Section R9-28-508. Self-directed Attendant Care (SDAC)

A.      For purposes of this Article the following terms are defined: “Competent member” means a person who is oriented, exhibits evidence of logical thought, and can provide directions.

“Fiscal and Employer Agent” or “FEA” is a company specified by the program contractor or the Administration in contract to serve as an employment/payroll processing center for attendant care workers employed by the mem- ber to provide SDAC services.

“Medically stable” means the member’s skilled-care medical needs are routine and not subject to frequent change because of health issues.

“Personal care” means activities of daily life such as dressing, bathing, eating and mobility.

B.       In lieu of receiving other attendant care services a competent member who meets the requirements of A.R.S. § 36-2951 or the member’s legal guardian may choose to employ through the FEA a person to provide Self-directed Attendant Care

(SDAC) services. A paid caregiver described under R9-28-506 and a parent of a minor child shall not receive reimbursement for SDAC services.

C.      The attendant care worker chosen to provide SDAC services does not need to be a registered provider. The attendant care worker shall have, at a minimum, hands-on training in First Aid, CPR, Universal Precautions, and state and federal laws regarding privacy of health information or training of similar efficacy as approved by the Administration.

D.      The Administration or Program Contractor shall cover SDAC services only if the member resides in the member’s home, and shall not cover SDAC services if the member is institutional- ized or residing in an alternative residential setting. If the member has a legal guardian, the legal guardian shall be pres- ent when SDAC services are provided.

E.       A member who chooses to receive SDAC services is not pre- cluded from receiving medically necessary, cost-effective home health services from other agencies or providers if the services provided are not duplicative of the specific attendant care or skilled service already received through the program contractor.

F.       A competent member or legal guardian may employ an SDAC attendant care worker to provide personal care, homemaker and general supervision services.

G.      A competent member, who is medically stable, or the mem- ber’s legal guardian may employ an attendant care worker to also provide the following skilled services:

1.        Bowel care, including suppositories, enemas, manual evacuation, and digital stimulation;

2.        Bladder catheterizations (non-indwelling) that do not require a sterile procedure;

3.        Wound care (non-sterile);

4.        Glucose monitoring;

5.        Glucagon as directed by the health care provider;

6.        Insulin by subcutaneous injection only if the member is not able to self-inject;

7.        Permanent gastrostomy tube feeding; and

8.        Additional services requested in writing with the approval of the Director and the Arizona State Board of Nursing.

H.      The Administration or program contractor shall not cover ser- vices under subsection (G) unless:

1.        For each SDAC attendant care worker employed by a member or legal guardian, a registered nurse licensed under A.R.S. Title 32, Chapter 15 visits the member and SDAC attendant care worker before a skilled service is provided. The registered nurse will assess, educate, and train the member and SDAC attendant care worker regarding the specific skilled service that the member requires; and

2.        The registered nurse determines in writing that the atten- dant care worker understands how and demonstrates the skill to perform the processes or procedures required to provide the specific skilled service.

Historical Note

Adopted effective October 1, 1988, filed September 1,

1988 (Supp. 88-3). Amended effective April 25, 1990

(Supp. 90-2). Amended effective December 8, 1997 (Supp. 97-4). Section repealed by final rulemaking at 6

A.A.R. 896, effective February 8, 2000 (Supp. 00-1). New Section made by final rulemaking at 16 A.A.R.

2386, effective January 16, 2011 (Supp. 10-4). Amended by final rulemaking at 18 A.A.R. 2344, effective Novem- ber 11, 2012 (Supp. 12-3).