PCA Checklist for MA Billing

HANDOUT G

PCA Checklist for MA Billing

• Training and orientation is the responsibility of the school or district and must be provided by a qualified professional. PCA Training Certification required by MDHS and offered on the MDHS web-site must be completed by June 30, 2012 or prior to the PCA being placed with the student in order to bill MA.

• IEP Team, parents/guardians and IEP health related providers authorize students’ PCA services.

• Covered PCA Services: Child must be dependent in at least ONE ADL (Activity of Daily Living) ORdemonstrates Level 1 behaviors in order to qualify for PCA services. Once they qualify, you can bill for all of the following tasks:

Activities of Daily Living—ADLs are services and supports furnished to an individual, as needed, to assist in accomplishing their activities of daily living including health and hygiene activities integral to the activity (e.g., cleaning up spills, laundering soiled clothing, and cleaning up toileting accidents).

_____ Eating_____ Bathing, including personal hygiene

_____ Toileting_____ Transferring

_____ Grooming_____ Mobility

_____ Dressing_____ Positioning

Intervention and redirection for behaviors –Level 1 behaviors:

_____ Self-injurious behavior

_____ Physical injury to others

_____ Destruction of property

If a student qualifies for PCA services based on a Level 1 behavior, then you can bill for Level 2 behaviors and Other Health Related procedures and tasks.

Level 2 behaviors:

_____ *Increased vulnerability due to cognitive deficits or socially inappropriate behavior

_____ *Resisting care and verbal aggression that cause care to take longer than normally expected

* = must have one ADL OR Level 1 Behavior before can bill for either Level 2 behaviors and Other Health Related procedures and tasks.

Other Health related procedures and tasks - examples

_____ ROM-range of motion _____ Assistance with self-administered meds

_____ Intervention for seizure(effective 07-12) _____ Sensory integration

when child is having a seizure

• PCA Initial Training Documentation/Orientation and/or Care Plan -

_____ To be completed within 7 days of student being placed with PCA.

_____ Includes detailed written description of the actual services delivered to an individual child.

_____QP (Qualified Provider) must review PCA initial Training/Orientation and/or Care Plan annually. Needs to be signed by QP supervisor, PCA and dated.

_____ Copy kept in student’s special education file.

_____ Can be used as a tool for PCA substitutes/teachers.

_____ Master Copy on SpEd forms – MA FORMS.

• PCA Mini Time Study—to be completed ONCE after PCA services are determined and PCA is trained

_____Update only if time/services change for PCA/student, or new PCA assisting, etc.

PCA Mini Time Study should reflect what is written under “Child Specific Paraprofessional Support”(CSPS). CSPS should be written in separate paragraphs dividing “academics”, “behaviors”, and “ADLs”.

*PCA verbiage must be used whenever MA billing will be done.

*Paraprofessional is used when a student receives “academic” assistance only. PCA is for “medical” assistance. When student receiving both types of services, always use PCA in the description.

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• This information MUST BE INCLUDED in the child/student’s IEP under “Child Specific Paraprofessional Support”:

_____Identification of medical diagnosis or condition related to the need for PCA services and

_____Description of the student’s condition and/or ability to function and

_____Description of PCA assistance that will be provided to student and

_____Clarification as to why these services are necessary for the student to benefit from special

instruction and the outcome of the PCA service provided.

_____ Frequency and average duration per day (based on the Mini Time Study)

• PCA Supervision by Qualified Professional:

_____Provided within the Qualified Professional’s (QP) scope of practice and as designated in the IEP; not provided by phone or consulting with third parties; based on the regular school calendar; can be documented separately.

_____Qualified Professional (QP) – PCA supervision is provided by a licensed RN, PHN, LSN, mental health professional, physical therapist, occupational therapist, speech-language pathologist, audiologist, physician, social worker or qualified developmental disabilities specialist.

_____Qualified Developmental Disabilities Specialist- individual with a four year degree in related field and one year work experience with individuals with developmental disabilities; individual with a two year degree in related field and two year’s work experience with individuals with developmental disabilities; or an individual with a community-based developmental disability services diploma and two year’s work experience with individuals with developmental disabilities.

_____Related fields: human services, sociology, counseling, speech communication, gerontology, human development, anthropology, special education, rehabilitation counseling.

• Qualified Professional (QP) responsibilities:

_____Supervise PCAs and assure competency to provide the services in care plans;

_____Record any actions taken to correct deficiencies in the PCA’s work, results of evaluations and revision of care plans as necessary;

_____Develop and monitor the care plan; train and evaluate individual PCA’s; evaluate effectiveness of services; review documentation.

_____Provide ongoing monitoring and supervision through direct training, demonstrations, observation, and consultations;

____Appropriately assign tasks;

_____Ensure through direct observation or consultation that the PCA providing the service: is capable of providing services; is knowledgeable about the care plan, changes to the plan, essential needs and activities to be provided; understands to notify the QP about concerns and changes to the child’s condition or behavior; and, keeps written documentation asrequired.

_____Provide initial evaluation within 14 days of starting to provide regularly scheduled services or sooner as determined by the qualified professional. Provide on-going supervision every 90 days for the first year and every 120 days after the first year for the same PCA and child. Provide additional supervisionas appropriate\;

_____Additional training and evaluations may be conducted based on the child’s needs and the PCAs ability to meet those needs.

****”Communication with Primary Care Provider” is no longer required. (August 20, 2013 IEP Technical Guide Update – page E.31)

Fall 2011

Updated: 11-30-2011

Updated: 05-01-2012

Updated: 07-01-12*PCA evaluation

Updated August 28, 2012*PCA Supervision

Updated September 13, 2012-MMR

Minor wording 02-13

Updated: August 2013