Pcs: Coverage And Limitations

01. Medical Care and Services. Tasks related to a participant's physical or functional requirements provided in the participant's personal residence including assistance with: (7-1-26) a. Basic personal care and grooming; (7-1-26) b. Bladder or bowel routines or requirements; (7-1-26) c. Food, nutrition, and diet activities; (7-1-26) d. Continuation of at home active treatment programs to increase or maintain independence for participants with DD; (7-1-26) e. Physician-ordered medications ordinarily self-administered; (7-1-26) f. Non-nasogastric gastrostomy tube feedings that meet the following requirements: (7-1-26) i. Non-complex tasks that can be safely performed in a participant’s location; (7-1-26) ii. An RN assessed a participant's needs and developed a written procedure according to a participant’s individualized needs; (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 553 Page 128 iii. An RN delegates by name who can perform this procedure only after an individual demonstrates safe performance of the individualized procedure. RNs must document the strengths and weaknesses of any delegates, and evaluate their performance monthly; (7-1-26) iv. Delegates must report any change in participant status or problems with the procedure immediately to the RN; (7-1-26) v. The supervisor RN maintains documentation of the individualized procedure, the supervised performance of the procedure, and follow-up evaluations of delegates readily available for review, in the participant's record; and (7-1-26) vi. Direct care workers only give routine medication through a non-nasogastric tube as authorized by a supervisor RN. (7-1-26) 02. Non-Medical Care and Services. Includes the following tasks, when no natural supports are available: (7-1-26) a. Minimal housekeeping tasks incidental to the delivery of an ADL care task essential to participant comfort or health and excludes services for any other residents. (7-1-26) b. Accompanying a participant to medical appointments or other trips reasonably required for medical diagnosis or treatment. (7-1-26) c. Shopping for food or other items specific to a participant’s health and maintenance. (7-1-26) 03. Place of Service. PCS may be provided in a participant's personal residence, including a CFH, a RALF, or a PCS Family Alternate Care Home (FACH), and in the community only when an individual’s daily activities take them out of the home and are limited to tasks in their approved service plan. (7-1-26) 04. Service Exclusions. (7-1-26) a. Irrigating or suctioning any body cavity requiring sterile procedures or applying dressings with prescription medication or aseptic techniques; (7-1-26) b. Catheter insertion or sterile irrigation; (7-1-26) c. Injecting fluids into veins, muscles or skin; and (7-1-26) d. Administering medication not authorized by a supervisor RN. (7-1-26) 05. Participant Limitations. Sixteen (16) hours per week unless authorized under EPSDT. (7-1-26) 06. Provider Limitations. No home, regardless of the number of providers in a home, may serve more than two (2) children authorized for eight (8) or more hours of PCS per day. (7-1-26)