PCA Frequently Asked Questions

30-Day Notice Requirement
Activity of Daily Living (ADL) Dependencies
Appeals
Assessment Forms
Behaviors

Consumer Directed Community Support (CDCS)
Consumer Support Grant (CSG)

Directing Own Care

Flexible Use

Guardian or Responsible Party

Mental Health Services

PCA Assessment

Reassessment Schedule

Qualified Professional (QP)

Waiver Services

30-Day Notice Requirement

Are lead agencies required to put MMIS reason codes on the service agreements?

Yes. Lead agencies must use the appropriate reason codes if a recipient’s PCA assessment results in one of the following:

  • • Denial because person does not meet the access criteria for the program
  • • Reduction of time or budget amount
  • • Termination from the program
  • The corresponding reason codes on the service agreement provide the recipient with additional information and instructions on the change in their services. Refer to the DSD MMIS Reference Guide or the PCA Phase II project for detailed instructions.

    When a person receiving PCA services gets a reduction in hours or termination of services, they receive a 30-day notice. If they file an appeal and lose, do they need to receive another 30-day notice?

    No. The person would not get an additional 30-day notice if the appeal decision were upheld. DHS updates the service agreement to reflect the appeal decision. A new notice is sent with the appeal results to the individual.

    Why is the 30-day notice of reduction or termination of PCA services only mentioned under the “Current Waiver and AC Program Recipients” section of the PCA Phase II 2011 Reassessment Schedule?

    DHS received questions whether the 30-day notice applied to waiver and AC recipients. The 30-day notice of a reduction or termination of PCA services applies to state plan, managed care, waiver and AC recipients.

    If an assessment is completed more than 30-days in advance of the 7/1/11 PCA changes, is a DTR required for managed care?

    Yes. Recipients must receive the 30-day notice of a reduction or termination of PCA services. Recipients must receive the DTR whenever a service is denied, reduced or terminated (contract section 8.3). There is a protocol for adding new DTR reason codes, if needed. Submit draft language and why it is needed to DHS.

    A current state plan PCA recipient has a service agreement that started 7/1/10 and ends 6/30/11. If the county does not complete the assessment until June 1 or later, does the recipient’s PCA service end 30-days from the date of the assessment?

    No. The new service agreement based on the reassessment would end 30 days from the end of the prior agreement on 7/31/11.

    Activity of Daily Living (ADL) Dependencies

    Do the PCA Phase II changes to access criteria impact the assessment of dependencies and behavioral needs?

    No. The assessment process for dependencies and behavioral needs remains the same. Determining dependency:

  • • The PCA Assessment and Service Plan (DHS-3244) and Supplemental Waiver PCA Assessment and Service Plan (DHS-3428D) forms have separate areas for activities of daily living (ADLs), behaviors and complex health-related need. Assess each area to get the complete picture of the need of the individual. All areas affect the home care rating.
  • • ADL dependency is determined by the needs of the individual, not the diagnosis.
  • • Dependency determination is based on statute:
  • • Minnesota Statues section 256B.0659, subd. 1 “Dependency in activities of daily living” means a person requires assistance to begin and complete one or more of the activities of daily living.
  • • Minnesota Statues section 256B.0659, subd. 4
  • (1) A person must be assessed as depended in an activity of daily living based on a person’s daily need or need on the days during the week the activity is completed for:

    (i) Cuing and constant supervision to complete the task; or

    (ii) Hands-on assistance to complete the task; and

    (2) A child may not be found to be dependent in an activity of daily living if because of the child’s age an adult would either perform the activity for the child or assist the child with the activity. Assistance needed is the assistance appropriate for a typical child of the same age.

  • • When determining whether an individual needs “constant supervision,” make a distinction between constant and intermittent supervision. It is not considered constant supervision if during the activity, the individual can be left safely without supervision from time to time.
  • • The intent of “assistance with dependencies” is to support the completion of an activity of daily living, not to prevent or limit activities.
  • Can a behavior be assessed as an ADL? For example, if a child runs out of the yard when not supervised, is this considered an ADL in mobility?

    No. This example is not an ADL dependency in mobility. If the individual has the functional ability to perform the activity, move, walk or ambulate, they would not get a dependency in an ADL. This behavior issue needs to be addressed in the care plan to ensure health and safety. If he/she has the ability to put clothes on but refuses, this is a behavior concern, not a dependency in dressing.

    We do not anticipate individuals previously assessed with Level 1 behavior to access PCA services to be assessed differently so that the behavior issue now becomes an ADL dependency. Assessors need to work to separate the issues. Additional information on the difference between an ADL dependency and a behavioral issue is found in the PCA refresher training.

    ADL dependencies are defined differently in the PCA and LTCC assessments. Is the PCA access criteria based on the PCA ADL dependency definitions?

    Yes. The PCA access criteria is based on the PCA definition of dependency. The PCA Assessment and Service Plan Instructions and Guidelines provide definitions and crosswalk between the different assessment forms.

    Appeals

    How can I look up an appeal decision? Even when I put in the date span and docket number, I’m still not able to find it.

