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Personal Care Assistance

Reassessment for PCA services

Page posted: 03/22/10

Page reviewed:

Page updated: 10/17/12

Legal Authority

Minn. Stat. §256B.0659, subd. 3a

Definition

Reassessment: An assessment for PCA services completed before the end of a person’s current service agreement on an annual basis.
Late reassessment
: An assessment that has not been completed and entered into MMIS before the end of the person’s current service agreement end date.

Policy

Reassessment
Complete the reassessment as a face-to-face assessment or service update. Enter the reassessment into MMIS before the end of the current service agreement to prevent a gap in service.
Reassessments are subject to the 10-day notice of reduction or termination.

Penalty
Late reassessments are assessed a 25% penalty of the total rate of reimbursement to the county for the assessment. If either or both of the following dates are seven days past the end of the service agreement, the penalty is assessed:

  • • Date the assessment is entered into MMIS and
  • • Julian date as noted in MMIS when the county enters the data
  • Reconsideration of late assessment penalty
    The county may request a reconsideration of the penalty.

    Criteria for Penalty Reconsideration

    There are many reasons that prevent a county from providing a timely reassessment.

    To request a reconsideration, one or more of the following criteria must be in place:

  • • County scheduled the visits, however the recipient was not available at the scheduled time (documentation of at least two scheduled visits)
  • • DHS action on service agreement that prevented the assessment from occurring timely
  • • Recipient experienced a temporary disenrollment from a health plan
  • • Recipient moved from another county during the service agreement year
  • • Recipient’s Medical Assistance eligibility lapsed
  • • Assessment conducted within 30 days of the provider referral
  • Lead Agency Responsibilities

    The lead agency is responsible to:

    1. Enter assessment data into MMIS following current policy and instructions
    2. Resolve edits that can be solved by the lead agency
    3. Transmit to DHS

    When the assessor is unable to complete a timely PCA reassessment, use the following process to request reconsideration:

    1. Enter assessment data into MMIS
    2. Add comment(s) to the comments screen identifying need for reconsideration and reason(s)
    3. Route the Service Agreement to the 580 queue

    Request repayment of an assessed penalty
    Process under construction while the MMIS system change is completed.

    PCA Provider Agency Responsibilities

    The PCA provider is responsible to notify the lead agency of the need to reassess PCA services. Providers risk a gap in ability to submit claims if the referral is not submitted to the county in a timely manner.

    1. Complete the Referral for PCA Services (DHS-3244P) (PDF).
    2. Fax the completed referral 60 days before the end of the service agreement.

    DHS Responsibilities

    Reassessments with edits
    DHS is responsible to:

    1. Review all reassessments routed to the 580 queue
    2. Determine action steps for authorization

    Reassessments with requests for reconsideration
    1. DHS is responsible to review all requests for reconsideration for late reassessments
    2. DHS will retro-date the new service agreement if it meets the following criteria:

  • • Recipient does not have a gap in Medical Assistance eligibility during the identified date span
  • • Reconsideration criteria is substantiated
  • • Is compliant with current law and policy
  • Additional Information

    Referral for PCA reassessment

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    © 2017 Minnesota Department of Human Services Updated: 9/12/13 2:25 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 9/12/13 2:25 PM