Personal Care Coverage
Change Effective 8/1/11
Frequently Asked Questions
What services are covered?
Housekeeping services, also called Level 1 care, and/or home attendant services, also called Level 2 care
How does the member qualify?
- Must have a physical or mental disability that requires some additional assistance to allow the member to live at home (or their current living arrangement) independently and
- Must be able to manage their personal affairs or finances or has a designee that manages their personal affairs for them
Who can make a request?
The member’s physician, a family member, the member or other designees can make the request.
How can you make a request?
- Contact the Care Coordination Department at 1-800-765-3805 and ask to initiate a request for Personal Care Services.
- All requests must be accompanied by a Physician Order form, also called the “MA241A” which should be faxed to the Care Coordination Department at 1-800-338-4195, to the attention of the Personal Care Coordinator. (See “Forms” to obtain a copy of the MA241A)
How do we review requests?
- SHP will complete the review of the request within 28 days of receipt.
- We will have a nurse visit the member’s home to complete a home nurse assessment (See “Forms” to obtain a copy if the nursing assessment form) once we receive your request with a physician order (the MA241A)
- Our Care Coordination staff will determine the plan of care which includes the type of personal care and housekeeping services and number of hours approved.
- SHP will send letters with our approval or denial to the physician and the member
- Approvals will be for a maximum of 6 months.
- Members have Appeal and Fair Hearing rights if we deny the request in whole or in part
What about members who are already receiving personal care services that were approved by HRA?
- SHP will honor any existing authorization
- SHP will request an updated physician order and will complete a new home assessment at the end of the previously approved time period.
- If SHP decides to decrease or deny personal care services, Appeal and Fair Hearing rights apply and the member may request “aid continuing” services if the member files a request for a Fair Hearing within 10 days after SHP denies or decreases services.
If you are a Personal Care Agency click here to review our Personal Care Agency Quick Reference Guide.