    PCA appeal decisions are in the Fair Hearing Decision Database. To narrow the search criteria, insert a percent symbol (%) in the “search text” field. Then type in the docket number, first or last name of the recipient or type of appeal (e.g. PCA, waiver, MFIP, etc.). Enter the date range from and to date. Click on the “search” button.

    Assessment Forms

    Why can’t we use the PCA Supplemental Waiver form for DD Waiver recipients?

    As part of the DD Waiver plan requirements, public health nurses are required to complete the PCA assessment for DD Waiver recipient. Therefore, PHNs use the PCA Assessment and Service Plan (DHS-3244). Lead agency assessors complete the Waiver Supplemental (DHS-3428D) form for the AC and all other waiver programs.

    Can we complete the LTCC and PCA assessment at the same time for recipients at risk of losing access to PCA services 7/1/11?

    Yes. Recipients with less than two activities of daily living (ADLs) must have the complete PCA Assessment and Service Plan (DHS-3244) with the LTCC (DHS-3427) during the PCA Phase II Project. DHS requires the full PCA Assessment for tracking and reporting the impacts of the legislative changes effective 7/1/11. The Supplemental Waiver PCA Assessment and Service Plan (DHS-3428D) cannot be used for these recipients.
    Complete t
    he following steps:

  • • Conduct assessment and provide thorough documentation on the PCA Assessment and Service Plan (DHS-3244) form.
  • • Enter the information from the PCA Assessment and Service Plan (DHS-3244) into MMIS as a type B service agreement.
  • • Provide a 30-day notice for a termination of PCA services on the type “B” service agreement (SA) with the appropriate reason code if the recipient has less than two ADLs.
  • • Enter the LTCC (DHS-3427) screening document into MMIS.
  • • Enter the appropriate waiver agreement if the recipient is determined waiver eligible. The agreement will autoroute to DHS for approval if an edit posts for overlapping SAs.
  • • Combine the total time and total charges for both the PCA Assessment and LTCC to bill under the LTCC using billing code T1023.
  • Example: For type “B” service agreements with an end date of 8/31/11 and the recipient has less than two ADLs.

  • • PCA assessment date – 7/28/11
  • • 30-day notice of PCA termination – 9/1/11-9/30/11
  • • Waiver agreement start date – 10/1/11
  • • NOTE: Refer to number five above if the recipient waives 30-day notice requirement to open early on the waiver.
  • Why was a supplemental form created for waiver recipients on extended PCA services? Why isn’t it integrated into the LTCC?

    All state plan PCA services must meet the same access, assessment and authorization criteria per Minnesota Statute. For waivers, the Supplemental PCA Assessment and Service Plan form determine the amount of daily time billed as state plan PCA. If the person needs more service, extended waiver PCA or another waiver service may be authorized.

    Behaviors

    Does someone need a Level I Behavior to qualify for additional time for the behaviors?

    No. Level I Behavior determines the base home care rating. Any of the three behaviors: level 1, increased vulnerability and resistive to care; qualify for an additional 30 minutes of time.

    Consumer Directed Community Support (CDCS)

    Families using PCA services for people with behaviors that get a decrease in PCA time with the new PCA criteria may seek CDCS to make up the difference. How do lead agencies prepare for that?

    If a person does not receive services through a waiver, they are not able to access CDCS. The county of financial responsibility would place the person a waiver if they meet the level of care criteria and eligibility requirements. Counties are still required to operate within their waiver aggregate and base services on the disability related needs.

    Someone qualifies for PCA services on the waiver, but chooses CDCS. Is the time allowed for services under Personal Supports the same as it would be if not on CDCS within the established budget guidelines?

    If the person chooses to access state plan PCA services while on a waiver, they are limited to their assessed amount and must comply with all of the MA state plan PCA rules and guidelines. The waiver could be accessed for Extended PCA services if there were disability related needs that exceeded the PCA authorization.

    If the Personal Supports category is accessed, the person is not required to adhere to what they were or would have been authorized under MA state plan PCA. The number of hours of Personal Supports authorized needs to be consistent with their assessed needs.

    Is a qualified professional (QP) required for people on CDCS with state plan PCA services? Is there a minimum amount?

    Yes. A QP is required for people using state plan PCA within their authorized CDCS budget. People are required to comply with all of the requirements of the state plan service.

    No, there is no minimum amount. It is up to the public health nurse (PHN) or Long Term Care Consultation (LTCC) assessor to authorize the amount of QP units required for a person and follow QP authorization policies.

    How will these PCA changes impact personal supports under CDCS?

    The PCA changes only affect CDCS if the person is purchasing state plan PCA services within the CDCS budget. All applicable program rules must be adhered to.

    If we use the definition of personal care from the PCA program and apply it to Personal Supports under CDCS, do you anticipate any changes? I am wondering about age-appropriate services and the definition in relation to a CDCS paid parent. Do we use the PCA definition for deciding paid parents for CDCS?

    No. We do not apply PCA standard to the Personal Support category within CDCS. People may purchase state plan PCA services as a component of their plan. There are no changes to the Personal Supports services under CDCS.

