(a)
Personal care services as specified in section
51183 are provided when authorized
by the staff of a designated county department based on the state approved
Uniformity Assessment tool. To the extent not inconsistent with statutes and
regulations governing the Medi-Cal program, the needs assessment process shall
be governed by the Department of Social Services' Manual of Policies and
Procedures Sections
30-760,
30-761, and
30-763.
(b) Personal care services may be provided
only to a categorically needy beneficiary as defined in Welfare and
Institutions Code, Section
14050.1,
who has a chronic, disabling condition that causes functional impairment that
is expected to last at least 12 consecutive months or that is expected to
result in death within 12 months and who is unable to remain safely at home
without the services. The services shall be provided in the beneficiary's home
or other locations as may be authorized by the Director subject to federal
approval. Personal care services authorized shall not exceed 283 hours in a
calendar month.
(c) Personal care
services will be prescribed by a physician. The beneficiary's medical necessity
for personal care shall be certified by a licensed physician. Physician
certification shall be done annually.
(d) Registered nurse supervision consists of
review of the service plan and provision of supportive intervention. The nurse
shall review each case record at least every twelve months. The nurse shall
make home visits to evaluate the beneficiary's condition and the effectiveness
of personal care services based on review of the case record or whenever
determined as necessary by staff of a designated county department. If
appropriate, the nurse shall arrange for medical follow-up. All nurse
supervision activities shall be documented and signed in the case record of the
beneficiary.
(e) Paramedical
services when included in the personal care plan of treatment must be ordered
by a licensed health care professional lawfully authorized by the State. The
order shall include a statement of informed consent saying that the beneficiary
has been informed of the potential risks arising from receipt of such services.
The statement of informed consent shall be signed and dated by the beneficiary,
the personal representative of the beneficiary, or in the case of a minor, the
legal parent or guardian.
(f)
Grooming shall exclude cutting with scissors or clipping toenails.
(g) Menstrual care is limited to external
application of sanitary napkin and cleaning. Catheter insertion, ostomy
irrigation and bowel program are not bowel or bladder care but
paramedical.
(h) Repositioning,
transfer skin care, and range of motion exercises have the following
limitations:
(1) Includes moving from one
sitting or lying position to another sitting or lying position; e.g., from bed
to or from a wheelchair, or sofa, coming to a standing position and/or rubbing
skin and repositioning to promote circulation and prevent skin breakdown.
However, if decubiti have developed, the need for skin and wound care is a
paramedical service.
(2) Range of
motion exercises shall be limited to the general supervision of exercises which
have been taught to the beneficiary by a licensed therapist or other health
care professional to restore mobility restricted because of the injury, disuse
or disease. Range of motion exercises shall be limited to maintenance therapy
when the specialized knowledge or judgment of a qualified therapist is not
required and the exercises are consistent with the beneficiary's capacity and
tolerance. Such exercises shall include the carrying out of maintenance
programs. i.e., the performance of the repetitive exercises required to
maintain function, improve gait, maintain strength or endurance; passive
exercises to maintain range of motion in paralyzed extremities; and assistive
walking.