C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 440—SERVICES: GENERAL PROVISIONS › Subpart A—Definitions

42 C.F.R. § 440.167

Personal care services

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Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G of this chapter—

(a) Personal care services means services furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or institution for mental disease that are—

(1) Authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized for the individual in accordance with a service plan approved by the State;

(2) Provided by an individual who is qualified to provide such services and who is not a member of the individual's family; and

(3) Furnished in a home, and at the State's option, in another location.

(b) For purposes of this section, family member means a legally responsible relative.

[42 FR 47902, Sept. 11, 1997]
Notes of Decisions
Cited in 20 cases (6 in the last 5 years), 1999–2025 · leading case: M.R. v. Dreyfus, 697 F.3d 706 (9th Cir. 2011).
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M.R. v. Dreyfus, 697 F.3d 706 (9th Cir. 2011). · cites it 2× “§ 1396d(a)(24); see also 42 C.F.R. § 440.167 (b) (clarify- ing that a family member is “a legally responsible relative”); CTRS.”
Tran v. State, 303 Neb. 1 (Neb. 2019). “See, 42 C.F.R. 440.167(a)(3) (2018) ; 471 Neb.”
M.R. v. Dreyfus, 663 F.3d 1100 (9th Cir. 2011). · cites it 2× “§ 1396d(a)(24); see also 42 C.F.R. § 440.167 (b) (clarifying that a family member is “a legally responsible relative”); CTRS.”
United States Ex Rel. Feldman v. City of New York, 808 F. Supp. 2d 641 (S.D.N.Y. 2011). “4, § 4480; see also 42 CFR § 440.167 ; DOH Reg. § 505.14(a)(1) (defining PCS as “assistance with personal hygiene, dressing and feeding; and nutritional and environmental support functions”).”
Kuppersmith v. Dowling, 710 N.E.2d 660 (NY 1999). “According to Federal regulations, “personal care services” are (1) authorized by a physician in accordance with the recipient’s plan of treatment; (2) provided by an individual who is qualified to provide the services and not a member of the recipient’s family; and (3) furnished…”
Strouchler v. Shah, 891 F. Supp. 2d 504 (S.D.N.Y. 2012). “See 42 C.F.R. § 440.167 ; 18 N.Y.C.R.R. § 505.”
Jensen v. Missouri Dep't of Health & Senior Servs., 186 S.W.3d 857 (Mo. Ct. App. 2006). · cites it 2× “167 of the Code of Federal Regulations, 42 C.F.R. § 440.167 (a)(1) *860 (1997); and the State Medicaid Manual, Centers for Medicare & Medicaid Services, U.”
Carter v. Gregoire, 672 F. Supp. 2d 1146 (W.D. Wash. 2009). · cites it 2× “” 42 C.F.R. § 440.167 (b). In promulgating this definition, CMS observed that it was consistent with Congress’s clear intent “to preclude family members from providing personal care services,” and that the agency has always maintained that spouses and parents are inherently…”
Calenzo v. Shah, 112 A.D.3d 709 (N.Y. App. Div. 2013). “The DOH argues that interpreting the subject regulation so as not to include stepparents in the list of family members ineligible to serve as PAs renders the regulation partially inconsistent with federal statute and regulation (see 42 USC § 1396d [a] [24]; 42 CFR 440.167 [b]).…”
State v. McWilliams, 283 P.3d 187 (Kan. 2012). · cites it 3× “) 42 C.F.R. § 440.167 (a); accord 42 U.S.C.”
Indiana Prot. & Advocacy Servs. Comm'n v. Indiana Fam. & Soc. Servs. Admin. (7th Cir. 2025). · cites it 4× “§ 1396d(a)(24) and 42 C.F.R. § 440.167 , both of which define “personal care ser- vices,” the category of services to which attendant care and structured family caregiving belong.”
Indiana Prot. & Advocacy Servs. Comm'n v. Indiana Fam. & Soc. Servs. Admin. (7th Cir. 2025). · cites it 4× “§ 1396d(a)(24) and 42 C.F.R. § 440.167 , both of which define “personal care ser- vices,” the category of services to which attendant care and structured family caregiving belong.”
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— 42 C.F.R. § 440.167(a)(3) — 3 cases
Tran v. State, 303 Neb. 1 (Neb. 2019). “See, 42 C.F.R. 440.167(a)(3) (2018) ; 471 Neb.”
Tran v. State, 303 Neb. 1 (Neb. 2019).
Tran v. State, 303 Neb. 1 (Neb. 2019).
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