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Assessment for PCA services

Page posted: 01/07/10

Page reviewed:

Page updated: 8/12/13

Legal Authority

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

Definition

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

Policy

Assessments for PCA services include the following:

  • Authorize PCA services
  • Determine need for services
  • Document the health status of a person
  • Evaluate effectiveness of services
  • Identify appropriate services
  • Provide information about PCA service options (Traditional vs. PCA Choice sample)
  • Recommend referrals to appropriate payers and community resources
  • If a person cannot direct his/her own care, the responsible party must be present for the assessment.

    An assessment for PCA services is valid for 12 months if the person has not had a significant change in condition whether the person chooses a different provider or enrolls or disenrolls from a managed care plan.

    A county may complete and bill for two face-to-face assessments per year without authorization.

    State Plan, CSG and DD Waiver

    County public health nurses (PHNs) or PHNs under contract with the county:

  • Complete PCA assessments.
  • Use the PCA Assessment and Service Plan (DHS 3244) (PDF)
  • CAC, CADI, EW and BI Waivers and Alternative Care

    Lead agency assessors:

    Managed care health plans

    The appropriate assessors complete the PCA assessments. See PCA assessments for managed care enrollees (PDF).

    Types of PCA Assessments

    Face-to-face

    Assessors in the county of residence complete PCA assessments in person when:

  • A change in condition during the past year resulted in increased PCA services
  • PCA services are requested for the first time
  • Person is using the PCA Choice option or Consumer Support Grant (CSG)
  • Person needs increased services beyond a 45-day temporary increase of services authorization
  • DHS also recommends that face-to-face assessments occur:

  • Annually for children as the age-appropriate dependencies for children change as they grow
  • When there has been a change in responsible party since the last face-to-face assessment
  • Complete face-to-face assessments in either the:

  • Institution when planning the discharge of a person to their place of residence or
  • Place of residence
  • Temporary increase to an existing service agreement up to 45 days

    Assessors in the county of residence assess for a temporary increase in PCA services up to 45 days period. This is for when a person requires an increase in PCA services due to a change in condition. The assessors conduct assessments by telephone using data from the current PCA assessment as a baseline. A face-to-face assessment is required for increases lasting more than 45 days.

    Temporary start of service up to 45 days

    Assessors in the county of residence assess temporary start of services for up to 45 days when PCA services need to begin before assessors can make the face-to-face assessment. The assessor collects information about the need for services by telephone with the provider, person who receives services or other health care providers.

    Service update

    Assessors in the county of residence complete service updates by telephone with the person or their responsible party when:

  • No change is needed in the authorized number of PCA units
  • Person has not had a significant change in condition
  • Person is not using PCA Choice
  • DHS recommends that service updates not be done for children as their age-appropriate dependencies change as they grow.

    Use the PCA Assessment and Service Plan (DHS 3244) (PDF) to document the service update.
    1. On page one, check same under Service Update.

    2. Enter information on pages two through nine into MMIS to generate the new service agreement.

    3. On page nine, in section four, Overall Results Since Last Assessment, be sure to check:

  • Units/hours: same
  • Phone service update
  • Assessment Timelines

    Face-to-face assessments

  • Within 30 days of an initial request for services
  • Within 60-30 days before the end date of the current service agreement for reassessments
  • Annually for PCA Choice recipients
  • At least once every three years for traditional PCA recipients
  • When there is a significant change in condition
  • Service update assessments

  • Annually for two consecutive years in place of a face-to-face assessment then followed by face-to-face assessment
  • For both face-to-face assessments and service updates, assessor must send the PCA Assessment and Service Plan (DHS 3244) (PDF) to recipient and provider within 10 business days of the assessment.

    Assessor Responsibilities

    State plan

    Using appropriate methods and forms, policies and instructions, assessors are responsible to:

  • Arrange for and complete the assessment for PCA services
  • Enter assessment data into MMIS
  • Resolve edits before transmitting to DHS
  • Waiver and Alternative Care

    Using appropriate methods and forms, policies and instructions, assessors are responsible to:

  • Arrange for and complete the assessment for PCA services
  • Enter the service agreement into MMIS
  • Authorize service agreement
  • Managed care health plans

    Assessors must follow health plan policy and processes for assessment, authorization and communication of assessment information.

       

    DHS Responsibilities

    The DSD Resource Center is a help desk that provides technical assistance to counties, health plans and DHS staff for the Medicaid Management Information System (MMIS) in screening documents and service agreements.

    Type B service agreements

    DHS is responsible to:

  • Review all assessments routed to the 580 and 590 queues
  • Determine action steps for authorization
  • Additional Information

    Referral for PCA Assessment and Reassessment
    DSD MMIS Reference Guide

    Complete County/Tribe Contact List (DHS-0005) (PDF)

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