PERSONAL CARE SERVICES (PCS)

Personal Care Services are availible through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)-Comprehensive Care Program, which in Texas is known as the Texas Health Steps-Comprehensive Care Program. Personal Care Services may be provided to individuals that are under 21 years of age and eligible for EPSDT. Personal Care Services are medically necessary when a beneficiary requires assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), or health related functions because of a physical, cognitive, or behavioral limitation that is related to the beneficiary's disability or chronic health condition.

Personal Care Services are support services provided to an EPSDT beneficiary who requires assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related functions due to physical, cognitive, or behavioral limitations related to his or her disability or chronic health condition.

Personal Care Services may include:
  • ADLs that include, but are not limited to, eating, toileting, grooming, dressing, bathing, transferring, maintaining continence, positioning, and mobility.
  • IADLs that include, but are not limited to, personal hygiene, meal preparation, grocery shopping, light housework, laundry, communication, transportation, and money management.
  • Health-related functions that include, but are not limited to, medication management, range of motion, exercise, skin care, use of durable medical equipment, reporting the beneficiary's condition, including changes to the beneficiary's condition or needs, and completing appropriate records.
  • Nurse-delegated tasks, including health maintenance activities, as permitted by the Texas Nursing Practice Act and its implementing regulations; and
  • Hands-on assistance, cuing, redirecting, or intervening, to accomplish the task.

Prior to authorizing Personal Care Services, HHSC or its designee will require completion of:
  • An assessment of the beneficiary with an HHSC-approved assessment form; and
  • Any other documentation required by HHSC to complete the authorization process.

An HHSC-approved written statement of need by the beneficiary's physician or usual source of care (i.e., a practitioner with ongoing clinical knowledge of, and a therapeutic relationship with, the beneficiary) must be on file with HHSC or its designee within 60 days of the initial start of care.

In evaluating the request for Personal Care Services, HHSC or its designee will determine the amount and duration of Personal Care Services by taking into account the following:
  • Whether the beneficiary has a physical, cognitive, or behavioral limitation related to a disability or chronic health condition that inhibits the beneficiary's ability to accomplish ADLs, IADLs, or related health functions;
  • The parent/guardian's need to sleep, work, attend school, and meet their own medical needs;
  • The parent/guardian's legal obligation to care for, support, and meet the medical, educational, and psycho-social needs of their other dependents;
  • The parent/guardian's physical ability to perform the Personal Care Services; and
  • Whether or not the need to assist the family in performing Personal Care Services on behalf of the client is related to a medical, cognitive, or behavioral condition that results in a level of functional ability that is below that expected of a typically developing child of the same chronological age.

HHSC will not arbitrarily deny authorization of Personal Care Services or reduce the number of requested hours of services based solely on the client's diagnosis, type of illness, or condition.

A beneficiary may receive Personal Care Services through the Consumer Directed Services (CDS) option.
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Personal Care Services limitations include the following:
  • HHSC will not reimburse for Personal Care Services used for or intended to provide:
       1. Respite care
       2. Child care
  • Personal Care Services shall neither replace parents or guardians as the primary care giver, nor provide all the care a beneficiary requires to live at home. Primary care givers remain responsible for a substantial portion of a beneficiary's daily care, and Personal Care Services are intended to support the care of the beneficiary living at home.

Authorization for Personal Care Services will be terminated by HHSC or its designee when:
  • The beneficiary is no longer eligible for Texas Medicaid;
  • The beneficiary no longer meets the medical necessity criteria for Personal Care Services;
  • The place of service(s) can no longer meet the beneficiary's health and safety needs;
  • The provider requests termination due to the beneficiary's lack of compliance with the service plan; or
  • The authorization for Personal Care Services expires.

A beneficiary may request a fair hearing in the event that Personal Care Services are denied, reduced, suspended, or terminated.​
For more information and to see if you qualify, please call 
​972-681-8420.
Also, learn about the CDS Option available for CAS clients.