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(1) Personal care services may be provided up to but not more than 40 hours of attendant service per week per recipient as defined by the plan of care. The department may, within its discretion, authorize additional hours in excess of this limit. Any services exceeding this limit must be prior authorized by the department. Prior authorization for excess hours may be authorized if additional assistance is required for:

(a) a period of time not to exceed three months and as the result of an acute medical episode;

(b) a period of time not to exceed three months and to prevent institutionalization during the absence of the normal caregiver; or

(c) a period of time not to exceed three months and during a post-hospitalization period.

(2) The base reimbursement for personal care services is $4.45 per 15-minute unit of service. Reimbursement above this amount is conditional and negotiated with the department. The rate is for units of attendant and nurse supervision service.

(a) A unit of attendant service is 15 minutes and means an on-site visit specific to a recipient.

(b) A unit of nurse supervision service is 15 minutes and means an on-site recipient visit and related activity specific to that recipient.

(3) A person retained personally by a recipient to deliver personal care services is not a provider of personal care services for the purposes of this rule and therefore may not be reimbursed for personal care services by the department.

(4) Reimbursement is not available for personal care provided by immediate family members.

History: 53-2-201, 53-6-101, 53-6-113, MCA; IMP, 53-6-101, 53-6-141, MCA; NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1980 MAR p. 2979, Eff. 11/29/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1987 MAR p. 372, Eff. 4/17/87; AMD, 1988 MAR p. 1259, Eff. 7/1/88; AMD, 1989 MAR p. 982, Eff. 7/28/89; AMD, 1993 MAR p. 1363, Eff. 6/25/93; AMD, 1995 MAR p. 1191, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 489; AMD, 2011 MAR p. 1386, Eff. 7/29/11.

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