waiver screener

The ISO acts as employer of record for PCAs — handles payroll, tax withholding, workers’ comp, and compliance. Conducts initial enrollment visits. Verifies care delivery before billing Medicaid. Under SB 511 (2023), must ensure direct care workers receive minimum $16/hour from the $25/hour Medicaid rate.

MSM Chapter 2600 · FA-24C · PT-83 Enrollment Checklist (Jan 2024) · SB 511 (2023)

The consumer or PCR selects, schedules, trains, supervises, and if necessary dismisses their own PCA. Develops the care and backup plan with ISO support. Especially valuable for children with autism — families can structure care around the child’s behavioral patterns rather than agency scheduling.

MSM Chapter 2600 · Nevada Medicaid PCA Program Overview

Under NRS 629.091, a licensed healthcare provider can authorize an unlicensed PCA to perform specific skilled tasks. Requires: (1) physician order, (2) Form FA-24C faxed to QIO-like vendor at (855) 709-6846, (3) separate prior authorization, (4) PCR must be present when delivered. Renewed annually. Not available under PT-30.

PT-30/83 Billing Guide — T1019 TF · Form FA-24C · NRS 629.091 · MSM Chapter 2600

The PCR who directs services cannot be reimbursed for acting as PCR or for personally providing any PCS or skilled services. Violation constitutes fraud under NRS 422.540 and is referred to the SUR Unit. Applies even if the PCR is not an LRI.

Form FA-24C — PCR Acknowledgment · NRS 422.540 · MSM Chapter 2600

Must hold a Personal Care Attendant Agency license from DPBH with ISO endorsement. Required documents: DPBH ISO certification, TIN documentation, Business Associate Addendum (NMH-3820), Advance Directives Compliance form, General Liability Insurance ($2M aggregate/$1M per occurrence, DHCFP as additional insured), Business Auto Insurance ($750K minimum). MSM Chapters to read and attest: 100, 3300, and 2600.

PT-83 Enrollment Checklist (Jan 2024) · MSM Chapter 100

Governs PT-30. Establishes covered ADL/IADL services, non-covered services (supervision, companion care, social visitation), provider qualifications, and prior authorization requirements. Compiled under NRS 422.2368 and 422.2369.

MSM Chapter 3500 (DHCFP, Nov 2024)

Governs PT-83. Same covered services as Ch. 3500 plus T1019 TF skilled services pathway under NRS 629.091. Consumer/PCR controls hiring and care direction. ISO is employer of record and fiscal manager.

MSM Chapter 2600 (DHCFP) · NRS 629.091

EPSDT requires coverage of services to “correct or ameliorate” physical and mental conditions even beyond the State Plan. Legal basis for the FA-24 medical necessity override — allows task time maximums to be exceeded when medically necessary for children under 21.

MSM Chapter 1500 · 42 CFR § 441.56 · SSA § 1905(r)(3)

MSM Chapters 3500 and 2600 both prohibit LRIs (parents, legal guardians, spouses) from being reimbursed without Form FA-24B documenting unavailability (employer verification) or incapability (physician certification). Without FA-24B on file when an LRI lives in the home, authorization is denied and paid claims are subject to recoupment under MSM Chapter 3300. Exception: Physical Disabilities 1915(c) Waiver allows LRI parent payment for specific attendant care tasks when approved by the ADSD case manager in the Plan of Care.

MSM Ch. 3500 §3503 · MSM Ch. 2600 · Form FA-24B · HCBS PD Waiver — adsd.nv.gov

Initial services require Form FA-24 completed by a PT or OT specifically certified with Nevada Medicaid for PCS assessments. General licensure is not sufficient. Contact DHCFP at (775) 684-3759 for certified assessor information.

PT-30/83 Billing Guide · MSM Chapter 3500

FA-24 scores each task on a 0–3 independence scale generating maximum daily time per task. ADLs: bathing/grooming/dressing (combined, up to 60 min/day), toileting, transferring, mobility, eating. IADLs: light housekeeping, laundry, essential shopping, meal prep. Total authorized units = sum of all task times per week.

FA-24 Functional Assessment Instructions (NMO-7073)

The PT/OT can exceed standard task time maximums by invoking the EPSDT override field. Must name the task, state standard time, state actual required time, and explain the specific medical reason. Example: “Bathing requires 75 min — 30 min ADL care + 45 min behavioral support necessary to complete the task.”

FA-24 Instructions (NMO-7073) · MSM Chapter 1500

Missing FA-24B causes the entire FA-24 to be returned and denied. One FA-24B per LRI in the household. Requires employer proof of work schedule OR physician certification of incapability.

