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1303 Hospital Ground • Knud Hansen Complex, Suite 1 • St. Thomas, Virgin Islands 00802-6722 • (340) 774-0930 3012 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • (340) 718-2980 MEDICAID PROGRAM PUBLIC NOTICE PERSONAL CARE ATTENDANT NURSING REIMBURSEMENT August 08, 2022 The Department of Human Services (DHS) is issuing this Public Notice of its intention to permanently add nursing supervision reimbursement to the permanent Personal Care Attendant service benefit under the United States Virgin Islands Medicaid Program (USVIMP) effective August 08, 2022. Section 1905(e)(24) of the Social Security Act and 42 CFR 447 establishes PCA as a covered service under the USVIMAP and provides for reimbursement for nursing supervision of that service. The USVIMP added PCA as a covered service, effective March 20, 2020, as part of its Federal Public Health Emergency (PHE) COVID disaster relief coverage and incorporated that service permanently into its Medicaid Program effective January 01, 2022. However, reimbursement for nursing supervision of the PCA service was not included in the State plan that was effective January 01, 2022. This state plan amendment will add this nursing reimbursement for the PCA services to the USVIMAP. Personal care attendant services mean some or total assistance to an eligible member to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) such as personal hygiene, dressing and feeding, and nutritional services in their homes or in community-based residential settings. Such PCA services may include, but are not limited, to: • Assistance with nutrition and diet activities such as shopping, financial, meal preparation, and eating, • Performance of household services such as changing bed linens, making beds, washing dishes, cleaning, dusting, and vacuuming, and shopping for essential supplies, • Assistance with basic personal care such as bathing, grooming, bathroom/toileting and/or bedpan routines, walking, transferring from bed to chair or wheelchair, positioning, and • Assistance with self-administration of medications. • Transportation to medical appointments and assistance in arranging and scheduling such appointments. All persons providing PCA services must be subject to an on-going program of Supervision. The supervision must consist of nursing supervision: Nursing Supervision must assure that the patient’s needs are appropriately met by the PCA agency’s care plan for the level, amount, frequency, and duration of PCA services and that the person providing such services is competently and safely performing the functions and tasks specified in the individual plan of care. Nursing supervision must include: • an orientation visit with the member to receive the PCA services and the worker at the time of initial case assignment to ensure that the worker providing PCA services understands his/her responsibilities in conjunction with the medical needs of the patient and has received all necessary instructions. 1303 Hospital Ground • Knud Hansen Complex, Suite 1 • St. Thomas, Virgin Islands 00802-6722 • (340) 774-0930 3012 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • (340) 718-2980 • ongoing evaluation of the patient’s needs to determine if the level, amount, frequency, and duration of PCA services continue to be appropriate; and • evaluation of the ability of the person providing the services and arranging for or providing necessary instructions to meet the medically related needs of the patient in keeping with the goals established by the member’s individual plan of care. The USVIMP will reimburse for nursing supervision as follows: 1) The USVIMAP will reimburse a flat rate of $120.00 for an initial nursing orientation, assessment, and plan of care development visit with the client and the PCA worker. 2) Ongoing nursing supervision to ensure that the patient’s needs are being met and that the PCA worker is providing services in accordance with the plan of care will be reimbursed at $46.24 per hour that may be billed at $11.56 per 15-minute increment. We estimate that this nursing supervision will have a total cost of approximately $2.8 million annually that will be reimbursed by the Federal and local Virgin Islands Medicaid funding. The Medicaid State Plan Amendment which describes this coverage is available for review at: U.S. Virgin Islands DHS (gov.vi) It is also posted for review at the DHS District Office on St. Thomas, St. Croix, and St. John. You may also call 340-774-0930 on St. Thomas or 340-773-1311 on St, Croix. If you prefer to provide written comments on this proposal, please address them to the following address: USVI Department of Human Services Attn: Director, Medicaid Program 1303 Hospital Grounds – Building A St. Thomas, US Virgin Islands 00802 We invite your comments on the proposal and those comments must be received by DHS within 30 days of the date of this notice.