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.

DHS must update the Medicaid Management Information System (MMIS) to allow counties/tribal nations to enter a CFSS service agreement (SA). Some fields have minor changes. For more information, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

During the transition from CSG to CFSS, the county/tribal nation follows the instructions below to enter a new SA in MMIS:

AGMT START DT

Enter SA start date. SA start date is the first of the month following end date on current CSG service agreement.

AGMT END DT

Enter SA end date. SA end date is the last day of the month.

RECIP ID

Enter person’s PMI (Person Master Index) number.

DOB

Enter person’s birth date in MMDDYYYY format.

AUTH SIG (Y/N)

Type Y (yes) or N (no) to indicate if assessor signed the PCA Assessment and Service Plan (DHS-3244).

SACTAD NBR

Leave the SACTAD NBR field blank.

RESP PARTY (Y/N)

Enter Y (yes) or N (no) to indicate if person has a responsible party.

LIVES WITH RESP PARTY (Y/N)

Enter Y (yes) or N (no) to indicate if person lives with responsible party.

RESP PARTY NAME

Enter first and last name of responsible party.

PROC and MOD1-4 fields

1. Enter procedure code T2025 (CONSUMER SUPPORT GRANT) and:

2. Tab past the four modifier fields.

START/END DT fields

Enter the correct dates in MMDDYY format. Line start and end dates for CSG and fiscal support entity lines are the same as the AGMT START/END dates on the ASA1 screen.

REQ TOT AMT

1. Multiply current (higher) monthly CSG budget amount times the number of months on the notice of reduction line.

2. Enter 95% of the total CSG amount on the line for FMS provider.

3. Enter 5% of the total CSG amount on the line for county provider.

4. Enter the total CSG amount on the line when FMS is NOT used.

5. Document CSG monthly amount from current SA on the AHC3 screen for DHS reviewer.

PROV NBR

Enter provider’s NPI (National Provider Index) number or UMPI (Unique Minnesota Provider Index) number in the provider number field:

RSN CD

Enter appropriate reason code to trigger MMIS to add legal notice language to the service agreement letters for notice of termination of CSG.

PHONE

Enter phone number of assessor.

SPRVSN NURSE

Enter last and first name of assessor.

ASSESSMENT DATE

Enter date of assessment in MMDDYY format.

BEGIN DATE and END DATE

Leave being and end dates blank. MMIS auto-populates BEGIN DATE and END DATE fields on the AHC1 screen after function key F9 is used.

NURSE VISIT

Leave nurse visit field blank.

HOME HEALTH AIDE CD

Enter X in code (CD) field when combining HHA (home health aide) services with PCA.

PDN-RN CD

Enter X in code (CD) field when combining HCN (home care nurse) services with PCA.

PDN-LPN CD

Enter X in code (CD) field when combining LPN (home care licensed practical nurse) services with PCA.

PCA CD

Enter X in CD field in front of PC to indicate PCA.

PC SUPERVISION CD

Enter X in CD field for supervision of PCA.

DIAGNOSIS 1

Enter person’s primary diagnosis ICD-9-CM code.

DIAGNOSIS 2 and DIAGNOSIS 3

Enter second and third diagnosis code when information is available.

CD fields

1. Enter X in assessment CD (code) fields to indicate needed activity.
2. Leave CD fields blank when activity does not apply.

FSG

Enter N (no) person does not receive FSG (Family Support Grant). Exception code 886 posts effective 08/01/2102 when code is Y (yes) or field is blank.

REF COMP

1. Enter Y (yes) in referral-completed field to indicate if assessor made referral(s) for other services.

2. Enter N/A (not applicable) when no referral for other services is required.

EN

1. Enter X in EN field if person is on a ventilator a minimum of 6 hours per day for a minimum of 30 days.

2. Leave EN field blank when EN does not apply.

PROV OWN/CTRL

Enter Y (yes), N (no) or U (uncertain) in provider owns or controls housing field.

ADDITIONAL COMMENTS

1. Document CSG dollar amount on current SA (the higher amount) for each CSG line.

2. Document reason for termination of CSG.

3. Document date of termination of CSG.

4. Date and initial all comments.

1. Document reason for termination of CSG.

2. Date and initial all comments.

1. Document reason for termination of CSG.

2. Date and initial all comments.