Page reviewed:

Page updated: 12/4/25

Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, Minn. Stat. §256B.0659, subd. 17a, Minn. Stat. §256.476, subd. 11, Minn. Stat. §256B.0913, Minn. Stat. §256B.85, subd. 7a

Transition from PCA to CFSS

DHS is in the process of replacing PCA with CFSS. For more information about this transition, refer to CFSS Manual – Transition from PCA and CSG to CFSS.

Similarities

For both PCA and CFSS:

Differences

In PCA, the process and procedures are the same for both traditional PCA and PCA Choice.

In CFSS, the process and procedures are different in the CFSS agency model and the CFSS budget model.

Definitions

Overview

This page provides counties/tribal nations with instructions to implement the enhanced rate or budget for people at initial assessment or reassessment.

Counties/tribal nations and provider agencies working with a person who receives PCA/CFSS through a managed care organization (MCO) must check with the MCO about how it manages the enhanced rate or budget.

The information on this page applies to people at initial assessment or reassessment who are eligible for at least 10 hours of state plan PCA per day and receive:

For information about CDCS enhanced budgets, refer to CDCS – Enhanced budget process.

Qualifying training

To qualify for the wage and wage-related cost increase resulting from the enhanced rate/budget, the worker must complete qualifying trainings and submit documentation of training completion on Minnesota Direct Support Worker Training.

Tracking qualifying trainings

Counties/tribal nations are not responsible to track whether a worker has completed the qualifying trainings. A company contracted with DHS tracks this information and shares it with the worker and DHS.

PCA/CFSS provider agencies and financial management services (FMS) providers should encourage workers to review DHS – Qualifying for the enhanced rate. It has information about how to register for qualifying trainings and submit documentation of completed trainings.

If a worker completed the qualifying trainings using a license or certification, their eligibility expires when that license or certificate expires. A worker is responsible to submit proof of continuing eligibility (i.e., an updated certificate, license or proof they completed another qualifying training) on Minnesota Direct Support Worker Training before their eligibility expires to remain qualified. If a worker fails to remain qualified, the provider agency/FMS provider will no longer receive the enhanced reimbursement.

The process to update the individual provider enrollment file can take up to 30 days after the DHS contractor verifies recertification. Workers should start the recertification process before their license or certification expiration date to avoid a lapse in enhanced reimbursement to the provider agency/FMS provider.

Passing on the increase

Traditional PCA, PCA Choice and CFSS agency model (including extended PCA/CFSS)

Starting on the date the worker qualifies, the PCA/CFSS provider agency must pass on the 12.5% enhanced rate in wages, the employer’s share of taxes and/or worker’s compensation premiums to the specific worker who both:

CSG and CFSS budget model

The FMS provider must work with the person to add the additional information to the service delivery plan to give the 12.5% enhancement to the specific worker who both:

For instructions, refer to the FMS provider responsibilities section below.

Person’s responsibilities

Traditional PCA and PCA Choice

A person using PCA does not have any responsibilities related to the enhanced rate/budget.

CFSS agency model

A person using the CFSS agency model can use the instructions described in the CFSS calculations section below when writing their service delivery plan.

CFSS budget model

Person who has a qualifying worker at assessment

If a person using the CFSS budget model has a qualifying worker at assessment, they are responsible to:

Person who finds a qualifying worker after assessment

If a person using the CFSS budget model finds a qualifying worker after assessment, they are responsible to:

CSG

Person who has a qualifying worker at assessment

This section is not applicable because the county/tribal nation cannot enter new CSG service agreements.

Person who finds a qualifying worker after assessment

If a person using CSG finds a qualifying worker after assessment, they are responsible to:

PCA/CFSS provider agency’s responsibilities

PCA/CFSS provider agencies are responsible to:

FMS provider’s responsibilities

CFSS agency model

For a person using the CFSS agency model, the FMS provider’s responsibilities are the same as usual.

CFSS budget model

For a person using the CFSS budget model, the FMS provider is responsible to:

1. Receive and keep a record of confirmation letters workers submit.

2. Confirm the worker qualifies by checking the FMS provider’s MN–ITS account.

3. Help the person pass on the 12.5% enhancement to workers who completed the qualifying trainings in wages.

4. For people without a qualifying worker, not bill for any amount that exceeds the person’s non-enhanced budget (unless the person later gets a qualifying worker).

