Personal Assistance/NC

About

This definition was retrieved on 2009-04-04 from the NC Division MH/DD/SAS Service Definitions Manual (PDF) dated 2003-01-15.

Definition

Personal Assistance is a support service which provides aid to a client so that the client can engage in activities and interactions from which the client would otherwise be limited or excluded because of his disability or disabilities. The assistance includes: (1) assistance in personal or regular living activities in the client's home, (2) support in skill development, or (3) support and accompaniment of the client in regular community activities or in specialized treatment, habilitation or rehabilitation service programs.

Guidelines:

1. Include face-to-face time providing assistance to the client and time spent transporting the individual to or from services.
2. Homemaker and Personal Care which are not directed at training new client skills and other similar services are to be reported in this category.
3. This service is usually provided by non-professionals--with the single goal of providing assistance to the client so s/he can function in more normal environments. When professionals provide this service in addition to habilitation or treatment during the same time period, the outpatient treatment (or other relevant code) should be given precedence for reporting and those documentation requirements shall be met.
4. Staff Travel Time to be reported separately.
5. Preparation/documentation time NOT reported.

Therapeutic Relationship and Interventions

There should be a supportive therapeutic relationship between the provider and the client which addresses and/or implements interventions outlined in the service plan. These may include 1) assistance in personal or regular living activities in the client's home, (2) support in skill development, or 3)support and accompaniment of the client in regular community activities or in specialized treatment, habilitation or rehabilitation service programs.

Structure of Daily Living

This service focuses on providing or assisting individuals in homemaking and personal care activities to enable the individual to remain in the least restrictive environment.

Cognitive and Behavioral Skill Acquisition

This service is intended to assist individuals to live as independently as possible.

Service Type

Personal Assistance is a periodic service. This service is not Medicaid billable.

Resiliency/Environmental Intervention

This service focuses on assisting the individuals in becoming connected to naturally occurring support systems and relationships in the community to provide and enhance opportunities for meaningful community participation.

Service Delivery Setting

This service can be provided - in any location.

Medical Necessity

A. There is an Axis I or II diagnosis present or the person has a condition that may be defined as a developmental disability as defined in GS 122C-3 (12a)

AND

B. Level of Care Criteria, NCSNAP/ASAM

AND

C. The recipient is experiencing difficulties in at least one of the following areas:

1. Functional impairment
2. crisis intervention/diversion/aftercare needs, and/or
3. at risk of placement outside the natural home setting.

AND

D. The recipient’s level of functioning has not been restored or improved and may indicate a need for clinical interventions in a natural setting if any of the following apply:

1. At risk for out of home placement, hospitalization, and/or institutionalization due to symptoms associated with diagnosis.
2. Presents with intensive verbal, and limited physical aggression due to symptoms associated with diagnosis, which are sufficient to create functional problems in a community setting.
3. At risk of exclusion from services, placement or significant community support systems as a result of functional behavioral problems associated with the diagnosis.
4. Requires a structured setting to foster successful integration into the community through individualized interventions and activities.

Service Order Requirement

N/A

Continuation/Utilization Review Criteria

The client continues to have needs that are met by this service definition.

Discharge Criteria

Consumer’s level of functioning has improved with respect to the goals outlined in the service plan, or no longer benefits from this service. The decision should be based on one of the following:

1. Consumer has achieved service plan goals, discharge to a lower level of care is indicated.
2. Consumer is not making progress, or is regressing, and all realistic treatment options within this modality have been exhausted.

Service Maintenance Criteria

If the recipient is functioning effectively with this service and discharge would otherwise be indicated, personal assistance should be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn. The decision should be based on any one of the following:

A. Evidence that gains will be lost in the absence of personal assistance is documented in the service record.

OR

B. In the event there are epidemiologically sound expectations that symptoms will persist and that ongoing treatment interventions are needed to sustain functional gains, the presence of a DSM IV diagnosis would necessitate a disability management approach.

*Note: Any denial, reduction, suspension, or termination of service requires notification to the recipient and/or legal guardian about their appeal rights.