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Qualified professional (QP) services

Page posted: 5/26/2011

Page reviewed:

Page updated: 8/12/13

Legal Authority

Minn. Stat. 256B.0625, subd. 19c, Minn. Stat. 256B.0659, subd. 13 through subd. 15 and subd. 25

Policy

All PCAs must be supervised by a QP.

The qualified professional (QP) performs the duties of training, supervision, and evaluation of the personal care assistance staff and evaluation of the effectiveness of personal care assistance services.

QP services delivered and billed under PCA must be within the QPs professional scope of practice.

A limit of 96 fifteen-minute units per year of QP services may be authorized for each recipient receiving PCA services. PCA provider agencies may request an exception to the 96 units per year from DHS.

After 180 days of service, the QP may alternate face-to-face visits with telephone visits with the recipient and responsible party to oversee the delivery of PCA services.

Managed care organizations have the authority to require all QP visits to be conducted face-to-face. PCA provider agencies must check with the recipient's health plans to see if it allows for QP visits to be done telephonically or by Web visits.

Covered Services

QP services include the following:

Care planning

Traditional PCA

The QP is responsible for developing the care plan with the recipient/responsible party.

PCA Choice

The PCA Choice recipient/responsible party can request assistance from their PCA Choice provider agency's QP to develop the care plan.

Training

Traditional PCA

  • Training and orientation of PCAs on the individual needs of the recipient
  • Training PCAs for a recipient who is ventilator dependent
  • Training new procedures or equipment
  • Training based on changes to the care plan
  • Training based on the needs of the recipient and the PCA's ability to meet those needs
  • PCA Choice

  • Training and orientation of PCAs at the request of the recipient
  • Training PCAs for a recipient who is ventilator dependent
  • Supervision and evaluation

    Traditional PCA

    The QP provides required supervision and evaluation of the PCA staff to

  • Ensure competency of PCA staff to provide required PCA services
  • Ensure PCA staff are knowledgeable about care plan before services are performed
  • Ensure PCA staff can identify conditions when they should notify the QP, MD and responsible party (RP), including conditions when immediate notification is required.
  • Traditional PCA and PCA Choice

    The QP is responsible to oversee the delivery of and evaluate the effectiveness of PCA services including:

  • The satisfaction level of the recipient/responsible party
  • The month-to-month plan for use of PCA services
  • The care plan
  • The documentation of PCA services provided
  • Non-Covered Services

    The following are not eligible for payment as qualified professional services:

  • Direct professional nursing or personal care tasks
  • Agency administrative activities
  • Training other than the individualized training required to provide care for a recipient
  • Travel time
  • Services beyond the scope of qualified professional covered services
  • PCA Provider Agency Responsibilities

    Documentation

    Qualified professional must document the following:

  • Personal care assistance care plan
  • Month-to-month planned use of personal care units
  • Changes in the need of the recipient requiring change to the level of service and care plan
  • Evaluation results of supervision visits and any corrective actions
  • All communication with the recipient and personal care assistants
  • Training for the care of the recipient
  • The date, time and activity detail must be indicated on all documentation

    Qualified professionals must keep documentation, as appropriate, in:

  • PCA provider agency recipient file
  • PCA provider employee file
  • Recipient's home
  • Additional Information

    Assistance with self-administered medication
    Flexible use of PCA services

    PCA care plan

    PCA Choice option

    PCA services

    Provider enrollment requirements

    QP criteria

    QP services

    QP unit increases

    QP visits

    Shared service option for PCA

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