Medicaid in Illuminate

Personal Care Services

Illuminate Web Site Address: eup.illuminateed.com

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Personal Care Tip SheetDefinition:Personal Care Services are a range of human assistance services provided to persons with disabilities and chronic conditions which enable them to accomplish tasks they would normally do for themselves if they did not have a disability. Assistance may be in the form of hands-on assistance or cueing so that the person performs the task by him/herself.

Personal Care Services: Examples: Feeding/Meal Preparation ……………………………………………. Feeding, cueing to feed self, meal preparation activities Respiratory Assistance ………………………………………………….. Suctioning, positioning to improve air flow, tracheotomy Toileting ……………………………………………………………………….. Pulling pants down/up, wiping, changing diapers, cueing to

complete toileting tasks Dressing …………………………………………………………………….... Putting clothes on/taking off (includes shoes and winter attire) Personal Hygiene …………………………………………………………. Brushing teeth, washing hands/face, menstrual care Transferring …………………………………………………………………. Moving from a wheelchair to another place and back again (chair, toilet, mat, etc.) Mobility/Positioning ……………………………………………………. Assisting student in getting from one place (or position) to another with or without assistive devices (walker, cane, stand by

assistance, etc.) Behavior Redirection/Intervention ……………………………… Implementation of behavior plan, de-escalating aggressive

behaviors, or specific intervention for harmful activities to self or others

Other Health Related Functions ………………………………….. As specified in IEP

The need for personal care services must be included in the IEP/IFSP and authorized by a licensed practitioner operating within the scope of their practice.

Personal Care Services are not covered if they are provided by a family member, not documented in the IEP/IFSP or educational in focus, such as tutoring, preparation of educational materials or Braille interpretation

If you have questions about logging encounters for Medicaid billing, contact Cindy Wagner at cwagner@eup.k12.mi.us or (906) 632-3373 ext. 109.

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Personal Care Service Category Definitions (from dropdown on logging page)

Personal Care Service Definition

Feeding/Meal Preparation Assisting/cueing student with meal and snack feeding. Assisting/cueing student in preparing his/her meal or snack (such as grinding food in a food processor in order for the student to be able to eat, preparation of formula).

Respiratory Assistance Assistance with exercises to increase lung capacity.

Toileting Physically assisting/cueing student to access the toilet.

Dressing Assisting/cueing student to dress themselves for outdoors, following toileting, etc.

Personal Hygiene Assisting/cueing student with teeth brushing, maintaining hygienic conditions, assistance with female menstrual periods, diaper changes, wiping nose, etc.

Transferring Physically assisting student to move about the classroom as needed.

Mobility/Positioning Assisting/cueing student to adjust his/her positioning to prevent stiff muscles/sores, (using stander).

Redirection and Intervention for Behavior Any cueing or physical hands-on redirection of student for behavior purposes.

Other Health Functions Broad range of assistance/cueing that is not covered under other categories. Use this area if the service is not listed in another category. Skilled nursing services are not billable by personal care providers.

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Illuminate Encounter Entry: How to Add Students to Personal Care Provider Caseload

• Click the Special Ed tab• Click the Provider Case Load link• Enter a few letters up to an entire LAST NAME, FIRST NAME, ROLE and/or

SITE• Click the Search button• Select the desired Personal Care Provider by clicking on his/her name• Click the “Add Personal Care Student” link• Input all or some of the student’s first and last name and click the Search

button.• Click on the Student Name of the student you would like to add.• Input the date on which the Personal Care Services will begin.• Click the Submit button. You have now successfully added the selected

student to the Provider Case Load and are ready to log encounters for Personal Care

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Adding Personal Care Encounters

• Click the Add Encounter for All Current Students blue link• Input the date for which you would like to log encounters• Click the Change Week button• Using the Drop Down menu, select the personal care services delivered to

the respective student for each day of the week• Click the Save button• Upon successful save, a Green Dialogue Box indicating “Your encounters

were saved successfully” will appear

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Random Moment Time Studies

• Random Moment Time Studies (RMTS) gather information about the amount of time school personnel spend performing direct service activities in support of special education students. The information is used to determine federal reimbursement.

• If selected for a RMTS, you will be notified by email from miaop (Michigan Administrative Outreach Program). The email will provide you with the date and time of your moment and a web site link specific to you and your moment that you will use to complete and submit your RMTS form online.

• The time study asks direct short questions: 1) Who was with you? 2) What were you doing? 3) Why were you doing this activity? 4) Does the student have an IEP in place for the services you are performing?

• When responding to the time study questions, you need to make sure that enough detail is provided to allow anyone to easily determine if the service is educational or medical. If you are assisting a child with a medical disability that prevents the child from being able to perform the task without assistance, this needs to be noted. There are no wrong responses, only incomplete ones that do not allow the coders to appropriately code your response. Time study responses are to reflect what you were doing at that moment in time. If you are not at work when your moment occurs, you should still complete the survey. For example, if your time is during your lunch break, simply respond that you were on a break. If what you were doing did not involve a student, since there is no option to answer “n/a”, please answer no to these questions.

• Some common examples of responses that would not provide enough detail and complete/detailed responses are listed to the right.

Incomplete or Brief Response Complete/Detailed Response after Follow-Up

Sitting with a child while eating Supervising swallowing

Putting on coat Assisting a child to put on their coat that is unable to dress themselves

Getting child on bus Assisting child to board bus that is unable to board without assistance

Escorting student Assisting student with physical disabilities to move from classroom to classroom

Assisting a student Assisting a disabled child with hygiene, clothing, toileting, ambulation, positioning, ambulation, eating, etc.

Working on IEP goals This is not personal care service

Transitioning This is not personal care service

Eating lunch with child Assisting the child to self feed, setting up food for a disabled child

Assisting a student as part of my daily routine

Assisting a student with feeding, etc. as part of my daily routine

Working with student in bathroom Assisting with toileting

Sitting with student in circle Sitting with student as student needs physical support in order to participate in activity