Relatives or Guardians as Paid Providers
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Defines rules and conditions under which relatives, guardians, and legally responsible individuals may be employed and paid to provide home- and community-based services under the Arkansas PASSE program; applies to providers and members served by Arkansas Medicaid programs described in this statement.
Removed PSCP definition and added PCSP as a related policy; updated references.
When Relatives or Guardians May Be Paid
Coverage Conditions and Exclusions for Relatives/Guardians
Conditions under which relatives/guardians may be paid and program-specific exclusions:
Program-specific exclusions
- Personal Care Services (PCS): PCS are provided by an individual who is not a member of the member's family; family is defined to include a member's spouse, a minor's parent/stepparent/foster parent/anyone acting as a minor's parent, the member's legal guardian, and an attorney-in-fact granted authority to direct the member's care.
- PCS travel time is not reimbursable if any adult accompanying or driving the member is a family member reasonably able to assist the member in transit.
- Private Duty Nursing (PDN): The following persons cannot provide care through PDN - a spouse; a minor's parent or anyone acting as a minor's parent; a minor's guardian or anyone acting as a minor's guardian; an adult's guardian or anyone acting as an adult's guardian; anyone who resides with the member regardless of relationship.
Billing and Coding Notes
| No codes listed |
Provider Enrollment, Billing, and Operational Rules
Provider enrollment, billing, employment and hour limits for relatives/guardians
All providers, including relatives, must meet Arkansas provider certification requirements, training requirements, and all Medicaid enrollment requirements. The provider on file with Arkansas Medicaid is the biller of services; the relative, guardian, or legally responsible paid individual must be employed by that enrolled provider and follow the provider's billing policies and Arkansas Medicaid certification and enrollment rules. Providers who employ relatives/guardians must also have a staffing backup plan in place for the member. Relatives/guardians living in the home should not provide more than 40 hours per 7-day period of paid support; requests for more than 40 hours will be considered based on factors such as availability of nonrelative providers and the number of hours of support needed.
- Ensure the enrolled provider on file with Arkansas Medicaid is the billing entity for services.
- Employ relatives/guardians as staff under the enrolled provider; maintain payroll and employment documentation as applicable.
- Maintain documentation that the relative/guardian completed required Arkansas provider certification and training prior to providing paid services.
- Implement and document a staffing backup plan for members when relatives/guardians are employed.
- Monitor and document hours worked by relatives/guardians to avoid exceeding 40 hours per 7-day period unless justified and approved.
Travel time non-reimbursable if family member can assist
Travel time to or from the member is not reimbursable when an accompanying adult who is a family member is reasonably able to assist the member during transit.
- Do not bill travel time for PCS when any other adult accompanying the member is a family member reasonably able to assist during transit.
Exclusion: relatives/guardians cannot provide paid licensed professional services
Relatives, guardians, and legally responsible individuals are explicitly prohibited from being paid to provide professional licensed services such as registered nurses, licensed practical nurses, and licensed mental health professionals.
- Do not employ or bill relatives/guardians to provide licensed professional services (examples listed: registered nurses, licensed practical nurses, licensed mental health professionals).
- Apply program-specific exclusions (for PDN: spouse, minor's parent, minor's guardian, adult's guardian, and anyone residing with the member are excluded from providing PDN).
Key Term Definitions
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