Most frequent questions and answers
Medicaid Services are provided after application to MEDICAID HMO or thru entitlements from the state of Texas – HHS (Tx. Health and Human Services). Financial criteria along with functional limitations must be met to qualify for MEDICAID funded services.
Private Care services may be attained by any individual requesting services with the ability to Self Pay or who has authorization from their Long Term Care Insurance.
MEDICAID funded programs allow for PCA (Personal Care Attendant), also known as a “Provider“, to assist with personal care, such as bathing, grooming, dressing and also with light housekeeping, meal preparation, accompanying to doctor appointments and grocery shopping, to name a few. Pet care and driving client’s vehicle is not allowed with the MEDICAID funded programs.
PRIVATE CARE recipients can allow for the above personal care services and can also include more companionship hours and allows for PCA to drive the client’s vehicle to run errands.
MEDICAID PROGRAMS – In most cases the case worker from the Texas HHS or HMO (STAR PLUS/STAR KIDS) interviews the individual and awards the hours based on a set formula that is used to determine task times. These calculations are completed when the number of days per week of service needed is put into the formula. PRIDE PHC SERVICES, Inc. staff do not play any role in the authorization or determination of service hours allotted to an individual.
PRIVATE CARE – hours are determined by individuals requesting services, along with limitations set by their Long Term Care Insurance carriers, when applicable.
MEDICAID PROGRAMS – an average 5-day case is 15 hours/week, and a 7-day case is 20 hours/week.
PRIVATE CARE – very greatly from 1 visit per week to 24 hour care.
MEDICAID PROGRAM – NO. The awarded hours are based on the client’s need for assistance with tasks as noted in the service plan. There is no calculation for providing companionship of non-task oriented care. If a client routinely does not allow the provider to perform the authorized tasks, re-evaluation of the client’s needs will be performed by the HHS or HMO/MCO caseworker. Additionally, a PCA cannot be in client’s home performing tasks, if the client is not at home. Nor can the PCA provide services in a hospital or nursing home, as the individuals personal care needs will be met by that facilities personnel.
PRIVATE CARE – YES. The PCA can provided companionship as part of the ISP (Individualized Service Plan). Additionally, clients can request Private Care services to be provided in a setting outside of the clients home.
MEDICAID PROGRAM – EVV is an ELECTRONIC VISIT VERIFICATION system. Recently, EVV was implemented by the Texas Health and Human Services Commission as a requirement to provider agencies. PCAs must utilize the EVV system to clock IN and OUT of client’s home. A client’s home phone is used to call IN and OUT at the beginning and end of scheduled services. This allows for proper time keeping and for more accurate tracking of services delivered. If a client does not have a home phone or does not want to allow the PCA from the provider agency to use their home phone, then a “TOKEN“ will be installed. The TOKEN must be affixed to a item in the home and is not to be removed from the client’s home. PCAs must utilize the numbers displayed on the TOKEN to verify IN and OUT times. PCAs are NEVER to use client’s CELL PHONES with EVV processes. Contact office for more information regarding EVV features and requirements.
PRIVATE CARE- Pride PHC Services uses an EVV (Electronic Visit Verification) system for to manage PCAs clocking IN and OUT of service.
MEDICAID PROGRAM – NO. The provider can only work for anyone who is authorized services. If more than one person in a household qualifies for services, the provider can also work for that person as well, but each client has their own specific service times and the provider must adhere to the total amount of hours awarded.
PRIVATE CARE – Usually, services are provided for one individual in the household at one time. If there is a companion that requires care, then rates will be adjusted and negotiated with the family prior during the initial assessment.
MEDICAID PROGRAM – The provider does the tasks that are identified in the client’s service plan. They can help with personal care tasks such as: bathing, dressing, hair/skin care, light housekeeping, laundry, meal preparation, shopping and can change adult briefs, if client is incontinent.
PRIVATE CARE – Most tasks provided will be the same personal care tasks listed above. An individual requesting Private Care services can look to include just about any appropriate task they want performed during the requested service time.
MEDICAID PROGRAMS – NO. A person does not have to be 65 years old or older to qualify for services.
PRIVATE CARE – NO. A person does not need to be 65 years old or older to qualify for services.
MEDICAID PROGRAMS (DADS and HMO/MCO) – NO. Pet care is not a task that can be provided.
PRIVATE CARE – YES. Services are directed by the individual and can include pet care as part of the service plan. This can be discussed during the initial assessment for appropriateness.
MEDICAID PROGRAM – NO. The provider is NEVER allowed to transport the client anywhere. Providers CANNOT be required to have a vehicle. Services can be terminated if a client insists that a provider transport them. Providers can “accompany“ the client on VIA or public transportation.
PRIVATE CARE – PCA can transport the client in the client’s personally insured vehicle to appointments and on errands. Client will need to provide proof of insurance.
MEDICAID PROGRAMS – YES. A client may have a POC (Provider Of Choice). All PCAs, including client’s POC must be 18 years of age, have proper identification, and be a citizen of the U.S., or a legal alien. Additionally, they must be able to pass a criminal history, Nurse Aide Registry and Employee Misconduct Registry check.
PRIVATE CARE – YES. A client may have a POC (Provider Of Choice). All PCAs, including client’s POC must be 18 years of age, have proper identification, and be a citizen of the U.S., or a legal alien. Additionally, they must be able to pass a criminal history, Nurse Aide Registry and Employee Misconduct Registry check.
MEDICAID PROGRAM – NO. If you are in the hospital, on vacation or just request no services for a period of time, we can SUSPEND the case until you are ready for services again.
PRIVATE CARE – NO. You will not lose your services. Just let us know when you will be returning and we will resume services at that time.
MEDICAID PROGRAM – NO. An agency is only paid for worked hours. If your provider is late, leaves early or is a no show, you must notify the agency so proper actions can be taken and/or a replacement PCA can be assigned. PCAs are not allowed to work in client’s home if client is not home.
MEIDICAID PROGRAMS – YES. If you have a change in your health condition, you can request to be assessed for an increase in hours. An agency can only recommend changes to your authorizing agency. Changes must be approved by the HHS or HMO/MCO caseworker.
PRIVATE CARE – YES. You may request and increase in hours at any time.