CSG

If an eligible person identifies a qualifying worker after the assessor enters the assessment, the FMS provider follows the instructions in the modifying existing service agreements section lower on this page.

Note: The county/tribal nation does not enter new CSG service agreements.

Consultation services provider’s responsibilities

CFSS consultation services providers are responsible to answer a person’s questions about the enhanced rate, including:

Lead agency’s responsibilities

The lead agency is responsible to conduct the assessment as usual and authorize eligible people at the enhanced rate/budget using the applicable instructions in this section for:

Note: The lead agency authorizes the enhanced rate/budget for all people eligible for 10 or more hours of state plan PCA/CFSS, regardless of whether they have a qualifying worker.

For people enrolled in an MCO, the MCO follows its own process for the enhanced rate/budget.

For people not enrolled in an MCO, the county/tribal nation must enter a valid value in the applicable field. In PCA, the field is called “PCA complex,” and in CFSS, the field is called “PC complex.” If the county/tribal nation enters a PCA/CFSS service agreement that does not have a valid value in the PCA/PC complex field, the county/tribal nation will receive an exception code (i.e., edit) to resolve.

State plan PCA/CFSS not on a waiver/AC (type B service agreement)

If the person is eligible

To authorize the enhanced rate in MMIS for an eligible person, the county/tribal nation must do all the following:

1. Enter a Y indicator in the PCA/PC complex field on the ALT4 screen of the long-term care (LTC) screening document (not applicable if county/tribal nation is not entering a screening document).

2. Enter a Y indicator in the PCA/PC complex field on the ASA2 screen in the service agreement.

3. Enter the applicable modifiers on the personal care (T1019) line items on the ASA3 screen of the service agreement using the new state-set enhanced rate:

4. Use the state-set enhanced rate by following instructions in the section below about using the correct rate/budget.

Note: If the county/tribal nation enters a Y in the PCA/PC complex field and a TG modifier on the personal care (T1019) line, MMIS will auto-generate reason code 604 and add a notification on the person’s and provider’s letter to inform them of their eligibility.

If the person is not eligible

If the person is not eligible for the enhanced rate, the county/tribal nation must do all the following:

1. Enter an N indicator in the PCA/PC complex field on the ALT4 screen of the LTC screening document (not applicable if county/tribal nation is not entering a screening document).

2. Enter an N indicator in the PCA/PC complex field on the ASA2 screen on the service agreement.

State plan PCA/CFSS on a waiver/AC (including extended PCA/CFSS)

If the person is eligible

To authorize the enhanced rate in MMIS for an eligible person, the county/tribal nation must do all the following:

1. Enter a Y indicator in the PCA/PC complex field on the ALT4 screen of the LTC screening document to correspond with field 100a on the LTC Screening Document, DHS-3427 (PDF).

2. AC/EW only: If adding the enhanced rate on the service agreement creates a budget that exceeds the current AC/EW case mix cap:

3. Enter a Y indicator in the PCA/PC complex field on the ASA2 screen in the service agreement.

4. Enter the applicable modifier on the personal care line items on the ASA3 screen on the service agreement.

The state plan personal care HCPCS codes are:

The extended PCA/CFSS personal care HCPCS codes are:

5.Use the state-set enhanced rate by following instructions in the section below about using the correct rate/budget.

Note: If the county/tribal nation enters a Y in the PCA/PC complex field and a TG modifier on the personal care (T1019) line, MMIS will auto-generate reason code 604 and add a notification on the person’s and provider’s letter to inform them of their eligibility.

If the person is not eligible

If the person is not eligible for the enhanced rate, the county/tribal nation must do all the following:

1. Enter an N indicator in the PCA/PC complex field on the ALT4 screen of the LTC screening document.

2. Enter an N indicator in the PCA/PC complex field on the ASA2 screen on the service agreement.

CSG

The county/tribal nation does not enter new CSG service agreements.

If the person and FMS provider identify a qualifying worker during the approved service agreement span, the person and FMS provider can initiate the process of requesting the enhanced budget. For information about this process, refer to the modifying existing service agreements section on this page.

