DHS is in the process of replacing personal care assistance (PCA) and the Consumer Support Grant (CSG) with Community First Services and Supports (CFSS). For more information about this transition, refer to CFSS Manual – Transition from PCA and CSG to CFSS.

For a Medicaid Management Information System (MMIS) transition summary, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

Similarities

For both PCA and CFSS, the county/tribal nation enters:

Differences

In PCA, the county/tribal nation:

In CFSS, the county/tribal nation:

The county/tribal nation enters lines for the person’s specific services on the ASA3 screen. This page describes how to enter a worker supervision/training line in both PCA (T1019 – UA) and CFSS (S5116). For information and instructions about other ASA3 line types, refer to DSD MMIS Reference Guide – ASA3 screen overview.

PCA

For a person who currently uses PCA, the county/tribal nation enters six months of worker supervision/training (T1019 – UA) services. If the county/tribal nation does not enter a worker supervision/training (T1019 – UA) line, MMIS post an exception code the county/tribal nation must resolve.

Note: If the person will use more than one PCA provider agency, the county/tribal nation must enter a worker supervision/training (T1019 – UA) line for each provider.

CFSS

For a person who uses CFSS, the county/tribal nation enters a worker supervision/training (S5116) line, unless the person does not use personal care services (T1019).

If a person uses the CFSS agency model, they must use personal care (T1019) services.

If a person uses the CFSS budget model, they can choose not to use personal care (T1019) services.

MMIS post an exception code the county/tribal nation must resolve if the county/tribal nation:

Note: If the person will use more than one CFSS provider agency (CFSS agency model only), the county/tribal nation must enter a worker supervision/training (S5116) line for each provider agency.

Person who currently uses PCA

When a person who currently uses PCA is eligible for and selects CFSS, the county/tribal nation authorizes six months of PCA, including a personal care (T1019) line, PCA worker supervision/training (T1019 – UA) line and consultation services (T1023) line. After the county/tribal nation approves the person’s CFSS service delivery plan, the county/tribal nation enters a new service agreement (SA) with the CFSS services.

Person who does not currently use PCA

When a person new to services is eligible for and selects CFSS, the county/tribal nation authorizes consultation services (T1023) only. Once the county/tribal nation approves the person’s CFSS service delivery plan, the county/tribal nation adds lines for the other services the person selected.

In the optional line comments (LI COMMENTS) field, the county/tribal nation enters additional clarifying information, if desired. This comment appears in the person’s letter and the provider’s letter.

In the procedure code (PROC) field, the county/tribal nation enters the procedure code for each authorized service.

PCA

In the procedure code (PROC) field, the county/tribal nation enters the personal care procedure code (T1019).

Note: If the county/tribal nation enters a PCA worker supervision/training (T1019 – UA) line without a personal care (T1019) line, MMIS posts an exception code the county/tribal nation must resolve.

CFSS

In the PROC field, the county/tribal nation enters the worker supervision/training procedure code (S5116).

Note: If the county/tribal nation enters a worker supervision/training (S5116) line without a personal care (T1019) line, MMIS posts an exception code the county/tribal nation must resolve.

In the modifiers (MOD1-4) field, the county/tribal nation enters modifiers to provide additional information needed for authorization and billing.

PCA

The county/tribal nation enters the PCA worker supervision/training modifier (UA) in the first modifier field. The county/tribal nation does not enter other modifiers.

CFSS

The county/tribal nation enters the worker supervision/training procedure code (S5116) with the modifier for the model the person selected:

The county/tribal nation does not enter other modifiers.

Note: The county/tribal nation must enter the same model modifier (U9 or UB) for all lines with overlapping dates. If the county/tribal nation enters different model modifiers for two or more lines with overlapping dates, MMIS posts an exception code the county/tribal nation must resolve.

Claims-only modifier

The county/tribal nation does not enter the formal worker training modifier (UD) for a person who uses the CFSS agency model. In the CFSS agency model, the provider agency only uses the claims-only modifier for billing purposes.

In the start/end date (START/END DT) fields, the county/tribal nation enters start and end dates in MMDDYY format. Start and end dates indicate when the line starts and ends.

