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Personal Care Assistant Services in Schools. Tia Campbell, RN, MSN Ashley Barton, LCSW DMAS/DOE Annual Conference October 6, 2009. Personal Care Services. Services provided by the assistant are related to the child’s physical and behavioral health requirements, including:

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personal care assistant services in schools

Personal Care Assistant Services in Schools

Tia Campbell, RN, MSN

Ashley Barton, LCSW

DMAS/DOE Annual Conference October 6, 2009

personal care services
Personal Care Services
  • Services provided by the assistant are related to the child’s 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;
personal care services3
Personal Care Services
  • behavioral issues; and
  • other remedial services to promote reduction of a child’s disabilities.
  • monitoring of a health related service
    • i.e.: bus driver aide or monitoring the need for suctioning
categories of services
Categories of Services
  • Nursing
  • Practitioners of the Healing Arts
    • Occupational Therapy
    • Physical Therapy
    • Speech Language Pathology
    • Psychology (Behavioral)
nursing personal care assistants
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.
nursing personal care assistants6
Nursing Personal Care Assistants
  • Must be identified in the student’s 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.
personal care assistants for practitioners of the healing arts
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
personal care assistants for practitioners of the healing arts8
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; however…supervision must be direct.
authorization for services
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
provider requirements
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.
provider requirements11
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
plan of care med 14
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 individual’s IEP
plan of care med 1413
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
plan of care med 1414
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
student log med 15
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
student log med 1516
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
supervision
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 child’s progress and make any adjustment to goals or treatment modalities.
supervision18
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.
supervision19
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.
supervision20
Supervision
  • An on-site visit must be conducted at least every 90 calendar days.
  • Supervisor shall identify any gaps in aide’s ability to function competently and shall provide training as indicated.
billing
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.
billing22
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.
resources
Resources
  • Amy Edwards

Medicaid in Schools Specialist, DOE

804-692-0150

Amy.edwards@doe.virginia.gov

  • Ashley Barton, LCSW

Maternal & Child Health Specialist, DMAS

804-371-7824

Ashley.barton@dmas.virginia.gov