Personal Care Services Provided in a Residential Care Facility Setting or the Participant’s Home
Please note that, pursuant to 13 CSR 70-91.010(4)(A) 2.F., documentation for services delivered by the provider in the Personal Care Program must include the following:
F. For each date of service: the signature of the recipient, or the mark of the recipient witnessed by at least one (1) person, or the signature of another responsible person present in the recipient’s home or licensed Residential Care Facility I or II at the time of service. “Responsible person” may include the personal care aide’s supervisor, if the supervisor is present in the hom e at the time of service delivery. The personal care aide may only sign on behalf of the recipient when the recipient is unable to sign and there is no other responsible person present.
Please also note that the MO HealthNet Personal Care Program Manual 13.7.D(1) states:
6. For each date of service: the signature of the participant, or the mark of the participant witnessed by at least one person, or the signature of another responsible person present in the participant’s home or licensed Residential Care Facility I or II at the time of service. A responsible person may include the personal care aide’s supervisor, if the supervisor is present in the home at the time of service delivery. The personal care aide may only sign on behalf of the participant when the participant is unable to sign and there is no other responsible person present. The entire signature of the participant or witness to the mark or the responsible party must be present in the record for each date of service billed to MO HealthNet. Initials are not acceptable in lieu of the entire signature. The participant’s DCN is not required on the time sheet.
The regulation and the manual do not establish a hierarchy of preferences regarding the signature. As long as the signature of the recipient (in its entirety; initials are not permitted), the witnessed mark of the recipient (the witness’s entire signature must be present; initials of the witness are not permitted) or the signature (in its entirety; initials are not permitted) of another responsible person present in the recipient’s home or RCF I or II at the time of the service (“responsible person” may include the personal care aide’s supervisor, if the supervisor is present in the home at the time of service delivery) is present for each date of service, then the above- requirements will be fulfilled. However, the personal care aide may only sign on behalf of the participant when the participant is unable to sign and there is no other responsible person present (the reason for the participant’s inability to sign must be documented.
The same standards apply if a recipient has made a blanket signature statement, such as, “the requirement is too burdensome and I therefore authorize the provider’s staff to sign on my behalf.” If the recipient has chosen to do this, the entire signature of the other responsible person must still be present for each date of service. The personal care aide still may only sign when there is no other responsible person present, and in such case, the recipient must be unable to sign. Documentation must be provided to support the reason the recipient was unable to sign.
In a Residential Care Facility setting, note that all tasks performed for each recipient by date of services and by staff shifts during each twenty-four (24)-hour period must be documented. For example, if three (3) aides provide services to one recipient in a twenty-four (24)-hour period, each aide must document all tasks performed by each recipient by date of services, but the recipient need only sign (in accordance with the above-guidance) once in the applicable (24)- hour period.