    Consumer Support Grant (CSG)

    Will CSG consumers that have banked the monthly budget for a large purchase lose the unspent dollar amount by the end of their current service agreement?

    Yes. CSG consumers will not be able to carry over any unspent balance from a prior service agreement once they have been reassessed under the new PCA criteria.

    Directing Own Care

    What do we do for a person who is mentally capable, but physically cannot provide for their safety since we cannot provide around-the-clock PCA? (E.g., fire in the house)

    The person needs to take care of his or her own needs. They would work with the PCA provider to develop an emergency back-up plan.

    Flexible Use

    Recipients that had their service agreement ended early as part of the PCA 6-month Reassessment Project and have Flexible Use, will they lose any banked hours that were saved prior to the date of the adjustment?

    Yes. Recipients will not be able to carry over any banked hours from a prior service agreement once they have been reassessed under the new PCA criteria.

    Guardian or Responsible Party

    Does the responsible party need to be present during the PCA assessment interview?

    If a person cannot direct his/her own care, a responsible party is required and must be present during the assessment. If the assessor determines during the assessment that the person cannot direct their own care and there is no responsible party, stop the assessment until a responsible party can be present.

    Who needs to sign the PCA Assessment and Service Plan form?

    Either the person or responsible party must sign the form that the assessment was completed. A person does not lose their appeal rights by signing the form.

    Can the PCA be the responsible party?

    No. Responsible party is defined in Minn. Stat. §256B.0659, subd. 9. A responsible party cannot be the:

  • • Personal care assistant
  • • Owner or staff member of the PCA provider agency
  • • Staff employed by or under contract with the lead agency acting as part of their employment
  • Mental Health Service

    What is the status of behavior aide services as a replacement to PCA? Where is there a list of providers in our area?

    The behavioral health aide (BHA) is not an identical replacement for PCA services, but it might be a more appropriate service based on the individual’s needs. BHA services looks for long-term outcomes for individuals when providing services. It is “rehabilitative mental health services plan to restore a child’s functioning that has been reduced by a mental health disorder.”

    A list of providers and other information is available on the Children’s Mental Health web site.

    PCA Assessment

    Does the PCA assessment need to be conducted in person?

    Yes. An assessor must meet with the person face-to-face to complete an initial PCA assessment or a reassessment with the new PCA criteria, which takes effect January 1, 2010. A service update may be used after the face-to-face assessment if the person has not had a change of need for service. A telephone interview is allowed when a person is requesting an emergency start of PCA services.

    Reassessment Schedule

    Resources and referrals were provided during a face-to-face assessment prior to 7/1/11 for those recipients with six-month service authorization. Can we do a service update for the reassessment for PCA Phase II if there is no change of condition as long as we provide a 30-day notice of termination?

    No. Everyone at risk of losing PCA services with the two ADL criteria effective 7/1/11 requires a face-to-face assessment prior to the termination of service. You must provide a 30-day notice of termination of PCA service.

    Do recipients that do not meet the two ADL criteria for 7/1/11 have the right to request a new PCA assessment?

    Yes. A recipient can receive up to two assessments in a calendar year without prior authorization. If a recipient, responsible party or provider requests a second assessment, the lead agency must conduct the assessment within 30 days of the request.

    When should PCA services for waiver recipients end under the PCA Phase II Project?

    Assess waiver recipients at their regular assessment schedule. Individuals with less than two ADLs that are due for assessments in December need to be assessed by 11/30/11. For recipients that do not meet the two ADL dependency criteria upon assessment, provide a 30-day notice of termination of PCA service as assessments are completed. Recipients with assessments dates prior to 7/1/11 can maintain their prior level of PCA service through 6/30/11 with a 30-day notice. Assessments after 7/1/11 would receive their 30-day notice as assessments are completed throughout the remainder of 2011.

    Refer to the PCA Phase II Reassessment Schedule and examples for further information and clarification.

    The PCA Phase II Reassessment Schedule states to complete assessments for managed care recipients, not on a waiver, between 1/1/11 and 6/30/11. Does this mean that all members not on a waiver need assessments during this time or only complete those whose assessments are due during this period?

    Assess all members at their regular assessment time in 2011 including waivers. Assess only those individuals, not on a waiver, with fewer than two ADLs between 1/1/11 and 6/30/11. Waiver recipients with fewer than two ADLs need to have their assessments completed by 11/30/11.

    Qualified Professional (QP)

    The QP is required for everyone that receives PCA services starting January 1, 2010. When should that information be added to the service agreement?

    Add QP services to the service agreement at the time of reassessment for recipients currently on the program. For initial assessments, add QP services to service agreements with service dates after January 1, 2010.

    If the recipient has more that one provider agency, does each provider agency receive 96 units for the QP?

    No. QP services are limited to 96 units per recipient per 12-month service agreement. There is an exception process for providers to request additional units. DHS may approve requests that justify additional units based on recipient need.

    Waiver Services

    If a person gets a reduction in PCA services and they have additional needs, are they able to get additional services through the waiver?

    Yes. If the person needs other services, they should be screened for waiver services. To get additional services under the waiver, they need to meet the level of care criteria and eligibility requirements for the waiver.


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