ParaRegs-Medi-Cal-Personal-Care-Assessments

 

568      QA Needs Assessments

 

 

568-1

ADDED 12/06

 

When assessing time for services (both within and outside the time guidelines), the time authorized shall be based on the recipient’s individual level of need necessary to ensure his/her health, safety, and independence based on the scope of tasks identified for service.

 

In determining the amount of time per task, the recipient’s ability to perform the tasks based on his/her functional index ranking shall be a contributing factor, but not the sole factor. Other factors could include the recipient’s living environment, and/or the recipient’s fluctuation in needs due to daily variances in the recipient’s functional capacity (e.g., "good days" and "bad days").

 

In determining the amount of time per task, universal precautions should be considered. Universal precautions are protective practices necessary to ensure safety and prevent the spread of infectious diseases. Universal precautions should be followed by anyone providing a service, which may include contact with blood or body fluids such as saliva, mucus, vaginal secretions, semen, or other internal body fluids such as urine or feces. Universal precautions include the use of protective barriers such as gloves or facemask depending on the type and amount of exposure expected, and always washing hands before and after performing tasks. More information regarding universal precautions can be obtained by contacting the National Center for Disease Control.

 

(MPP 30-757.1(a))

568-1A

ADDED 12/06

 

For services in this section where time guidelines are specified, the services shall be subject to the specified time guideline unless the recipient's needs require an exception to the guideline. When assessing time for services (both within and outside the time guidelines), the time authorized shall be based on the recipient's individual level of need necessary to ensure his/her health, safety, and independence based on the scope of tasks identified for service. In accordance with Welfare and Institutions Code Section 12301.2, the dual purpose of the guidelines is to provide counties with a tool for both consistently and accurately assessing service needs and authorizing time.

 

An exception to the time guideline may result in receiving more or less time based on the recipient's need for each supportive service and the amount of time needed to complete the task.

 

Exceptions to the hourly task guidelines identified in this section shall be made when necessary to enable the recipient to establish and maintain an independent living arrangement and/or remain safely in his/her home or abode of his/her own choosing and shall be considered a normal part of the authorization process.

 

No exception shall result in the recipient's hours exceeding the maximum limits of 195 hours per month as specified at Section 30-765.121 for nonseverely impaired cases or 283 hours per month for severely impaired cases as specified in Section 30-765.111.

 

No exception shall result in the recipient's hours exceeding the maximum limit for PCSP cases as specified at Section 30-780.2(b).

 

No exceptions to hourly task guidelines shall be made due to inefficiency or incompetence of the provider.

 

When an exception to an hourly task guideline is made in a recipient's case, the reason

for the exception shall be documented in the case file.

 

(30-757.1(a)

568-1B

ADDED 3/07

 

General The following are general regulatory standards that apply to all functions. The standards for each function are defined in more detail in individual scales that follow.

 

Rank 1:           Independent: Able to perform function without human assistance although the recipient may have difficulty in performing the function, but the completion of the function, with or without a device or mobility aid, poses no substantial risk to his/her safety. A recipient who ranks a “1” in any function shall not be authorized the correlated service activity.

 

Rank 2:           Able to perform a function but needs verbal assistance such as reminding, guidance, or encouragement.

 

Rank 3:           Can perform the function with some human assistance, including, but not limited to, direct physical assistance from a provider.

 

Rank 4:           Can perform a function but only with substantial human assistance.

 

Rank 5:           Cannot perform the function with or without human assistance.

 

Rank 6:           Paramedical Services needed.

 

Variable Functioning If the recipient’s functioning varies throughout the month, the functional rank should reflect the functioning on reoccurring bad days. It is not solely based on a “worst” day scenario (e.g., a recipient who suffers from arthritis will have days when pain is significant and days when pain is mild; therefore, in this case you would rank a recipient based on the reoccurring days where the frequency of pain is significant).

 

(All County Letter 06-34E1, attachment B, December 21, 2006)

568-2A

ADDED 6/07

 

Task Definition

 

Meal Preparation (MPP 30-757.131)

Preparation of meals which includes planning menus; removing food from refrigerator or pantry; washing/drying hands before and after meal preparation; washing, peeling, and slicing vegetables; opening packages, cans, and bags; measuring and mixing ingredients; lifting pots and pans; trimming meat; reheating food; cooking and safely operating stove; setting the table; serving the meals; pureeing food; and cutting the food into bite-size pieces.

