Abilities, LLC provides Personal Assistant services in accordance with the Missouri DMH DD Waiver Manual, applicable HCBS Settings Rule requirements, and each individual's PCSP. Personal Assistant services support individuals in completing tasks related to daily living that they are unable to do independently due to their disability, enabling fuller participation in their home and community life.
Personal Assistant services include assistive supports for any Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) that the individual is unable to do independently due to their disability. Support may take the form of hands-on assistance (performing a task for or with the individual), cueing (prompting the individual to initiate or complete a task independently), or incidental teaching (building skills while delivering support in natural everyday contexts).
Personal Assistant services may be provided in the individual's own home, family home, or community. They must always be provided in the presence of the individual and may be delivered on an episodic or continuing basis as determined by the PCSP.
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Examples of ADLs and IADLs
Personal Assistant services may assist with, but are not limited to:
- Personal hygiene, bathing, grooming, and dressing.
- Mobility and transferring.
- Meal preparation and feeding.
- Medication management (where authorized and trained per 9 CSR 45-3.070).
- Light housekeeping and home tasks.
- Transportation and community access.
- Shopping and errands.
- Managing finances and appointments.
- Communication support.
- Individuals receiving Group Home, ISL, or Shared Living may not receive Personal Assistant as a separate waiver service.
- Personal Assistant must always be provided in the presence of the individual. It may never be delivered remotely.
- Personal Assistant shall not be provided concurrently with, or as a substitute for, facility-based Day Habilitation services.
- Different types of non-residential habilitation services may not be billed during the same period of the day.
- Services are solely for the individual. Personal Assistant may not be used for household tasks that are shared responsibilities of the family unit.
- For minor children, Personal Assistant must not replace supports parents would ordinarily provide, nor duplicate educationally-related services.
- Maximum authorized units: 96 units (24 hours) per day.
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PA services cannot be provided while an individual is sleeping. This service requires active assistance with ADLs and IADLs. If the individual is asleep, there is no service being delivered and time may not be billed. Staff may not sleep during any PA shift. These are active service hours. Sleeping on shift is not permitted under any circumstance.
Personal Assistant services are billed in 15-minute increments using MO HealthNet procedure codes. Both the Community Program Manager and the Finance Director hold access to the billing system.
| Service | Proc. Code | Unit | Maximum |
| Personal Assistant: Individual | T1019 | 15 min | 96 units per day |
| Personal Assistant Medical: Agency | T1019 SC | 15 min | 96 units per day |
| Hospital Supports (POS 21) | T1019 | 15 min | 96 units per day |
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Hospital Supports: PA services delivered in a hospital or inpatient setting are billed with Place of Service code 21. This applies when an individual is admitted to a hospital and the agency continues to provide personal care supports during the admission. Documentation must clearly reflect the hospital setting and the specific ADL or IADL support provided. Hospital Supports require prior authorization and must be reflected in the individual's PCSP.
All Personal Assistant claims must be submitted to MO HealthNet within 365 days of the date of service. Claims submitted after this window will not be paid regardless of the reason for the delay.
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EVV requirements for Personal Assistant
All Personal Assistant service visits are subject to Electronic Visit Verification (EVV) requirements under Section 12006 of the 21st Century CURES Act and Missouri Code of State Regulations 13 CSR 70-3.320. EVV electronically verifies when, where, and by whom Medicaid-funded services are delivered.
- CSPs document PA visits in SetWorks using the EVV link on the home page dashboard.
- Clock in at the actual start of service delivery.
- Clock out at the actual end of service delivery.
- All data entered must reflect actual service delivered. Times must be actual, not estimated or rounded.
- Never share SetWorks login credentials with any other person.
- Never clock in or out on behalf of another employee.
- Report any system error, technical problem, or inability to complete EVV entry to the Community Program Manager immediately.
- If SetWorks is unavailable, notify the Community Program Manager. Do not attempt a manual entry.
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Required EVV data elements
For every Personal Assistant visit, the following six data elements must be accurately documented in SetWorks at the time of service:
- Type of service performed (procedure code and applicable modifiers).
- Identity of the individual receiving services.
- Identity of the CSP providing services, including Family Care Safety Registrant (FCSR) number. The FCSR number is entered into each CSP's SetWorks profile by Human Resources at the time of hire.
- Date of service.
- Service start time.
- Service end time.
The location where services began and ended must also be captured per 13 CSR 70-3.320. SetWorks collects this via GPS or approved location technology at the time of clock-in and clock-out.
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Community Program Manager EVV responsibilities
- Ensure SetWorks is configured to transmit visit data to Sandata/EAS at least once daily.
- Log in to EAS at minimum once weekly to verify that visit data is present, accurate, and in verified status.
- Investigate and resolve any missing, unverified, or flagged visits promptly.
- Confirm all Personal Assistant visits are visible and verified in EAS before submitting corresponding MO HealthNet claims.
- Manual visit entries may only be made by the Community Program Manager or a designated supervisor, never by the CSP who performed the visit.
- Monitor CSP EVV compliance on an ongoing basis and address patterns through coaching and corrective action.
- Report any suspected falsification of EVV data to MMAC within two business days of discovery.
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Claims Validation: As of January 7, 2026, MO HealthNet validates all Personal Assistant claims against EAS visit data before payment. Hard edits are in effect: any Personal Assistant claim submitted without a matching verified visit in EAS will be denied. The Community Program Manager must confirm every visit is visible and verified in EAS before submitting any corresponding claim.
Manual entries are only permitted when EVV is unavailable or when documented circumstances make real-time entry impossible. Only the Community Program Manager or a designated supervisor may create a manual entry. The CSP must notify the Community Program Manager as soon as possible. The entry must include the date and time of the manual entry, the reason, and the name of the person creating it. Repeated manual entries by the same CSP are subject to audit and corrective action.
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Falsification prohibition
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Falsification of EVV data, including knowingly entering inaccurate times, locations, service types, or identity information, or clocking in or out on behalf of another employee, is strictly prohibited under 13 CSR 70-3.320 and constitutes Medicaid fraud. Any suspected falsification must be reported to MMAC within two business days of discovery at MMAC.EVV@dss.mo.gov.
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Service delivery standards
Every Personal Assistant visit must reflect each individual's PCSP goals, preferences, and assessed needs; support the individual's autonomy, dignity, and right to make choices; be delivered in the most integrated, least restrictive setting appropriate; comply with all HCBS Settings Rule requirements; and not duplicate any other authorized service billed concurrently. Where the individual has documented goals, outcomes, or an implementation strategy in their PCSP, every visit must reflect them. Think of every visit as an opportunity to support not just the task at hand, but the whole person.