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Department of Human Services Department of Human Services  
 
Individual PCA Enrollment Criteria

Revised: 04-23-2014

Initial Enrollment/Affiliation
Processing Timelines

Re-instating an inactive affiliation

Reporting Changes


Initial Enrollment/Affiliation
Qualify the PCA
Follow the steps below to ensure the person meets all of the requirements to be enrolled as an individual PCA.

1. Determine if the person meets the personal care assistant criteria.
2. Request and keep a copy of the person’s certificate showing successful completion of the Individual Personal Care Assistant (PCA) Training requirements
3. Verify to ensure the person is not on the Office of Inspector (OIG) Exclusion list.
4. Verify to ensure the person is not on the MHCP Enrolled Provider Excluded Provider Lists as an excluded individual provider
5. Submit a background study to DHS Licensing through NETStudy. Use the Agency ID assigned to the PCA Agency at the time of enrollment with MHCP
6. Wait to receive notice from DHS Licensing that the person is one of the following before you allow them to begin work as an individual PCA provider:
• not disqualified or
• has a set-aside to the disqualification

MHCP does not require the individual PCA to complete the enrollment process to get a Unique Minnesota Provider Identifier (UMPI) before providing PCA services.

Request Enrollment/Affiliation
After ensuring the person is qualified to be an individual PCA provider, follow the process below to enroll/affiliate an individual PCA with a PCA provider agency.

1. Log in to MN–ITS and review the Provider Lists (Individual PCA’s) [MHCP updates the list twice weekly] to determine if MHCP reports the individual PCA has:
• a Unique Minnesota Provider Identifier (UMPI)
• previous enrollment under a different name (if so, submit proof of legal name change along with the individual enrollment/affiliation request)
• current affiliations to any other PCA Provider agencies (if the person reports no longer or never affiliated with an agency on the list, send a note with the request reporting this and MHCP will remove the person’s affiliation with the agencies they no longer or never were employed)
2. Request enrollment/affiliation of the individual PCA to your agency by completing the following steps:
A. Complete the following forms online and ensure all bolded fields are completed:
Individual Personal Care Assistant (PCA) Provider Enrollment Application (DHS-4469)
Individual PCA Provider Agreement
(DHS-4611)

B. Verify the information on the application and agreement is accurate with your agency records and is consistent with the information submitted to DHS Licensing through NETStudy.
C. Print the forms and verify with the individual PCA information on the forms is correct.
D. Have the individual PCA document on the application if other agency affiliations have ended, including the other agency name and affiliation end date.
E. Have the individual PCA verify the information is correct and sign both forms.
F. Fax both forms at the same time to MHCP Provider Enrollment at 651-431-7462.
G. Retain a copy of your fax confirmation for your records.

When processing complete initial enrollment/affiliation requests, MHCP also ensures the individual PCA provider:

• is not on the OIG Exclusions list
• Is not on the Individual MHCP Excluded Provider Lists
• has successfully completed the Individual Personal Care Assistant (PCA) Training as applicable
• has passed the background study with the agency requesting affiliation
• is working for only one agency if under 18 years of age

MHCP shares enrollment/affiliation information with the MCOs, on a weekly basis.


Processing Timelines
Upon receipt of all individual PCA enrollment/affiliation requests, MHCP briefly reviews all documentation to ensure receipt of complete requests. MHCP processes only complete requests within 30 days of the receipt of the request.

If a request is incomplete, MHCP will return the request by faxing both the document used during the request and a Request for Resubmission (DHS-5678) form back to the agency fax number provided on the Individual Personal Care Assistant (PCA) Provider Enrollment Application. MHCP will not retain any documentation from an incomplete request. The Request for Resubmission form contains information explaining why the request was incomplete and returned.

Each request, including corrected and resubmitted request is considered a new request and is subject to the same processing timelines (30 days) as an initial request.

Contact the MHCP Provider Call Center after allowing 30 days for processing. Complete the following before calling to verify the status of an Individual PCA affiliation request:

• Reviewed faxes returned to the agency for incomplete application requests and have waited 30 days since correcting and resubmitting the additional request
• Review the Individual PCA Provider Lists in MN–ITS to see if affiliation has already occurred
• Review the PRVLTR folder in their MN–ITS mailbox
• When calling, must have fax dates ready

If enrollment documents submitted are not complete & correct and additional info or corrections are requested you must allow up to 30 days from the date the most recent paperwork was sent for processing.


Reinstating an inactive affiliation
Follow the steps for Initial Enrollment/Affiliation selecting to reactivate an individual PCA provider with your agency. If the individual PCA provider has maintained continuous employment with your agency, MHCP does not require you to do a new background study prior to reactivation.


Reporting Changes
Report changes for an individual PCA by completing and faxing the Individual PCA Information Change Form (DHS-5716) to Provider Enrollment at 651-431-7462.

Refer to the Helpful Hints letter dated and sent to PCA provider agencies on July 15, 2009, for more information when completing the documents above.


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