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-2B

ADDED 6/07

 

Functional Index for Meal Preparation

 

Rank 1:           Independent: Can plan, prepare, serve, and cleanup meals.

 

Rank 2:           Needs only reminding or guidance in menu planning, meal preparation, and/or cleanup.

 

Rank 3:           Requires another person to prepare and cleanup main meal(s) on less than a daily basis (e.g., recipient can reheat food prepared by someone else, can prepare simple meals, and/or needs some help with cleanup but requires another person to prepare and cleanup with more complex meals which involve, peeling, cutting, etc., on less than a daily basis).

 

Rank 4:           Requires another person to prepare main meal(s) and cleanup on a daily basis.

 

Rank 5:           Totally dependent on another person to prepare and cleanup all meals.

 

Rank 6:           Is tube-fed. All aspects of tube feeding are evaluated as a “paramedical service

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B)

568-2C

ADDED 6/07

 

Grid for Meal Preparation

 

                        Low                 High

Rank 2                        3.02                 7.00

Rank 3                        3.50                 7.00

Rank 4                        5.25                 7.00

Rank 5                        7.00                 7.00

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-2D

ADDED 6/07

 

Meal Preparation

 

Factors/Exception Examples

 

Factors For Consideration Include, But Not Limited To:

·         The extent to which the recipient can assist or perform tasks safely.

·         Types of food the recipient usually eats for breakfast, lunch, dinner, and snacks and the amount of time needed to prepare the food (e.g., more cooked meals versus meals that do not require cooking).

·         Whether the recipient is able to reheat meals prepared in advance and the types of food the recipient eats on days the provider does not work.

·         The frequency the recipient eats.

·         Time for universal precautions, as appropriate

 

Exceptions Include, But Not Limited To:

·         If the recipient must have meals pureed or cut into bite-sized pieces.

·         If the recipient has special dietary requirements that require longer preparation times or preparation of more frequent meals.

·         If the recipient eats meals that require less preparation time (e.g., toast and coffee for breakfast).

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-2E

ADDED 6/08

 

Q: If an IHSS recipient chooses to eat meals separately from other family members residing in the home, must the IHSS recipient's needs be prorated unless the recipient has a health and safety need requiring his/her meals to be prepared separately?

 

A: No, these services do not have to be prorated.  The regulation does not require that there be a health and safety reason for the recipient to eat meals separately. Consequently, the recipient may have meals provided.

 

(All County Letter 08-18, April 23, 2008, question and answer 11)

568-2F

ADDED 6/08

 

Q: Can Meal Preparation and Meal Cleanup be performed outside of the recipient’s home?

 

A: Meal preparation and cleanup must be done in the recipient’s home. It is inferred from the language of the statute and regulations that the intent is to provide these services in the home of the recipient.

 

(All County Letter 08-18, April 23, 2008, question and answer 10)

568-3A

ADDED 6/07

 

Task Definition

 

Meal Cleanup (MPP 30-757.132)

Loading and unloading dishwasher; washing, rinsing, and drying dishes, pots, pans, utensils, and culinary appliances and putting them away; storing/putting away leftover foods/liquids; wiping up tables, counters, stoves/ovens, and sinks; and washing/drying hands.

 

Note: This does not include general cleaning of the refrigerator, stove/oven, or counters and sinks, as these IHSS services are assessed as “domestic services” (MPP 30-757.11).

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-3B

ADDED 6/07

 

Functional Index for Meal Cleanup

 

Rank 1:           Independent: Can plan, prepare, serve, and cleanup meals.

 

Rank 2:           Needs only reminding or guidance in menu planning, meal preparation, and/or cleanup.

 

Rank 3:           Requires another person to prepare and cleanup main meal(s) on less than a daily basis (e.g., recipient can reheat food prepared by someone else, can prepare simple meals, and/or needs some help with cleanup but requires another person to prepare and cleanup with more complex meals which involve, peeling, cutting, etc., on less than a daily basis).

