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PCA Relative Caregiver Payments
September 2, 2011 MHCP Provider Update PCA-11-02R
Effective for dates of service on and after October 1, 2011, the 2011 Minnesota Legislative Session, 1st Special Session, Chapter 9, article 7, section 10, requires MHCP to pay fee-for-service PCA service claims at 80% of the allowable rate when the individual PCA provider is related to the recipient in one of the following ways:
Related means the individual PCA is related to the recipient by blood or through a legal adoption process.
This requirement does not apply to:
Review the Home Care Service Rate Limits Effective September 1, 2011 for PCA service rate information.
For each individual PCA provider and the recipient(s) for whom they provide services, MHCP requires all PCA agencies to identify, document and report individual PCA and recipient relationships for all fee-for-service PCA services, including the extended PCA services through the waiver or Alternative Care (AC) programs.
Identify & Document Relationships
Identify and document the relationship of each individual PCA provider with each recipient for whom they provide services:
Do not submit these forms but keep in your PCA agency files. Failure to maintain required documentation may result in a $500 fine to the PCA provider agency.
MHCP is now requiring you to report the relationship between the individual PCA provider and the recipient to MHCP on fee-for-service PCA claims using only two modifiers. If your agency has already completed system programming for relationship modifiers previously announced and this change will cause a hardship for your agency, contact the MHCP Provider Call Center at (651) 431-2700 or 1-800-366-5411 to report this information.
Use one of the two modifiers from the table below to report the relationship on the claim:
The public health nurse and the county/tribal case managers are not required to:
Except for QP supervision (T1019 UA) claims, all other fee-for-service T1019 claim lines must also include at least one of the relationship modifiers from the table above on each claim line. All other HCPCS code and modifier combinations still apply to PCA claims. MHCP will cut back the payment rate during the claim processing.
MHCP will deny PCA service claim lines with dates of service on and after 10/1/11 when you:
DHS is encouraging managed care organizations (MCOs) to use the same procedures described above, including requiring the same modifiers on claims. The rates paid by MCOs are determined by your contracts with the MCO. Contact the MCO with any questions about MCO effective dates for these changes and for rate information.
MHCP is updating the following agency enrollment forms to reflect the new relationship requirements (do not submit to MHCP):
MHCP will collect these and other enrollment forms only at the time of the PCA agencys next annual review. When it is time for your annual review, MHCP will place a letter of request in the PRVLTR folder in your MNITS mailbox.
If you have questions about this information, call the MHCP Provider Call Center at (651) 431-2700 or 1-800-366-5411.
Sign up to receive Provider Updates and other MHCP notices in your e-mail account.
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