Missouri manual section 6.24
Personal assistant supports
Official service name: Personal Assistant
Personal Assistant services provide hands-on help, cueing, task completion, and incidental teaching for activities of daily living and instrumental activities of daily living that a person cannot complete because of disability. Support may occur in the person's own or family home and in the community, including the workplace, and may be agency-provided or self-directed.
What the manual describes
What this service can help with
- Hands-on assistance with activities of daily living
- Cueing or completing instrumental activities of daily living that the person cannot do independently
- Participating more fully in home, community, and workplace life
- Learning or maintaining skills through incidental teaching while assistance is provided
- Choosing an agency-based or self-directed service arrangement
- Meeting specialized medical-support needs through Medical Personal Assistant services when the additional requirements are met
Source-backed working pathway
To establish you'll probably need:
These steps translate the cited manual section into a practical review sequence. Confirm the current local process before acting.
Describe the assistance the person needs.
Identify each activity of daily living or instrumental activity of daily living the person cannot complete because of disability, whether hands-on help, cueing, or task completion is needed, where support should occur, and what home or community outcome matters.
Confirm the correct funding route and avoid duplication.
The support coordinator and planning team should review Medicaid state-plan personal care, services for children under age 21, residential supports, day habilitation, and other authorized services. Available state-plan services must be used first, and the waiver service cannot duplicate another service. A person eligible to self-direct through both the Department of Health and Senior Services program and a Division of Developmental Disabilities waiver must choose which program to self-direct and use agency-based support for the other.
Choose agency-based or self-directed delivery.
Decide whether an agency or a self-directed arrangement best fits the person's preferences. For self-direction, identify the individual or designated representative who will hire, train, supervise, and arrange backup for workers through the approved financial-management service.
Identify the worker and any relative-provider conditions.
Confirm that the proposed worker is eligible, that no prohibited relationship or role applies, and that the person agrees with the arrangement. When a relative will be paid, the person-centered service plan must document why that arrangement best meets the person's needs and which hours are authorized, up to the manual's 40-hour-per-week cap.
Determine whether Medical Personal Assistant requirements apply.
If the person needs specialized medical tasks or more intensive medically related support, the team should document that need, obtain physician or advanced-practice-nurse documentation, complete local utilization review before funding approval, and define any licensed-nurse oversight, delegation, training, and competency requirements.
Put the complete service arrangement in the plan and authorize the start.
The person-centered service plan should identify tasks, schedule, locations, group size if any, worker qualifications and training, supervision, backup coverage, electronic visit verification, documentation, and coordination with other programs. Confirm the provider, units, referral, and start procedure before service begins.
Important boundaries
Limits that may affect fit or authorization
- The service must be provided in the person's presence, and Personal Assistant staff must remain awake.
- The planning team must prevent duplication with other services. Personal Assistant services cannot be provided concurrently with or as a substitute for facility-based day habilitation.
- Available Medicaid state-plan personal care, including applicable services for children under age 21, must be used before overlapping waiver Personal Assistant services.
- A person cannot simultaneously self-direct through the Department of Health and Senior Services consumer-directed personal-assistance program and a Division of Developmental Disabilities home- and community-based waiver. If eligible for both, the person must choose which program to self-direct and use an agency-based provider for the other.
- People receiving Group Home, Individualized Supported Living, or Shared Living services cannot also receive Personal Assistant services because personal assistance is included in those residential services.
- For a person living in a residential care facility or assisted living facility, waiver Personal Assistant services cannot duplicate or replace Medicaid state-plan personal care and are limited to assistance while the person is out in the community.
- For a minor child living with a parent or guardian, the service cannot replace ordinary parental support or educational services that are the responsibility of the school system.
- The service is solely for the person and not for household tasks expected to benefit the family or household generally.
- Certain relatives may be paid only when the manual's planning and employment conditions are met. A spouse, parent or stepparent or foster parent of a minor child, guardian, designated representative, or employer of record cannot fill the prohibited roles described by the manual.
- A paid relative may be authorized for no more than 40 hours per week. Support above that amount is treated as unpaid natural support.
- Group delivery to four through six people requires written approval from the Division of Developmental Disabilities regional office director.
- Transportation costs connected with community delivery are included in the service rate rather than billed as a separate Personal Assistant expense.
- The manual's billing table generally lists a maximum of 96 fifteen-minute units per day and limits self-directed team collaboration to 120 hours per person-centered-plan year. Current authorization and billing rules must be confirmed before relying on those amounts.
- Comprehensive and Community Support waivers remain under a temporary renewal extension through December 27, 2026, or until CMS grants final approval. Confirm the currently approved rules with the support coordinator; proposed renewal changes are not automatically active.
Do not assume this part
Questions to confirm locally
- Which specific daily-living tasks require support, and what assistance should the worker provide for each one?
- Which Medicaid state-plan, children's, residential, day, or other services must be used or coordinated first?
- If the person is eligible to self-direct through both Department of Health and Senior Services personal assistance and a Division of Developmental Disabilities waiver, which program will be self-directed and which will use an agency?
- If the person lives in a residential care facility or assisted living facility, is the requested waiver support limited to community assistance outside the facility?
- Would agency-based or self-directed Personal Assistant services best fit the person's preferences and ability to manage workers?
- Is the proposed worker eligible, and do any relative-provider, guardian, designated-representative, or employer-of-record restrictions apply?
- Does the request include specialized medical tasks that require Medical Personal Assistant authorization, documentation, delegation, or nurse oversight?
- Will support occur one-to-one or in a group, and is regional-office written approval needed for the proposed group size?
- What schedule, locations, units, worker training, electronic visit verification, backup coverage, and documentation are currently required?
- How will the waiver plan be coordinated with the Department of Health and Senior Services or children's service authorization when those programs also apply?