 

Rank 4:           Requires another person to prepare meal(s) and cleanup on a daily basis.

 

Rank 5:           Totally dependent on another person to prepare and cleanup all meals.

 

Rank 6:           Is tube-fed. All aspects of tube feeding are evaluated as a “paramedical service

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B)

568-3C

ADDED 6/07

 

Grid for Meal Cleanup

 

                        Low                 High

Rank 2                        1.17                 3.50

Rank 3                        1.75                 3.50

Rank 4                        1.75                 3.50

Rank 5                        2.33                 3.50

 

 (ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-3D

ADDED 6/07

 

Meal Cleanup

 

Factors/Exception Examples

 

Factors For Consideration Include, But Not Limited To:

·         The extent to which the recipient can assist or perform tasks safely.

o   EX: A recipient with a Rank 3 in “meal cleanup” who has been determined able to wash breakfast/lunch dishes and utensils and only needs the provider to clean up after dinner would require time based on the provider performing cleanup for the dinner meal only.

o   EX: A recipient who has less control of utensils and/or spills food frequently may require more time for cleanup.

·         The types of meals requiring the cleanup.

o   EX: A recipient who chooses to eat eggs and bacon for breakfast would require more time for cleanup than a recipient who chooses to eat toast and coffee.

·         If the recipient can rinse the dishes and leave them in the sink until provider can wash them.

·         The frequency that meal cleanup is necessary.

·         If there is a dishwasher appliance available.

·         Time for universal precautions, as appropriate.

 

Exceptions Include, But Not Limited To:

·         If the recipient must eat frequent meals which require additional time for cleanup.

·         If the recipient eats light meals that require less time for cleanup.

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-4A

ADDED 6/07

 

Task Definition

 

Bowel and Bladder Care (MPP 30-757.14(a))

Assistance with using, emptying, and cleaning bed pans/bedside commodes, urinals, ostomy, enema and/or catheter receptacles; application of diapers; positioning for diaper changes; managing clothing; changing disposable barrier pads; putting on/taking off disposable gloves; wiping and cleaning recipient; assistance with getting on/off commode or toilet; and washing/drying recipient’s and provider’s hands.

 

Note: This does not include insertion of enemas, catheters, suppositories, digital stimulation as part of a bowel program or colostomy irrigation, as these are assessed as “paramedical services” (MPP 30-757.19).

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-4B

ADDED 6/07

 

Functional Index for Bowel and Bladder Care

 

Rank 1:           Independent: Able to manage Bowel, Bladder, and Menstrual Care with no assistance from another person.

 

Rank 2:           Requires reminding or direction only.

 

Rank 3:           Requires minimal assistance with some activities but the constant presence of the provider is not necessary.

 

Rank 4:           Unable to carry out most activities without assistance.

 

Rank 5:           Requires physical assistance in all areas of care.

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B)

568-4C

ADDED 6/07

 

Grid for Bowel and Bladder Care

 

                        Low                 High

Rank 2                        0.58                 2.00

Rank 3                        1.17                 3.33

Rank 4                        2.91                 5.83

Rank 5                        4.08                 8.00

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-4D

ADDED 6/07

Bowel and Bladder Care

 

Factors/Exception Examples

 

Factors For Consideration Include, But Not Limited To:

·         The extent to which the recipient can assist or perform tasks safely.

·         The frequency of the recipient’s urination and/or bowel movements.

·         If there are assistive devices available which result in decreased or increased need for assistance.

o   EX: Situations where elevated toilet seats and/or Hoyer lifts are available may result in less time needed for “bowel and bladder” care if the use of these devices results in decreased need for assistance by the recipient.

o   EX: Situations where a bathroom door is not wide enough to allow for easy wheelchair access may result in more time needed if its use results in an increased need.

·         Time for universal precautions, as appropriate.

 

Exceptions Include, But Not Limited To:

·         If the recipient has frequent urination or bowel movements.

·         If the recipient has frequent bowel or bladder accidents.

·         If the recipient has occasional bowel or bladder accidents that require assistance from another person.

·         If the recipient’s morbid obesity requires more time.

·         If the recipient has spasticity or locked limbs.

·         If the recipient is combative.

 

(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)

568-5A