Document name
Allowance – Personal Care
Document number
PRO 10/2014

Effective date: August 1, 2014

Last updated: June 25, 2014

Application: All claims on and after the effective date.

Policy subject: Allowance and expenses

Purpose:

To establish administrative guidelines for determining and providing personal care allowances (PCA).

BACKGROUND

Policy section content
Section detail

The WCB has approved POL 10/2014, Allowance – Personal Care, which establishes personal care allowances (PCA).

PROCEDURE

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Section detail

General

  1. When it becomes apparent that the worker needs personal care, the Case Manager (CM) will refer the worker to the Vocational Rehabilitation Specialist (VRS) for a personal care assessment. The CM will:
    1. Tell the VRS if the worker is to be assessed for a temporary or permanent PCA, and
    2. Give the VRS any relevant medical information.
  2. The VRS will recommend the:
    1. Level of PCA.
    2. Recipient of PCA.
    3. Duration of PCA, and
    4. Effective date of PCA.

    The VRS will use the criteria noted in the appendix to determine the level of PCA. If the VRS is uncertain about the level or duration of PCA needs, the VRS can get help from the Medical Officer.

  1. The VRS will confirm all decisions about PCA in writing.
  2. PCA will not provide payment for services associated with the following allowances:
    1. POL 15/2008, Allowance – Temporary Additional Expense, and
    2. POL 31/2016, Allowance – Independence.

Temporary Need for Personal Care

  1. The VRS will base the temporary care assessment on:
    1. The medical information on file.
    2. An in-person visit with the worker (when possible), and
    3. Other inquiries that may be necessary (e.g., the worker’s doctor, family members, Medical Officer).
  2. The VRS will review the amount of PCA the WCB pays based on medical reports confirming the worker’s progress and recovery.

Permanent Need for Personal Care

  1. If the worker needs permanent care, the VRS will ask a homecare agency in the worker’s local health region to assess the worker’s needs. If a local agency cannot assess the worker’s needs, the VRS will ask an agency from another health region to do the assessment. The WCB will pay for the assessor’s travel and meals (PRO 01/2019, Travel Expense Rates).
  2. The VRS will give the agency any medical information it needs to do the assessment (e.g., extent of the worker’s injury, other conditions that may affect personal care needs).
  3. Agencies will use the tool that is approved by the Saskatchewan Ministry of Health for doing assessments (currently MDS-Home Care).
  4. In addition to the assessment, the VRS may make more inquiries about the worker’s personal care needs when necessary (e.g., the worker’s doctor, family members, Medical Officer).
  5. The VRS will review the amount of PCA the WCB pays based on medical reports confirming the worker’s progress and recovery. If the worker’s recovery plateaus, the VRS will review the PCA (e.g., level, eligibility) at the end of December each year.

Payment for Personal Care

  1. The WCB will pay PCA on a monthly basis to the:
    1. Individual or agency providing care, or
    2. Worker (i.e., if there are multiple care providers).
  2. Homecare agencies will direct bill the WCB.
  3. The VRS will review bills and authorize payments. The WCB will only pay for reasonable costs. If the VRS pays less than the amount billed, the VRS will give a written explanation.
  4. If the worker does not need certified nursing care, the WCB will pay PCA in accordance with PRO 15/2020, CPI – Annual Increase.
  5. There can be cases where the worker’s care need is serious or unique enough that additional special care costs may be considered. PCA above level IV will require approval by a Team Leader.

Provisions for Individuals Providing Personal Care

  1. If the worker gets care from a person (not a business) that becomes unavailable, the VRS will suspend PCA if worker does not get care for more than 30 consecutive days.
  2. Individuals providing care may take up to 30 days of vacation per year without an interruption to their PCA. The VRS may suspend PCA if the person is away for more than 30 days.
  3. The VRS will pay someone else to provide care while the individual is away.

Attachments

Attachments

Policy references

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