Using the correct rate/budget

PCA

The county/tribal nation enters the current unit reimbursement rate listed in LTSS service rate limits, DHS-3945 (PDF) on the personal care (T1019) line.

CFSS agency model without goods, services or PERS

The county/tribal nation enters the current unit reimbursement rate listed in LTSS service rate limits, DHS-3945 (PDF) on the personal care (T1019) line.

CFSS agency model with goods, services or PERS

The county/tribal nation:

1. Calculates the personal care (T1019) line using one or more of the following methods:

2. Enters the goods and services and PERS lines as usual.

3. Enters the current state-set rate listed in LTSS service rate limits, DHS-3945 (PDF) on the personal care (T1019) line using the number of direct care units calculated in step 1.

If the total for the person’s personal care services, goods and services and PERS exceeds the maximum allowable for the person, the county/tribal nation will receive an exception code to resolve. The county/tribal nation must find the error in the calculations.

CFSS budget model

The enhanced budget is the current state-set rate multiplied by the number of units for which the person is eligible.

The total for the person’s personal care services, goods and services, PERS, FMS fee and failed background studies cannot exceed the maximum allowable amount for the person. If it does, the county/tribal nation will receive an exception code to resolve. The county/tribal nation must find the error in the calculations.

Extended PCA/CFSS

Extended PCA/CFSS hours do not count toward eligibility for the enhanced rate/budget. However, if a person is eligible for 10 or more hours of state plan PCA/CFSS and has a qualifying worker, the enhanced rate also applies to the person’s extended rate/budget.

Extended CFSS can only be used for personal care (T1019) services. The county/tribal nation:

Calculating CFSS-specific costs

In CFSS, people have the following additional options not available in PCA:

These options are affected by the enhanced rate/budget.

The following sections explain how to calculate the person’s direct care unit/dollars available. The following tools also can perform these calculations:

CFSS agency model without goods, services or PERS

There are no calculations necessary for a person on the CFSS agency model who does not purchase goods, services or PERS.

CFSS agency model with goods, services and/or PERS

In CFSS, people can use some of their units/dollars to purchase goods, services and/or PERS. For policy information, refer to CFSS Manual – Goods and services through CFSS and CFSS Manual – PERS through CFSS.

If a person is not eligible for the enhanced rate and purchases goods, services and/or PERS, the calculation for the units available for direct care is as follows:

1. Divide the total cost of the person’s goods, services and PERS by the current state-set non-enhanced rate.

2. Subtract this number from the total number of units for which the person is eligible to calculate the units available for direct care.

If a person is eligible for the enhanced rate and purchases goods, services and/or PERS, the calculation for the units available for direct care is as follows:

1. Divide the total cost of the person’s goods, services and PERS by the current state-set enhanced rate.

2. Subtract this number from the total number of units for which the person is eligible to calculate the units available for direct care.

CFSS budget model

If a person is not eligible for the enhanced budget, their total budget is the total units for which they are eligible multiplied by the current state-set non-enhanced rate.

If a person is eligible for the enhanced rate, their total budget is the total units for which they are eligible multiplied by the current state-set enhanced rate.

Modifying existing service agreements

Exceeding current AC/EW case mix cap

For AC/EW only, if adding the enhanced rate on the service agreement creates a budget that exceeds the current AC/EW case mix cap, the lead agency must request an exception to the case mix budget by following the budget exception process for AC/EW.

CSG

If person on CSG identifies a qualifying worker after the assessor enters the service agreement:

1. A DHS contractor notifies the worker that they completed the qualifying training.

2. The worker shows the notification to the person who receives CSG.

3. The person who receives CSG gives the notification to their FMS provider.

4. The FMS provider uses PCA Technical Change Request, DHS-4074A to request the enhanced budget from DHS. On DHS-4074A, the FMS provider should:

Once DHS receives DHS-4074A, DHS will check to see if the person who receives CSG is eligible, update the eligible person’s budget and generate a service agreement letter through MMIS. The person and FMS provider will add the additional information to the plan to give the qualified worker(s) a 12.5% wage or wage-related costs increase.