Minn. Stat. §256B.0652, subd. 9 and 14

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

Both PCA and CFSS allow for a 45-day temporary increase of services.

Differences

The policies for PCA and CFSS are the same, except for a small change in CFSS authorization for a person on a waiver.

45-day temporary increase of PCA/CFSS services: Process to increase PCA/CFSS services for up to 45 days when the person has had either of the following:

Responsible party (RP)/participant’s representative: An individual who is age 18 or older and capable of directing care on behalf of a person receiving PCA/CFSS services when the person is assessed as unable to direct their own care. In PCA, this individual is called the RP. In CFSS, this individual is called the participant’s representative.

Note: All references to “representative” on this page refer to the participant’s representative, unless otherwise specified.

A provider, person receiving services or RP/representative can request a temporary increase of PCA/CFSS services to address a change in condition. The provider must submit the request within five business days of the date they start providing a higher level of service.

The increase cannot exceed 45 days. If the person requires an increase of PCA/CFSS services for more than 45 days, the lead agency must complete an assessment. For information about assessments, refer to CFSS Manual – Assessment for PCA/CFSS services.

The person is responsible to:

The person must meet the criteria for a change in condition before the lead agency can authorize an increase. For information about the criteria, refer to CFSS Manual – PCA/CFSS change in condition or health status.

The lead agency uses CFSS Assessment for 45-Day Temporary Increase, DHS-6893M to conduct a telephone assessment to determine the person’s increased service needs. To gather information, the assessor may consult:

County/tribal nation instructions

Person not on a waiver/Alternative Care (AC)

The county/tribal nation must enter the assessment information into a service agreement in MMIS, including:

Then, the county/tribal nation must:

The county/tribal nation must update the person’s service delivery plan and enter a service agreement into MMIS that includes the data to support the existing PCA/CFSS authorization plus the additional PCA/CFSS units/dollars they request temporarily.

Person using PCA on a waiver/AC

In PCA, the waiver case manager adds the temporary increase of units as extended waiver PCA in the service agreement and authorizes it. For more information, refer to PCA Manual – Extended PCA services.

Person using CFSS on a waiver/AC

In CFSS, the waiver case manager authorizes the temporary increase using the same process as a person not on a waiver/AC.

Managed care organization (MCO) instructions

If a person receives PCA/CFSS services through an MCO, the PCA/CFSS provider agency or FMS provider must follow the MCO’s procedure for authorizing a temporary increase.

In CFSS, the consultation services provider is responsible to support the person receiving services, if requested.

For people who use PCA or the CFSS agency model, the PCA/CFSS provider agency is responsible to:

For people who use the CFSS budget model, the FMS provider is responsible to:

Note: If a person is using an FMS provider to purchase goods on the CFSS agency model, the FMS provider is not responsible for temporary increase activities. The CFSS provider agency is responsible to handle these activities.

DHS is responsible to: