required due to cognitive impairments that prevent an individual from knowing when or how to carry out ADL/IADL tasks. In such cases, personal assistance may include cueing along with supervision to ensure the individual performs the task properly.

(4) Services outside the ADL/IADL in section (3) above are not eligible for payment. Payment may not be made by the Authority to a PCA for any of the following excluded services:

(a) Shopping for entertainment purposes or non-essential items;

(b) Social companionship;

(c) Day care, partial hospitalization, respite or baby-sitting services;

(d) Care, grooming, or feeding of pets or other animals; or

(e) Yard work, gardening or home repair.

Or. Admin. Code § 410-172-0780

DMAP 85-2014(Temp), f. 12-24-14, cert. ef. 1-1-15 thru 6-29-15; DMAP 32-2015, f. 6-24-15, cert. ef. 6/26/2015; DMAP 36-2021, temporary amend filed 09/14/2021, effective 9/14/2021through 3/12/2022; DMAP 38-2022, amend filed 03/23/2022, effective 3/23/2022

Statutory/Other Authority: ORS 413.042 & 430.640

Statutes/Other Implemented: ORS 413.042, 414.025, 414.065, 430.640, 430.705 & 430.715