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How do states limit the PCS Benefit? States may limit the PCS benefit through two mechanisms: "medical necessity" and "utilization control." They can, for example, limit the hours of service provided each day or impose limits on the type of services provided." From Adults with Severe Disabilities: Federal and State Approaches for Personal Care and other Services,published May, 1999 (GAO-HEHS 99-101). Download from http://www.gao.gov/ Limits imposed by states on the Personal Care Services Benefit * Alaska (a) One assessment and treatment plan per 12 months Arizona (a) (b) Arkansas (c) Services cannot exceed 72 hours per month without prior approval. California Services must not exceed 283 hours per month. Wash., DC Services cannot exceed 4 hours per day or 1,040 hours in 12 months without prior authorization. Idaho (a) 16 hours per week Kansas Prior authorization is required for up to 24 hours per day. Maine Available to individuals with chronic or permanent disabilities who are able to self-direct a personal care attendant Maryland Services are provided at one of four intensity levels of care subject to prior authorization. Massachusetts Prior authorization is required. Michigan (b) Minnesota Prior authorization is required. Missouri (a) Need assessment to be completed every 6 months Montana 40 hours per week unless prior authorization is obtained Nebraska 40 hours per week unless prior authorization is obtained Nevada (a) Prior authorization is required. New Hampshire Recipients must be chronically wheelchair-bound. New Jersey 25 hours per week or up to 40 hours per week with prior authorization New York 6 months for one of three levels of services with prior authorization unless exceptions are authorized for up to 12 North Carolina 80 hours per month and covered only if no home health aide services are provided on the same day Oklahoma (c) Departmental approval is required. Oregon Prior authorization is required. South Dakota (a) 120 hours per calendar quarter Texas Lesser of 50 hours per week or the rate of the average nursing facility; prior authorization is required and a plan of treatment must be reviewed. Utah 60 hours per month and covered only if no home health aide services are provided on the same day Washington (c) (b) West Virginia Limited on a per-unit, per-month basis; prior authorization is required for additional hours of care. Wisconsin Prior authorization is required for more than 250 hours per calendar year; housekeeping tasks are limited to one-third of the time spent in the recipient’s home. (a) Provide personal care services to only the categorically needy. (b) No limitation specified. (c) Provide most Medicaid services to both categorically needy and medically needy, but limit personal care services to categorically needy. Source: Medicare and Medicaid Guide, Commerce Clearing House, Inc. * From Adults with Severe Disabilities: Federal and State Approaches for Personal Care and other Services,published May, 1999 (GAO-HEHS 99-101). Download from http://www.gao.gov/  Freedom Clearinghouse is a project of Free Hand Press, publisher of Mouth magazine. Website developed by Cliffwood Organic Works. Website hosted by DIMENET. | E-mail | Home |