PCA/CFSS managed care organization (MCO) disenrollment process
Page posted: 8/26/24 | Page reviewed: | Page updated: | |
Legal authority | |||
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. SimilaritiesBoth PCA and CFSS have policies and processes for MCO disenrollment. DifferencesThere are no differences in these policies or processes for PCA and CFSS. | ||
Overview | If a person is enrolled in Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+), their MCO authorizes their PCA/CFSS services. After a person exits their MCO, their PCA/CFSS provider has 30 days following the date of disenrollment to request a temporary authorization of fee-for-service PCA/CFSS services. DHS will approve a temporary fee-for-service authorization for PCA/CFSS services to continue for up to 90 days after disenrollment with proof of the MCO’s authorization for services. Authorization beyond 90 days requires an in-person assessment with the person’s county/tribal nation. | ||
PCA/CFSS provider agency’s responsibilities | If the PCA/CFSS provider performs their monthly Minnesota Health Care Programs (MHCP) eligibility check and discovers the person is disenrolled from their MCO, the provider must notify DHS and the county/tribal nation. For information about eligibility checks, refer to MHCP Provider Manual – Health care programs and services – MHCP member eligibility. Notification to DHSWithin 30 calendar days of the person’s disenrollment from their MCO, the provider must submit PCA/CFSS Technical Change Request, DHS-4074A to DHS and include a copy of the current MCO authorization. Notification to the county/tribal nationIf it is likely the person will not reenroll in the MCO within 90 days, the provider must send Referral for PCA/CFSS Services, DHS-3244P (PDF) to the county/tribal nation as soon as possible so the county/tribal nation can conduct an assessment. DHS will not authorize temporary or long-term services unless the person has a current assessment. | ||
County/tribal nation’s responsibilities | The county/tribal nation must conduct an assessment within 30 days of receiving a request from the provider or person. The person may need an assessment when: Once the county/tribal nation receives Referral for PCA/CFSS Services, DHS-3244P (PDF), the county/tribal nation is responsible to: | ||
DHS’ responsibilities | DHS staff will process the request for a temporary authorization after receiving the PCA/CFSS provider’s completed PCA/CFSS Technical Change Request, DHS-4074A with a copy of the current MCO authorization. | ||
Additional resources | CFSS Manual – PCA/CFSS service changes overview | ||
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