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Since July 2000, the Montana Department of Health and Human Services, Senior and Long-Term Care Division, has contracted with Mountain-Pacific for third-party authorization of personal care. Persons with full Medicaid coverage are eligible for service based on functional impairment.
Personal assistance service (PAS) is provided to persons who reside at home and have a medical necessity for assistance with activities of daily living. Qualified applicants must meet both the Medicaid program’s financial and medical requirements.
To apply for Medicaid, contact your county human services office.
Services – Services provided in the program include assistance with the following activities of daily living which include the following:
• bathing
• toileting
• mobility (including transferring from place to place)
• eating
• nutritional planning and meal preparation
• dressing
• personal hygiene and grooming
• exercise
Medical escort to a Medicaid-reimbursed service may be authorized in addition to the above activities when assistance is needed en route or at destination. Individuals who need help with activities of daily living may also receive help with the following:
• household tasks related to their living area
• shopping for food or medically necessary supplies
• laundry
Individual Assessment – Mountain-Pacific nurses assess personal-care needs by visiting individuals at their place of residence. If an applicant’s personal care needs fall within program parameters, the nurse completes an authorization form and sends it to a provider agency selected by the person or his or her designated representative. Services are reauthorized according to need, and a complete assessment is performed at least once every year.
Frequency of Care – The frequency of services provided is determined by the assessment. Depending on the assessment, services may be provided from one to seven days a week. Except for the health maintenance activities described under the self-directed option, skilled nursing services are not provided by this program.
Agency-Based Option – Under the agency-based option for care, the person selects a qualified provider agency. The agency works with the person to establish the schedule for service provision and provides the trained staff necessary for the delivery of care. A nurse from the provider agency completes an on-site visit at least once every 180 days for supervision of care.
Self-Directed Option – Under the self-directed option for care, the person or identified personal representative must hire, fire, supervise and manage the individuals providing the services. The person and an agency share co-employment status.
A qualified agency acts as the employer of record, processes paperwork, and issues paychecks, but the person is responsible for selecting and training attendants and for verifying that authorized services were provided. An employee from the agency completes an on-site visit at the time services are implemented and at least once every 180 days to provide oversight and to review the legal responsibilities associated with self-directed personal care.
A person’s health care professional must certify (on a form provided by the program) that the person has a medical need requiring personal care services or health maintenance activities and is capable of self-direction. Health maintenance activities are skilled tasks that are exempt from the Nurse Practice Act. These tasks are associated with bowel programs, wound care, urinary system management and administration of some medications. These activities must be something the person would be able to do in the absence of a disability and that can be safely performed in the home. A health care professional must approve these tasks.
Medicaid Personal Assistance Forms
SLTC-164 Oversight Documentation
SLTC-150 PAS Nurse Supervision Documentation
Discharge
Referral
Temporary Authorization
Change in Demographics
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