Aging and Disability Services Council Sharon Swift Butterworth ...

ISP year, the maximum service ceilings described in §48.6003(b)(8)(A)-(C) of this subchapter;
(B) For dental services during an ISP year, a maximum combined cost of $5,000 for general
dentistry and the services of an oral and maxillofacial surgeon and an additional maximum cost
of $5,000 for the services of an oral and maxillofacial surgeon.
(b) Claim Limits. [end addition]
[begin addition] (1) [end addition] A [begin addition] HCSSA may bill for a [end addition]
maximum of four hours [begin addition] of [end addition] [begin deletion] may be billed under
[end deletion] nursing services by [begin addition] an RN [end addition] [begin deletion] the
registered nurse [end deletion] to decide whether or not to delegate a nursing task to an adult
foster care provider.
[begin addition] (2) [end addition] [(b)] [begin addition] A HCSSA may bill for a
maximum of ten hours [end addition] [begin deletion] In order to avoid service breaks, the Home
and Community Support Services agency may bill [end deletion] for authorized [begin addition]
PAS [end addition] [begin deletion] personal assistance services [end deletion] hours performed
by [begin addition] an LVN or RN for an individual [end addition] [begin deletion] a licensed
nurse, for a maximum period of 10 hours [end deletion] during the [begin addition] ISP year [end
addition] [begin deletion] participant's individual service plan effective period [end deletion].
[begin addition] (A) [end addition] [(1)] The [begin addition] PAS [end addition] hours
performed by the [begin addition] LVN or RN [end addition] [begin deletion] nurse [end
deletion] may be billed at the nursing rate, only if there are no attendants available to perform the
needed delegated nursing tasks and only [begin addition] an LVN or RN [end addition] [begin
deletion] licensed nurses [end deletion] can be recruited [begin addition] to perform the
authorized PAS hours [end addition].
[begin addition] (B) [end addition] [(2)] The documentation must include all efforts the [begin
addition] HCSSA [end addition] [begin deletion] provider agency [end deletion] made in order to
find an attendant to deliver delegated [begin deletion] nursing [end deletion] tasks in order to
prevent a break in service.
[begin addition] (3) [end addition] [begin deletion] (c) [end deletion] Components of minor
home modifications cannot be billed without an invoice or in more than two billings.
[begin addition] §48.6085. Exception to Service Limit.
(a) If a DADS case manager receives information demonstrating that exceeding a limit to an
individual's service described in §48.6084(a)(2)(A)-(G) of this subchapter (relating to Service
Limits and Claim Limits) is necessary to meet an individual's needs, the DADS case manager
determines whether providing the service in excess of the limit is necessary for the ISP to meet
the criteria described in §48.6006(d)(1)-(5) of this subchapter (relating to Individual Service
Plan).
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