Medical Assistance Personal Care (MAPC) includes “hands on” in-home assistance with personal cares such as toileting, bathing, food preparation and feeding, dental, nail, and hair care, dressing assistance, transfers and assistance getting in and out of bed, and light cleaning and laundry associated with cares. MAPC is an important revenue source. By billing MA for these cares, Dane County reduces the cost of services billed to the MA Waiver and reduces the amount of local tax levy required to fund DD programs.
There are two ways adults with developmental disabilities access MAPC in Dane County:
- Through a separately licensed Personal Care or Home Health agency such as Interim Healthcare, Maxim, Catalyst Home Health, and Wisconsin Therapists (this list is not all inclusive).
- Through one of our contracted agencies, which include all agencies providing residential services to adults with developmental disabilities and Community Living Alliance (CLA). When these agencies provide MAPC, they use Dane County’s provider number for billing purposes, whereby Dane County is the provider of record. CLA coordinates the MAPC program for all residential agencies.
- If a person is receiving MAPC from a separately licensed agency, you would list the anticipated cost for MAPC on the Individual Service Plan and indicate the provider’s name and indicate it is MA billing.
- If the person is getting MAPC from their current contracted residential provider or CLA, the cost should only go on the ISP and you can leave the SPC code blank for MAPC and indicate it as an MA cost. You would list Dane County (DCDHS) as the provider.
For the dollar amount, you will need to estimate the costs, regardless of the provider. To estimate, multiply the approximate number of billable MAPC hours the person will receive by $16.08. This information should be available from the provider or CLA. If not, as this is only a plan, your best guess will be sufficient.
It is important to note that all the MAPC hours may not be billable. It will depend on whether the individual is home during the day as to whether they can bill the total authorized hours. It will also depend on factors such as whether they actually received a bath that day or Range of Motion or assistance in the bathroom throughout the day. Each personal care is added to create the total authorized hours for MAPC and if those cares are not provided, then we cannot bill Medicaid for that time. When developing your estimate for the ISP, average the MAPC hours per week (Saturday and Sunday will typically bill more) that are typically provided.
It should be noted that information on the Personal Care Screening Tool (or PCST) filled out by a nurse during the assessment of personal care needs must be consistent with the Long-Term Care Functional Screen (LTC-FS) filled out by brokers. For example, if assistance with bathing is listed on the PCST as a personal care need, the LTC-FS must also identify this area as a need as well. From time to time, the nurse and the broker may need to consult with one another in order to ensure that the two Screens match.