For Release: IMMEDIATE
Date: September 19, 2005

NC Medicaid Restructuring Personal Care Services

RALEIGH – During the last fiscal year, North Carolina’s Medicaid program spent more than $275 million on personal care services (PCS), a program which helps elderly and disabled persons remain at home. The General Assembly has directed that the state reduce the spending in this program and save over $44 million by June 30, 2006. This directive from legislators comes at a time when the state is kicking off a major restructuring of the PCS program.

“We are overhauling this program from top to bottom,” said Asssistant Secretary for Health/Medicaid Director Dr. Allen Dobson. “Some people obviously do need in-home care; for them it is a medical necessity. But, we need to make sure that we aren’t providing services that are frivolous, unnecessary and unrelated to a person’s medical condition.”

Personal Care Services must be provided in a person’s home and must be directly linked to a medical condition. The program covers services such as assistance with bathing and toileting, monitoring vital signs, and sometimes certain home management tasks like meal preparation.

The proposed changes that the state is making include:

• Assuring that Personal Care Services are medically necessary and directly related to a medical condition by requiring a standardized assessment and plan of care tool for anyone receiving PCS.
• Increasing the minimal requirements to qualify for PCS, requiring help with two activities of daily living.
• Providing specific guidelines for how long certain tasks should take.
• Requiring registered nurses who supervise PCS direct care workers to successfully complete a state-approved training course on PCS guidelines and criteria.
• Reducing risk of fraud/abuse by requiring the nurse performing client assessments and the physician approving the plan of care to certify that they are giving accurate information.
• Placing teams of nurses and other professionals throughout the state to check up on the providers and make sure they are in compliance with state policies.

The Division of Medical Assistance (state Medicaid agency) worked closely with the Association of Home and Hospice Care of North Carolina, a nonprofit trade association representing almost 500 in-home care agencies, in developing the new policies. The Division of Facility Services, the state agency which regulates home health care, also worked on the policies.

Comments on the proposed policy, which is available on DMA’s web site at http://www.dhhs.state.nc.us/dma/mp/proposedmp.htm, will be accepted through October 6. The new policy will be effective on October 17, 2005.

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