Paraprofessional vs. PCA (Personal Care Assistant) Identification
On IEP under “Child Specific Paraprofessional”:
· Paraprofessional personnel refer to “academic” assistance
· PCA personnel refer to “medical” assistance
· If a paraprofessional is providing both academic and medical assistance, for MA billing purposes, they should be referred to as a PCA only.
· IEP must delineate between paraprofessional service time and PCA time – this can be calculated by using the “Mini Time Study” which is conducted for 10 consecutive school days. We are billing the “average” PCA time for each activity of daily living (ADL) and Level 1 behavioral monitoring, redirection, and intervention, Level 2 behaviors and other health related services.
· After the “Mini Time Study” is completed you can calculate the total average amount of minutes per day each service requires.
· Delineate between paraprofessional and PCA time by the following categories:
1. Academic
2. Behavior
3. ADLs
4. Other health related services
· If you have a full-time PCA with a student who requires all-day intervention and redirection for Level 1 Behaviors, you may include this statement: “The presence of a PCA is required to ensure safety of self, others or property, which is considered invention in itself.”
· Make sure the IEP justifies the need for the PCA services for MA billing. Include:
1. Identification of medical diagnosis or condition related to the need for PCA services and,
2. Description of the student’s condition and/or ability to function, and
3. Description of PCA assistance that will be provided to the student, and
4. Clarification as to why these services are necessary for the student to benefit from their special instruction, and the outcome of the PCA services provided.
5. Frequency and average duration per day (based on the Mini Time Study).
If you find this time is going to fluctuate dramatically over a period of time, you may just include this statement “See Mini Time Study” for frequency and duration.
Feb 2013