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Personal Care Assistance

Assessment for PCA services

Page posted: 1/7/10

Page reviewed: 4/21/17

Page updated: 4/21/17

Legal authority

Minn. Stat. §256B.0659, subd. 3(a) and 4

Definition

Assessment for PCA services: A review and evaluation of a person’s need for PCA services.

Please Note: For information about assessments for PCA service completed using MnCHOICES, refer to the MnCHOICES webpage.

Process

During an assessment for PCA services, the assessment process includes the following:

Documenting the health status of a person

  • · Determine the need for services
  • · Identify appropriate services
  • · Evaluate the effectiveness of services
  • · Provide information about PCA service options (See Traditional PCA or PCA Choice (PDF))
  • Authorizing PCA services

  • · Recommend referrals to appropriate payers and community resources.
  • If a person cannot direct his or her own care, the responsible party must be present for the assessment.

    The assessment for PCA services is valid for 12 months.

    State Plan, Consumer Support Grant (CSG) or DD Waiver

    County public health nurses (PHNs) or PHNs under contract with the county, Managed Care Organization (MCO) or tribe complete PCA assessments and use the PCA Assessment and Service Plan (DHS 3244) (PDF)

    BI, CAC, CADI or EW waiver, or Alternative Care

    Lead agency assessors complete PCA assessments and use the Supplemental PCA Assessment and Service Plan (DHS-3428D) (PDF)

    Managed care health plans

    MCOs establish their own procedures for completing assessments and obtaining authorizations with one exception: Special Needs Basic Care (SNBC). For SNBC enrollees, follow the assessment process described on this page.

    Assessment types

    Face-to-face

    The county of residence, MCO or tribe completes a face-to-face PCA assessment when:

  • · A person requests PCA services for the first time
  • · Annually, unless it is being substituted with a service update
  • · The person’s condition changes, resulting in increased need for PCA services longer than 45 days
  • · The person uses the PCA Choice option or Consumer Support Grant (CSG)
  • The assessor completes in-person assessments in one of the following settings:

  • · A person’s residence
  • · Where services will be provided
  • · An institution (when planning the person’s discharge to a home or community-based setting).
  • Phone

    An assessor in the county of residence completes a PCA assessment by phone when the person needs a:

  • · Temporary increase to an existing service agreement for up to 45 days
  • · Temporary start of service for up to 45 days
  • · Service update.
  • Temporary increase to an existing service agreement – up to 45 days

    For more information, see the PCA Program Manual page titled, 45-day temporary increase of PCA services.

    Temporary start of service – up to 45 days

    For more information, see the PCA Program Manual page titled, 45-day temporary start of PCA services.

    Service update

    An assessor completes a service update by phone with the person or his or her responsible party when:

  • · No change is needed in the authorized number of PCA units
  • · The person has not had a significant change in condition
  • · The person is not using PCA Choice or Consumer Support Grant (CSG).
  • Use the PCA Assessment and Service Plan (DHS 3244) (PDF) to document the service update as indicated below:

  • · On page 1, check “same” under Service Update
  • · Enter assessment information into MMIS to generate the new service agreement
  • · On page 11, in section 4, titled Overall Results Since Last Assessment, be sure to check:
  • o Units/hours: same
  • o Phone service update
  • Timelines

    For both face-to-face and service update assessments, the assessor must send the PCA Assessment and Service Plan (DHS 3244) (PDF) to the person and chosen service provider within 10 business days of the assessment.

    Face-to-face assessments

    A face-to-face assessment occurs:

  • · Within 30 days of an initial request for services
  • · Within 60 days before the end date of the current service agreement for reassessments
  • · Annually for people who receive PCA Choice or CSG
  • · When the person has a significant change in condition
  • Service update assessment

    Assessors may use a service update assessment annually for two consecutive years in place of a face-to-face assessment. After two consecutive years of service update assessments, DHS requires a face-to-face assessment.

    Assessor responsibilities

    State plan, Waiver and Alternative Care

    Using appropriate methods and forms, policies and instructions, the assessor is responsible to:

  • · Arrange for and complete the assessment for PCA services
  • · Authorize MMIS waiver or state plan service agreement or resolve edits before routing state plan service agreements to DHS
  • · Provide required documentation to appropriate entities for service provision.
  • Managed care health plans

    The assessor must follow health plan policy and process for assessment, authorization and communication of assessment information.

    DHS responsibilities

    The DSD Resource Center is a help desk that provides technical assistance to lead agencies and providers about screening documents and service agreements.in the Medicaid Management Information System (MMIS).

    State plan non-waiver service agreements authorizing PCA services (also known as Type B):

    DHS is responsible for:

  • · Reviewing assessments routed to DHS
  • · Determining action steps for authorization
  • Additional information

    Referral for PCA Assessment and Reassessment

    DSD MMIS Reference Guide

    County and Tribal Information Directory (DHS-0005) (PDF)

    45-day temporary increase of PCA services

    45-day temporary start of PCA service

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    © 2017 Minnesota Department of Human Services Updated: 4/21/17 10:38 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 4/21/17 10:38 AM