Legal authority

Minn. Stat. §256B.85, subd. 8a and 12b, Minn. Stat. §256B.0652, subd. 14, Minnesota Bill of Rights for Clients of Home Care Providers Exempted from Licensure (PDF)

Comparison of PCA and 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

In both PCA and CFSS:

Differences

In PCA:

In CFSS:

Definition

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.

Overview

A person who receives PCA/CFSS services can decide to switch from one provider to another provider at any time.

The previous provider must release unused PCA/CFSS units/dollars so the units/dollars are available to the new provider.

The previous provider cannot bill for services provided after the last date of service documented on the change request. The new provider cannot bill for services before the start date documented on the change request.

Note: All references to “provider” on this page include PCA/CFSS provider agencies, consultation services providers and FMS providers, unless otherwise specified.

Process for transferring providers

The process to transfer PCA/CFSS providers depends on the person’s circumstances.

Note: A person using the CFSS budget model must wait until the end of the current quarter to switch FMS providers. However, the person can initiate the change before the end of the quarter.

Not on a waiver/AC and not enrolled in an MCO

Changing providers within 183 days of the start of services

When the person changes providers within 183 days of starting services:

1. The new provider contacts the county/tribal nation.

2. If the person is changing FMS providers, the county/tribal nation:

4. The county/tribal nation:

5. The consultation services provider updates the CFSS service delivery plan.

Changing providers more than 183 days after of the start of services

Process for previous provider

The previous provider must submit PCA Technical Change Request, DHS-4074A or CFSS Technical Change Request, DHS-6893K to DHS and include:

The previous provider must participate in a coordinated transfer to the new provider to ensure continuity of care.

Process for new provider

The new provider must submit PCA Technical Change Request, DHS-4074A or CFSS Technical Change Request, DHS-6893K to DHS within 30 days of the first date of service and include:

DHS will update the person’s service agreement if the provider accurately completed all information.

If the previous provider did not submit PCA Technical Change Request, DHS-4074A or CFSS Technical Change Request, DHS-6893K to DHS, the new provider must have the person or the RP/representative sign and date DHS-4074A or DHS-6893K to complete the transfer.

The new provider also must indicate when they provided a copy of DHS-4074A or DHS-6893K to the previous provider.

Waiver/AC

If a person using a waiver/AC switches providers:

1. The person or the new provider contacts the county/tribal nation.

2. If the provider contacted the county/tribal nation, the case manager confirms with the person that they want to switch providers.

3. The county/tribal nation:

4. If the person changes their FMS provider, the county/tribal nation completes Lead Agency Addendum to CFSS Individual Service Delivery Plan, DHS-6893W with the new FMS provider’s authorization amounts and adds a description of the previous provider’s authorized amounts in the comments field.

5. The county/tribal nation:

5. The consultation services provider updates the CFSS service delivery plan.

MCO

The previous provider and new provider must follow the MCO’s process for transferring providers.

Process for adding a provider

The county/tribal nation may enter a service agreement without a provider if the person does not select a provider. After the person selects a provider, follow the applicable instructions based on the person’s circumstances.

Note: When working with a person enrolled in an MCO, follow the MCO’s process.

Not on a waiver/AC and not enrolled in an MCO

PCA service agreement (including six-month service agreement during transition to CFSS)

If the county/tribal nation did not authorize a PCA provider agency or a consultation services provider, DHS must update the service agreement after the person selects a provider. After the person informs the provider they selected them, the provider must submit PCA Technical Change Request, DHS-4074A (PCA provider agency) or CFSS Technical Change Request, DHS-6893K (CFSS consultation services provider) to DHS within 30 days of the first date of service and include:

DHS will update the person’s service agreement if the provider accurately completed all information.

Note: These instructions only apply to adding a PCA provider or a consultation services provider to a person’s six-month PCA service agreement. After the county/tribal nation approves the person’s CFSS service delivery plan, the county/tribal nation enters a new service agreement with the person’s approved CFSS services. Providers cannot submit a request to DHS to add CFSS services to a six-month PCA service agreement, with the exception of consultation services.

CFSS service agreement

If the county/tribal nation did not authorize a CFSS provider and the person selects a provider within 183 days of the start date of the service agreement, the county/tribal nation can update the service agreement without contacting DHS. The person informs the provider of their choice, and the provider contacts the county/tribal nation to update the service agreement.

If the person selects a provider after 183 days of the start date of the service agreement, DHS must update the service agreement. After the person informs the provider they selected them, the provider must submit CFSS Technical Change Request, DHS-6893K to DHS within 30 days of the first date of service and include:

DHS will update the person’s service agreement if the provider accurately completed all information.

Note: These instructions only apply to adding a new provider to a CFSS service agreement. Providers cannot submit a request to DHS to add CFSS services to a six-month PCA service agreement, with the exception of consultation services.

Waiver/AC

A person on a waiver/AC must contact their case manager to change providers. After obtaining the necessary information, the case manager will modify the person’s service agreement.

Process for discontinuing as a person’s provider

If a provider decides to stop providing services to a person, the process depends on the person’s circumstances.

Not on a waiver/AC and not enrolled in an MCO

The provider must follow the instructions for a written notice, described in the section below. Then, they must submit PCA Technical Change Request, DHS-4074A or CFSS Technical Change Request, DHS-6893K to DHS and include:

Waiver/AC

The provider must follow the instructions for a written notice, described in the section below. Then, they must contact the person’s case manager to discontinue as the person’s provider.

MCO

The provider must follow the instructions for a written notice, described in the section below. Then, they must follow the MCO’s process to discontinue as the person’s provider.

Written notice for discontinuation

Regardless of whether the person receives services through fee-for-service, a waiver/AC or an MCO, the provider must give the person a written notice before discontinuing services.

Discontinuation initiated by the provider

PCA

For PCA, the provider must give the person at least a 10-day notice before discontinuing services.

CFSS

For CFSS, the provider must give the person at least a 30-day notice before discontinuing services, unless any of the following is true:

Discontinuation initiated by the person

If the person initiates the request to discontinue PCA/CFSS services with the provider, the provider must give the person a written acknowledgment that includes the date the provider received the request and the person’s requested termination date.