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317:35-15-13.2.Individual personal care assistants (IPCA) provider contractor; billing, training, and problem resolution

[Revised 09-01-17]

While the Oklahoma Health Care Authority (OHCA) is the contractor authorized under federal law, the Oklahoma Department of Human Services (DHS) nurse initiates initial contracts with qualified individuals for provision of personal care services per Oklahoma Administrative Code (OAC) 317:35-15-2. The contract renewal for the IPCA is the responsibility of OHCA.

(1) IPCA payment.  Payment for personal care services is made for care provided in the member's "own home" or in other limited types of living arrangements per OAC 317:35-15-2(b)(1) through (4). Personal care may not be approved when the client lives in the Personal Care Assistant's (PCA's) home except with the approval of DHS Aging Services.

(A) Reimbursement.  Personal care payment for a member is made according to the number of units of service identified in the service plan.

(i) The unit amounts paid to individual contractors is according to the established rates. A service plan is developed for each eligible individual in the home and units of service assigned to meet the needs of each member. The service plans combine units in the most efficient manner to meet the needs of all eligible persons in the household.

(ii) From the total amounts billed by the IPCA in (i) of this subparagraph, the OHCA, acting as agent for the member-employer withholds the appropriate percentage of FICA tax and sends it to the Internal Revenue Service as the individual contractor's contribution toward Social Security coverage. To ensure the individual contractor's Social Security account may be properly credited, it is vital that the individual contractor's Social Security number be entered correctly on each claim.

(iii) The contractor payment fee covers all personal care services included on the service and care plans developed by the DHS nurse. Payment is made for direct services and care of the eligible member(s) only. The area nurse, or designee, authorizes the number of units of service the member receives.

(iv) A member may select more than one IPCA. This may be necessary as indicated by the service and care plans.

(v) The IPCA may provide SoonerCare personal care services for several households during one week as long as the daily number of paid service units does not exceed eight hours, 32 units per day. The total number of hours per week cannot exceed 40, 160 units.

(B) Release of wage and/or employment information for IPCAs. Any inquiry received by the local office requesting wage and/or employment information for an IPCA is forwarded to the OHCA, Claims Resolution.

(2) IPCA member selection.  Members and/or family members recruit, interview, conduct reference checks, and select the individual for IPCA consideration. Prior to placing a personal care service provider in the member's home, an OSBI background check, a DHS Community Services Worker Registry check must be completed per Section 1-1944 through 1-1948 of Title 63 of the Oklahoma Statutes. The DHS nurse must also check the Certified Nurse Aide Registry. The DHS nurse must affirm that the applicant's name is not contained on any of the registries. The DHS nurse notifies OHCA when the applicant is on the Registry.

(A) Persons eligible to serve as IPCAs. Payment is made for personal care services to IPCAs who provide personal care services who meet the criteria per OAC 317:35-15-2(c)(1) through (8).

(B) Persons ineligible to serve as IPCAs.  Payment from SoonerCare funds for personal care services may not be made to an individual who is a legally responsible family member spouse, legal guardian, or parent of a minor child of the member being served, exceptions to legal guardian are made only with prior approval from Aging Services Division.

(i) Payment cannot be made to a DHS or an OHCA employee. Payment cannot be made to an immediate family member of a DHS employee who works in the same county without DHS Aging Services approval. When a family member relationship exists between a DHS nurse and an IPCA in the same county, the DHS nurse cannot manage services for a member whose IPCA is a family member of the DHS nurse.

(ii) If it is determined that an a DHS or OHCA employee is interfering in the process of providing services for personal or family benefit, he or she is subject to disciplinary action.

(3) IPCA orientation. When a member selects an IPCA, the DHS nurse contacts the individual to report to the county office to complete the Oklahoma State Department of Health form 805, Uniform Employment Application for Nurse Aide Staff, and the DHS Form 06PE039E, Employment Application Supplement, and for a determination of qualifications and orientation. For personal care members, this process is the responsibility of the DHS nurse. The IPCA can begin work when:

(A) he or she was interviewed by the member,

(B) he or she was oriented by the OKDHS nurse,

(C) he or she executed a contract (OHCA-0026) with the OHCA,

(D) the effective service date was established,

(E) all registries were checked and the IPCA's name is not listed,

(F) the Oklahoma State Department of Health Nurse Aide Registry was checked and no notations were found, and

(G) the OSBI background check was completed.

(4) Training of IPCAs.  It is the responsibility of the DHS nurse to make sure the IPCA has the training needed to carry out the plan of care prior to service initiation for each member.

(5) Problem resolution related to the performance of the IPCA. When it comes to the attention of the DHS nurse that there is a problem related to the performance of the IPCA, a counseling conference is held between the member, OKDHS nurse, and worker. The DHS nurse counsels the IPCA regarding problems with his or her performance. Counseling is considered when staff believes counseling will result in improved performance.

(6) Termination of the IPCA Provider Agreement.

(A) A recommendation for the termination of an IPCA's contract is submitted to OHCA and IPCA services are suspended immediately when:

(i) an IPCA's performance is such that his or her continued participation in the program could pose a threat to the health and safety of the member or others; or

(ii) the IPCA failed to comply with the expectations outlined in the PCA Provider Agreement and counseling is not appropriate or was not effective; or

(iii) an IPCA's name appears on the DHS Community Services Worker Registry, any of the registries listed in Section 1-1947 of Title 63 of the Oklahoma Statutes, even though his or her name may not have appeared on the Registry at the time of application or hiring.

(B) The DHS nurse makes the recommendation for the termination of the IPCA to DHS Aging Services who notifies the OHCA Legal Division of the recommendation. When the problem is related to allegations of abuse, neglect, or exploitation, DHS Adult Protective Services, State Attorney General's Medicaid Unit, OHCA, and the Oklahoma State Department of Health are notified by the DHS nurse.

(C) When the problem is related to allegations of abuse, neglect, or exploitation the DHS nurse follows the process as outlined in OAC 340:100-3-39.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.