(1) To qualify for personal care, a person must be medicaid eligible and demonstrate a medical need for personal care.

(2) Personal care services, except for escort services and household tasks, may be provided only in the recipient's home.

(3) Personal care services provided in licensed foster or group homes must be prior authorized by the department. Personal care services may be authorized when the person's medical needs are beyond the scope of services normally provided by programs funding services in foster or group home settings. For example, a person requiring additional assistance because of an acute medical episode or post-hospitalization period may receive personal care services in a foster or group home setting.

(4) Personal care services may not be provided to persons who reside in a hospital or long-term care facility as defined in 50-5-101 , MCA, and licensed under 50-5-201 , MCA.

(5) The recipient, in order to receive personal care services, must be capable of making choices about activities of daily living, understand the impact of these choices and assume responsibility for the choices or have someone residing within or outside the household willing to assist the recipient in decision making and to direct their activities.

(6) The type and amount of personal care services must be specified in a plan of care which governs delivery of services. The plan of care for a recipient must be approved by a physician and developed by a licensed nurse employed by a provider. The approval of the service plan must be renewed at least annually. The plan of care shall be developed based upon the completion of the department's recipient profile by the provider.

(7) The delivery of personal care services must be supervised by a licensed nurse.

(8) The recipient must agree to accept the provision of personal care services as specified in the plan of care.

(9) Household tasks and escort services must be provided only in conjunction with other personal care services and must be directly related to a recipient's medical needs.

(10) Household tasks may not account for more than 1/3 of the total time allocated per week for personal care services.

(11) Personal care services must be prescribed in writing at least annually by a physician and must be reviewed at least every 180 days by a licensed nurse.

(12) A recipient may receive personal care services through the medicaid home and community based services program for elderly and physically disabled persons or the medicaid home and community based services program for persons with developmental disabilities, in addition to the personal care services provided through these rules.

(13) Personal care providers must be independent contractors for purposes of federal and state wage and hour laws and workers' compensation laws. Personal care providers are limited to businesses incorporated under the laws of the state of Montana. Personal care providers must demonstrate that they are paying workers' compensation and unemployment insurance premiums.

(14) The department will enroll providers who provide the following documentation:

(a) the provider's articles of incorporation;

(b) a written contingency plan, approved by the department, addressing service delivery to clients in the event an agency is unable to deliver services in a timely manner or in the event the agency ceases operation;

(c) general liability insurance with a minimum coverage of $100,000 per person;

(d) motor vehicle liability insurance with a minimum coverage of $100,000 per person;

(e) current unemployment insurance and worker's compensation coverage;

(f) financial solvency, to include the ability to make a projected 4 month payroll; and

(g) a description of the proposed service area which must be defined to include at a minimum coverage of the entire area of at least one county or Indian reservation.

(15) The department may contract with out-of-state agencies to provide personal care services for Montana medicaid recipients living out of state.

(16) Personal care services may only be delivered by a personal care attendant employed by an enrolled medicaid provider that has met the criteria established by the department for the delivery of personal care services.

(17) Personal care services may not be provided to relieve a parent of child caring or other legal responsibilities.

(a) Personal care for disabled children may be appropriate when the parent is unqualified or otherwise unable to provide the personal care and the child is at risk of institutionalization unless the services are provided.

(18) Personal care services must be delivered in the most efficient manner available.

(19) Personal care services are not available to recipients who live in homes which are not safely accessible by normal modes of transportation.

(20) Personal care services may be terminated for any of the following reasons:

(a) the recipient or other persons in the household subjects the personal care attendant to physical or verbal abuse, sexual harassment, exposure to the use of illegal substances or to threats of physical harm;

(b) the recipient requests termination of services or refuses to accept help;

(c) the environment of the recipient is unsafe for the provision of personal care services;

(d) the recipient's physician requests termination of services;

(e) the recipient no longer has a medical need for personal care services;

(f) the recipient refuses the services of a personal care attendant based solely or partly on the attendant's race, creed, religion, sex, marital status, color, age, handicap or national origin; or

(g) the recipient refuses to accept services in accord with the plan of care.

(21) The department may terminate or reduce personal care services when funding for services is unavailable.

(22) The provider shall give at least 10 days advance notice to a recipient when personal care services are terminated for reasons listed in (20) (d) through (20) (g) .

(23) The provider may immediately but temporarily suspend services for the reasons listed in (20) (a) through (20) (c) . Following the temporary suspension of services the provider may enter into an agreement with the recipient to ensure that the violations of (20) (a) through (20) (c) do not reoccur. If the recipient fails to abide by the term of the agreement services may be permanently terminated.

(24) The department shall provide written notice to an applicant when personal care services are initially denied to the applicant.

(25) A person may request a fair hearing for any adverse determination made by the department. Fair hearings will be conducted as provided for in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.