Medicaid Waiver Compliance Review - PSW Rates Greater Than $30 - FY17

Personal Support Worker Rates Greater Than $30 - FY17


Personal Support became a Medicaid Home and Community Based Services Waiver program effective July 1, 2002 as a part of consolidation of the former Home Based Support Services program and former Supported Living Services program. The rates for personal support are not set by the State. Rates are negotiated, within an overall monthly allotment, among the individual, family, and provider(s). A higher negotiated rate results in a fewer number of units of service. Personal Support providers may be either individual providers or agency staff.

Basis for Review:

As a part of its ongoing efforts to ensure the financial integrity of the Adult Waiver and to ensure that Personal Support is being used as intended and paid at a reasonable rate, the Medicaid Waiver staff conducted a review of bills of $30.00 or more submitted by the providers in Fiscal Year 17.

Method of Review:

The DHS Division of Developmental Disabilities requested a report from the Department's Management Information Services section of accepted Medicaid adult waiver claims for Personal Support by individual providers paid at a rate of $30.00 or higher. The review revealed 194 paid personal support workers with a rate of $30.00 or more.

For the review, staff contacted community providers and asked the following questions:

Is the Personal Support Worker a relative?

Does the Personal Support Worker reside with the person?

Does the Personal Support worker have special qualifications?

Are there special circumstances justifying higher rate of pay?

Hourly Rate of PSW PSWs in this pay range Caregiver IS a Relative of the Individual Caregiver is NOT a Relative of the Individual Caregiver Resides with the Individual Caregiver does NOT Reside with the Individual Caregiver has *special qualifications Caregiver does NOT have *special qualifications The individual has **special needs The individual does NOT have **special needs
$30.00 to $34.99 72 11 61 9 63 21 51 2 70
$35.00 to $39.99 83 2 81 2 81 19 64 15 68
$40.00 to $44.99 34 8 26 4 30 7 27 3 31
$45.00 to $55.00 5 1 4 0 5 0 5 0 5
Total 194 22 172 15 179 47 147 20 174

*Some of the special qualifications that the personal support worker had were that they were a behavioral therapist, had a special education background, were a Qualified Intellectual Disability Professional (QIDP) or a trained Direct Support Person.

**Some of the special needs of the individuals were as follow: cerebral palsy, hearing issues, bi-polar, seizures, autism, spina bifida, traumatic brain injury, myocardial, fetal alcohol syndrome, Parkinson's, and blood sugar issues.