Personal Care Assistant Services in Schools

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Personal Care Assistant Services in Schools

• Tia Campbell, RN, MSN
• Ashley Barton, LCSW
• DMAS/DOE Annual Conference October 6, 2009

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Personal Care Services

• Services provided by the assistant are related to
  the childs physical and behavioral health
  requirements, including
• assistance with eating, dressing, hygiene,
  activities of daily living, bladder and bowel
  needs
• use of adaptive equipment
• ambulation and exercise

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Personal Care Services

• behavioral issues and
• other remedial services to promote reduction of a
  childs disabilities.
• monitoring of a health related service
• i.e. bus driver aide or monitoring the need for
  suctioning

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Categories of Services

• Nursing
• Practitioners of the Healing Arts
• Occupational Therapy
• Physical Therapy
• Speech Language Pathology
• Psychology (Behavioral)

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Nursing Personal Care Assistants

• Must meet minimum qualifications for unlicensed
  assistive personnel as required by the Department
  of Education, Virginia School Health Guidelines,
  VDH and VDOE, 1999
• Must receive training for assisting with meeting
  the specific health needs of the student as
  outlined in the Guidelines for Specialized Health
  Care Procedures Manual, VDH, 2004.

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Nursing Personal Care Assistants

• Must be identified in the students IEP.
• Must be included in the Plan of Care (POC)
  prepared by the licensed registered nurse (RN).
• Personal care assistants for nursing services
  must be supervised by a RN.
• ADL and IADL services do not require physician
  order.

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Personal Care Assistants for Practitioners of the
Healing Arts

• Specific services must be ordered by a Department
  of Medical Assistance Services (DMAS) qualified
  practitioner of the healing arts acting within
  the scope of their licensure

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Personal Care Assistants for Practitioners of the
Healing Arts

• Personal care assistants for the healing arts
  must be supervised by a DMAS qualified
  practitioner of the healing arts (OT, PT, SLP,
  Psychiatrist, Psychologist).
• Board of Physical Therapy (18 VAC 112-20-10 et
  seq.)
• Licensed PT can supervise support personnel who
  are designated routine tasks related to physical
  therapy howeversupervision must be direct.

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Authorization for Services

• Services must be authorized by the current
  Individualized Education Program (IEP)
• The student shall have a current order from a
  physician, physician assistant or nurse
  practitioner for specialized nursing procedures
  (i.e. tube feedings, catheterizations, and
  seizure monitoring)
• The service cannot be provided by a parent or a
  step-parent

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Provider Requirements

• Only provide services consistent with the
  training received.
• Guidelines for Specialized Health Care Procedures
• Medication Manual for Unlicensed Personnel
• Insulin and Glucagon Manual, etc.

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Provider Requirements

• The DOE training manuals may be found on the DOE
  website at www.doe.virginia.gov under the Board
  of Education Guidance Documents.
• Services are to assist the child with
  disabilities in self-sufficiency, communications,
  and mobility skills

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Plan of Care MED 14

• Developed by a licensed practitioner of the
  healing arts within the scope of their license.
• A separate plan of care should be developed per
  discipline based on the services needed.
• The plan of care developed by the licensed
  provider should be consistent with the health
  conditions and functional limitations documented
  on the individuals IEP

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Plan of Care MED 14

• Medical condition and diagnosis being address
• Specific to needs identified in assessment
• Goals and objectives
• Treatment intervention and which goal addressed

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Plan of Care MED 14

• Type, amount and frequency of service
• Anticipated duration of service
• Signed and dated by individual performing service
• Reviewed at least annually

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Student Log MED 15

• The personal care assistant shall document
• On a daily basis for non-nursing services
• For nursing assistants the documentation is per
  occurrence
• Date and amount of time

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Student Log MED 15

• Procedure
• Comments
• N Normal
• V variance from normal or standard. Include
  written explanation in Comment section
• Initials of the assistant
• Documentation of supervisory visit signed by
  applicable supervisor

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Supervision

• Supervision provided by the appropriate licensed
  practitioner of the healing arts.
• Supervisory visits are required as often as
  needed to ensure both quality and appropriateness
  of services.
• Review the childs progress and make any
  adjustment to goals or treatment modalities.

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Supervision

• Visits should be made on-site (direct) every 30
  calendar days.
• On-site visits may be conducted more frequently
  than every 30 calendar days depending on the
  intensity and level of services the child is
  receiving as well as the license requirements of
  the supervisor.

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Supervision

• If an on-site visit is not possible every 30
  calendar days, then an indirect visit may be
  conducted via telephone or off-site.
• Condition of the child as well as license
  requirements to determine the requirement for
  on-site supervision versus indirect and the
  frequency of supervision visits.

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Supervision

• An on-site visit must be conducted at least every
  90 calendar days.
• Supervisor shall identify any gaps in aides
  ability to function competently and shall provide
  training as indicated.

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Billing

• A unit of services equals 15 minutes for no more
  than 8.5 hours a day
• The number of units billed is not to exceed the
  number of units in a day that the student is in
  the care of the school
• While more than one assistant may attend the
  student during a school day, the unit for a
  particular period of the day shall not be billed
  for the services of more than one assistant.

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Billing

• If the total number of units billed ends up with
  a fraction of a unit, round to the nearest unit
• 50 minutes of care / 15 3.33 3 units
• 100 minutes of care / 15 6.66 7 units
• Regular school year is 180 days
• May vary among school divisions
• Services during the summer school sessions are
  billable as well.

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Resources

• Amy Edwards
• Medicaid in Schools Specialist, DOE
• 804-692-0150
• Amy.edwards_at_doe.virginia.gov
• Ashley Barton, LCSW
• Maternal Child Health Specialist, DMAS
• 804-371-7824
• Ashley.barton_at_dmas.virginia.gov