MMIS posts an exception code the county/tribal nation must resolve if the country/tribal nation enters start and end dates that:

The requested rate per unit (REQ RATE/UNIT) field lists the requested reimbursement rate.

PCA

In the requested rate per unit (REQ RATE/UNIT) field, the county/tribal nation enters the current rate listed under personal care assistance (PCA), supervision on Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

If the county/tribal nation enters a rate in the requested rate per unit (REQ RATE/UNIT) field that does not match the rate on file, MMIS posts an exception code the county/tribal nation must resolve.

CFSS

The county/tribal nation leaves the requested rate per unit (REQ RATE/UNIT) field blank. If the county/tribal nation edits this field, MMIS posts an exception code the county/tribal nation must resolve.

The requested total units (REQ TOT UNITS) field lists the total number of units for the specific line.

PCA

In the requested total units (REQ TOT UNITS) field, the county/tribal nation enters the total number of prorated units for the worker supervision/training (T1019 – UA) line date span.

If the SA does not have any partial months, the county/tribal nation enters eight times the number of months in the SA. The county/tribal nation enters 48 units when they authorize six months of PCA during the transition from PCA to CFSS.

If the SA has a partial month, the county/tribal nation estimates the percentage of the partial month. MMIS posts exception codes the county/tribal nation must resolve until the county/tribal nation enters the correct percentage.

CFSS

The county/tribal nation leaves the requested total units (REQ TOT UNITS) field blank. If the county/tribal nation edits this field, MMIS posts an exception code the county/tribal nation must resolve.

The requested total amount (REQ TOT AMT) field lists the current reimbursement rate for the specific line.

PCA

MMIS auto-populates the requested total amount (REQ TOT AMT) field when the county/tribal nation presses function key F9.

CFSS

In the requested total amount (REQ TOT AMT) field, the county/tribal nation enters the current rate listed under CFSS, worker training and development on Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF). The county/tribal nation always enters the full amount, regardless of the SA length.

In the provider number (PROV NBR) field, the county/tribal nation enters the provider number for the provider the person will use for this service.

If the person has selected a provider, the county/tribal nation enters the provider’s National Provider Identifier (NPI) number or Unique Minnesota Provider Identifier (UMPI) number.

PCA and CFSS agency model

In PCA or the CFSS agency model, the county/tribal nation enters the provider number for each of the person’s provider agencies. For each provider agency entered on the person’s personal care (T1019) lines, the county/tribal nation must enter a corresponding worker supervision/training (PCA: T1019 – UA; CFSS: S5116) line with a matching provider number.

CFSS budget model

In the CFSS budget model, the county/tribal nation enters the provider number for the person’s financial management service (FMS) provider.

The provider number entered on the worker supervision/training (S5116) line must match the provider number entered on the following line types with overlapping dates, if applicable:

No provider selected

If the person has not selected a provider, the county/tribal nation enters:

For more information, refer to DSD MMIS Reference Guide – Finalize a type B SA for PCA/CFSS.

Find a provider number in MMIS

If the person’s service delivery plan does not list the provider number, refer to Instructions for Completing and Entering the LTCC Screening Document and SA into MMIS, DHS-4625 (PDF).

MMIS auto-populates the provider name (PROV NAME) field when the county/tribal nation presses function key F9. This field lists the provider name based on the provider number the county/tribal nation enters in the provider number (PROV NBR) field. The county/tribal nation cannot edit this field.

MMIS auto-populates the shared services (SHR) field. If the county/tribal nation edits this field, MMIS overwrites their entry.

The county/tribal nation cannot edit the frequency (FREQ) field.

In the reason code (RSN CD) field, the county/tribal nation enters legal notice language to add to the SA when needed. If the county/tribal nation makes changes specific to personal care, they enter the appropriate reason codes in this field. For more information, refer to DSD MMIS Reference Guide – ASA3 screen overview.

MMIS reason code text

For a list of MMIS reason codes, refer to DSD MMIS Reference Guide – Type B home care SA MMIS reason codes.

If the county/tribal nation needs to enter more lines, they press function key F11 to display the next blank line. MMIS displays only two lines per page.

After the county/tribal nation enters all lines, they press a transmit key to advance to the AHC1 screen.