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Personal Care Assistance

Change of condition or health status

Page posted: 11/04/13

Page reviewed:

Page updated:

Legal Authority

Minn. Stat. §256B.0652, subd. 9

Policy

A recipient may experience a change in condition or health status and be eligible for an increase of time for PCA services. A change in a recipient’s condition or health status is evidenced by:

  • • Increase in the total number of dependencies of ADLs
  • • Addition of a dependency in a critical ADL
  • • Additional complex health-related need
  • • Additional description of behavior
  • Fee-for-service
    The temporary increase of time cannot exceed 45 days. At the end of the 45 days, if the person continues to have the change of condition or health status, a face-to-face assessment needs to be completed. See temporary 45-day increase of services policy.

    Waives and the Alternative Care (AC) program
    A temporary increase is addressed through use of the extended PCA service.

    Health plan
    The individual policy and process must be implemented.

    Determining Additional Time

    Assess additional time for the change of condition or health status based on the following categories.

    Home care rating and base unit determination

    1. Identify the total number of dependencies in ADLs.

    2. If this is a change from the current assessment, determine a new base unit for the temporary authorization.

    Determination of additional time

    1. Identify if the person has additional dependencies in critical ADLs, descriptions of behaviors, and/or complex health-related needs.
    2. For each additional dependency or description assessed, an additional 2 units or 30 minutes per day is added to the base unit determination.

    Total additional time for the temporary increase
    Determine the total time using the following formula OR steps.

    Formula
    New base units + new additional time - current authorization of time = total time to add for the 45 day request.

    Steps

    1. Add the new additional time to the new base units.
    2. Subtract the current authorization of time from step #1.
    3. This equals the total time to add for the 45-day request.

    Assessor Responsibilities

    The assessor is responsible to:

    1. Review information about the change of condition or health status using the current assessment data as a baseline.
    2. Obtain information from the recipient, family, provider, health care provider or other resources.
    3. Determine and authorize additional time if assessed to be appropriate.

    Fee-for-service PCA
    Enter a new service agreement into MMIS and route to DHS for authorization or denial.

    Waivers and the AC Program
    Add the temporary increase of units as extended waiver PCA service in the service agreement and authorize.

    Managed Care Organization
    Follow the individual health plan process for temporary increase assessment and authorization.

    PCA Provider Agency Responsibilities

    The provider is responsible to:

    1. Communicate change of condition or health status to the appropriate payer for follow up.
    2. Provide for increased staffing to meet the recipient’s needs.
    3. Make changes to the PCA care plan.
    4. Make referrals for other services that may help to meet the person’s needs.

    DHS Responsibilities

    DHS is responsible to review requests for 45-day temporary increases to an existing service agreement.

    1. If additional time assessed, add to the open Type B service agreement.
    2. If no additional time assessed, add comments to the MMIS provider and recipient screens.

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    © 2017 Minnesota Department of Human Services Updated: 11/8/13 4:26 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 11/8/13 4:26 PM