Section 210-RICR-50-10-2.10 - Budget DevelopmentA. Personal Choice monthly budgets are based on the functional assessment of participant need for hands-on assistance or supervision with ADLs (such as bathing, toileting, dressing, grooming, transfers, mobility, skincare, and/or eating) and IADLs (such as communication, shopping, housework, meal preparation, and/or food shopping), as described in § 2.9 of this Part and listed in the tables in § 2.15 of this Part.B. The Conflict-Free Case Management Agency and Service Advisement Team will perform assessments to determine the individual's budget and Individual Service and Spending Plan (ISSP). In accordance with the service provider agreements, a budget is developed based on the amount and level of assistance required, frequency of the task, and presence of any secondary conditions that would require a need for more time to complete the task. There are six (6) levels of assistance for each activity. 1. Determine Monthly Budget Amount: Each Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) has an amount of unit and/or functional time allowed to complete the task. The monthly figures for each ADL/IADL are added together to form a monthly budget. Taxes, worker's compensation insurance, and administrative costs are deducted from the Personal Choice participant's monthly budget. a. Unit Time - the amount of time allowed to complete the task if the participant is unable to participate and requires total assistance with the task.b. Functional Time - the amount of time allowed to complete the task if the participant is unable to participate and requires total assistance with the task and certain conditions or characteristics are present. These characteristics are listed in the table in § 2.15 of this Part.2. EOHHS will implement a budget re-assessment for any budget which is decreased by five hundred dollars ($500.00). This second (2nd) level re-assessment will be conducted by an EOHHS nurse and social worker in the home of the participant.3. Documentation of the assessment will be maintained by the Conflict-Free Case Management Agency, such as the functional, mobility and health assessments.C. The budget amount is determined by EOHHS and may be subject to change. The budget funds are set aside by Medicaid for the purchase of assistance to meet individual participant needs. The participant determines what services are required and the amount the participant is willing to pay for those services from their budget. Participants determine the hourly wage for PCA, which can range from fifteen dollars ($15.00) up to twenty-one dollars ($21.00) per hour. The budget does not allow for companionship, watching, or general supervision of a participant.D. The individual budget for participants in the Personal Choice program is limited to the purchase of personal care, homemaking, goods and services, and related taxes and fees. However, because participants are eligible for Medicaid long-term services and supports, participants are entitled to other medically necessary services which are paid directly by Medicaid outside of the scope of the individual budget. The person-centered service plan includes referrals to out-of-budget services. Such services include, but are not limited to, physician services, prescription drugs, adult day care, case management services, home modifications, home delivered meals, minor environmental modifications, PERS, special medical equipment, and supports facilitation. Such services may affect the individual budget amount if they increase the participant's independence in the community and reduce the level of assistance required to complete a particular task.E. The Case Manager will provide the participant/representative with a copy of the approved budget and the approved ISSP after sign off by the participant. Additional copies may be provided upon request.F. The Conflict-Free Case Management Agency will provide the Personal Choice fiscal intermediary with a copy of the approved budget.210 R.I. Code R. 210-RICR-50-10-2.10
Adopted effective 10/28/2019
Amended effective 12/15/2020
Amended effective 3/8/2023
Amended effective 2/12/2024