The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").
The following is guidance regarding flexibilities available for State Plan Personal Care services. For more details regarding services authorized by Department of Health and Senior Services (DHSS), Division of Senior and Disability Services, please reference the DHSS/DSDS website; for questions regarding processes and services authorized by the DHSS/Division of Community and Public Health (DCPH)/Special Health Care Needs (SHCN), contact the appropriate Regional Office; and for questions regarding processes and services authorized by the DCPH/Bureau of HIV, STD and Hepatitis.
Plan of Care Tasks: Providers may limit service delivery to essential services if needed due to staffing shortages or in order to limit exposure to COVID-19. If a provider limits service delivery, they should coordinate directly with participants/caregivers to best meet their needs and preferences regarding care plan delivery.
Providers able to meet the needs of participants may deliver any necessary tasks within the total authorized unit limit, even if the specific tasks are not listed on the current care plan. The appropriate authorizing agency should only be notified if an increase in total units is needed.
Health and Welfare Checks: Providers of Personal Care services have a new option to conduct telephone checks for participants in order to ensure their health, safety and welfare during the public health emergency (i.e. additional time to go over back-up plans, checking on symptoms prior to sending an aide, general questions related to resource needs during COVID-19 and the stay-at home order, and/or the participant is refusing services due to exposure risk or there are staffing limitations so multiple phone checks are needed, etc.). These services are in addition to and not in lieu of telephone-authorized nurse visits through the Personal Care Program discussed below.
An example form developed by fellow providers is linked for providers to utilize, but is not required. Telephone checks must be documented by the provider normal timesheet guidelines. For task, indicate – telephone check.
Up to five (5) hours or 20 units per month of Personal Care can be utilized (above the normal authorization level) for each participant to complete these vital checks. To bill for this service, providers shall bill procedure codes T1019, modifier SC (agency model) and T1019, modifiers U2 & SC (CDS). The codes can be billed with from and through dates but the dates must be in same calendar month. Billing dates may not precede March 13, 2020 and must only be for documented, provided services.
Eligible Caregivers: For Personal Care agency-model providers, family members (spouse, legally responsible individuals and legal guardian excluded) may be eligible to be hired as an aide to provide care. A family member (absent the exceptions above) will only be allowed to provide services if he/she does not reside in the same residence, and he/she will only be allowed to provide services if no other caregiver is available. Family Care Safety Registry (FCSR) filing is still required (see below for further guidance).
Personal Care and Advanced Personal Care Aides: Experience/certification requirements for personal care aides and advanced personal care aides are waived.
Graduate Nurses: Graduate nurses may be hired to complete authorized nurse visits. A graduate nurse may provide services until receipt of the results of the first licensure examination taken by the graduate nurse or until ninety (90) days after graduation, whichever comes first.
Training: Training requirements are suspended for personal care and advanced personal care aides. Providers are expected to train each individual on the person-specific needs of each participant they will begin serving via telephone or other means. The training must include information on participant rights and all information regarding abuse, neglect and exploitation of participants and the importance of reporting fraudulent activities to the State.
Oversight/Evaluations: Annual oversight visit requirements and employee evaluations are suspended. The provider is still responsible to ensure staff are conducting job duties accurately and according to all programmatic rules and regulations.
Family Care Safety Registry (FCSR): The state waives the requirement for the FCSR background check to be returned prior to the start of the individual providing care as it is anticipated there may be a delay in background check processing. The provider shall file the FCSR request prior to the aide providing care, and the aide/attendant may begin providing care immediately. If a potential aide/attendant requires a Good Cause Waiver, the state will waive the requirement for the waiver to be returned prior to the individual providing care. Providers shall only make this exception for crimes that are typically waived with the Good Cause Waiver.
Advanced Personal Care Evaluation: The Authorized Nurse Visit to evaluate Advanced Personal Care may be conducted via telephone or telemonitoring. Providers are encouraged to use professional judgment to determine whether a face-to-face visit or other appropriate follow up is needed.
Medication Set Up (in home): The Center for Disease Control and Prevention (CDC) recommends individuals maintain a 14-day supply of medications. Where possible, the medication setup task through Authorized Nurse Visits may be expanded to allow for up to a 21-day supply of medications if the participant has this amount of medication supply on hand. (Note: Pharmacies must adhere to current dispensary and prescription guidance and are not able to fill more than 2 weeks in advance.)
Authorized Nurse Visits: Authorized Nurse Visits may be provided by telephone or through telemonitoring, if appropriate. Nurses must use professional judgment to determine whether a face-to-face visit is needed in order to complete the task or if it can be provided by telephone or through telemonitoring. For example, if medications have been physically set up for two or three weeks, telephone or telemonitoring can be used to check on clients on weeks that it is not necessary for the provider nurse to go to the home for medication set up. There are no set time parameters on telephone visits however, every time the nurse is conducting a nurse visit no matter what the reason for the visit is, the nurse needs to be checking on the participant as a whole utilizing the sample triage form or a similar form for documentation
Provider Operations: Provider offices can close and staff may work remotely. Providers shall maintain phone availability to ensure participants, caregivers, and the State Agency personnel or designees are able to communicate with the provider regarding participant needs.