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Personal Care Assistance

Communication to physician of PCA services

Page posted: 06/21/10

Page reviewed: 05/23/17

Page updated: 05/23/17

Legal authority

Minn. Stat. §256B.0659, subd. 8


As part of the PCA assessment process, lead agencies (counties, tribes or health plans) send a communication of assessed needs to the recipient’s physician after the initial PCA assessment or reassessment using Communication to Physician of Personal Care Assistance Services (DHS-4690-ENG) (PDF).

DHS does not require providers to obtain documentation of the physician order as the PCA assessment process determines medical necessity. DHS no longer requires the Physician Statement of Need (PSON).

DHS does not require the physician communication form for:

  • • 45-day temporary increases to an existing service agreement
  • • 45-day temporary starts of service
  • • Service updates if there is no change with health condition or assessed needs.

    The physician communication form is required for an assessment or reassessment for services that continue after a temporary start or increase of PCA services.

    Lead agency responsibilities

    Lead agencies are responsible to:

    1. Conduct the PCA assessment within the required timeframe. For more information, see the Assessment for PCA services page.
    2. Obtain the physician name and mailing information to include on the assessment form.
    3. Complete the Communication to Physician of Personal Care Assistance Services (DHS-4690) (PDF) form based on the information on the PCA assessment form.
    5. Keep a copy on file for the agency record.
    6. Mail or fax the communication form to the physician.

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