FA-24 Form (Section 4) · Form FA-24B · MSM Chapter 3500

Completed FA-24 faxed to QIO-like vendor at (855) 709-6846. Vendor faxes Authorization Notice and service plan to provider. Services cannot begin until authorization is received. Auth number required on every claim. FA-24C for PT-83 skilled services is a separate submission.

PT-30/83 Billing Guide · MSM Chapter 3500 · Form FA-24C

The FA-24 override field is a designed program feature. Brief the PT/OT before the evaluation — the override must appear in the original assessment, not added afterward. For a child with autism, nearly every ADL task may legitimately require more time than the standard maximum.

FA-24 Instructions (NMO-7073) · MSM Chapter 1500 · 42 CFR § 441.56

Time managing behavioral challenges that prevent ADL task completion is part of the ADL task time — not separate supervision time. Document: “Child requires 45 min total for bathing — 15 min ADL care, 30 min behavioral de-escalation necessary to complete the task.”

MSM Chapter 3500 §3503 · FA-24 Instructions

Every covered task requiring any assistance should be scored. Missing tasks on the FA-24 directly reduces authorized hours with no appeal path. Before the assessment, provide the PT/OT a written list of every task requiring any assistance, with realistic time estimates.

PT-30/83 Billing Guide · FA-24 Instructions (NMO-7073)

Under PT-83, the family chooses who provides care and when. A qualifying relative (not an LRI) can be hired as the PCA through the ISO. Authorized hours and codes are identical to PT-30 — only the delivery model changes.

MSM Chapter 2600 · NRS 629.091 · PT-30/83 Billing Guide

A physician can authorize a family-hired unlicensed PCA to perform specific skilled tasks — medication administration, specialized feeding, etc. Requires physician order and FA-24C prior authorization. Available through PT-83 only.

PT-30/83 Billing Guide — T1019 TF · Form FA-24C · NRS 629.091

Under 42 CFR § 431.205, any denial must cite the specific MSM provision used. If it doesn’t cite a specific section, or cites one that doesn’t prohibit the service, that is grounds for reversal at a Medicaid Fair Hearing under 42 CFR § 431.200.

42 CFR § 431.200–431.250 · MSM Chapter 100 · MSM Chapter 3300

MSM Chapter 3500 explicitly excludes companion care (baby-sitting, supervision, social visitation). Pure behavioral supervision without simultaneously performing an ADL task cannot be billed under PT-30 or PT-83. Children needing both ADL assistance AND behavioral supervision may need PT-30/83 for ADLs and the IDD Waiver (PT-38, MSM 2100) for supervision — non-duplicative when documented correctly.

MSM Chapter 3500 §3503.1.B.2 · MSM Chapter 2100 (IDD Waiver)

A parent or legal guardian cannot be paid as a PCA under PT-30 or PT-83 without Form FA-24B on file. Claims paid without FA-24B are subject to recoupment under MSM Chapter 3300. Under PT-83, the PCR also cannot be reimbursed for directing or providing care even if not an LRI.

MSM Ch. 3500 · MSM Ch. 2600 · Form FA-24B · FA-24C (PCR acknowledgment)

Services requiring a licensed professional are excluded from PT-30 standard coverage. Skilled services can only be self-directed under the PT-83 T1019 TF pathway with a physician order and FA-24C prior authorization.

MSM Chapter 3500 · PT-30/83 Billing Guide — T1019 TF · NRS 629.091

Chronological log of each ADL task: task name, start/end time, assistance level, and behavioral events extending task time. The single most effective document for generating EPSDT override approvals.

FA-24 Instructions (NMO-7073)

Current autism diagnosis, co-occurring diagnoses with ADL impact, physician letter stating which tasks need more time than standard maximums with estimated times and specific medical reasons.

MSM Chapter 1500 · FA-24 Instructions

Required whenever the child lives with an LRI. Must document work schedule (employer verification) or incapability (physician certification). Missing FA-24B causes the entire FA-24 to be returned and denied. One FA-24B per LRI.

Form FA-24B (Nevada Medicaid) · MSM Chapter 3500

Required for T1019 TF under PT-83. Requires physician order specifying exact tasks being delegated. Fax to QIO-like vendor at (855) 709-6846 separately from FA-24. Must be renewed annually.

Form FA-24C (Nevada Medicaid) · PT-30/83 Billing Guide · NRS 629.091

Current IEP documenting ADL assistance during school hours, 1:1 aide assignment, and school nurse records. Establishes that support needs are recognized across settings — strengthens FA-24 EPSDT override documentation.

MSM Chapter 1500 · 42 CFR § 441.56