Minn. Stat. §256.0652

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, a person may:

A person who uses PCA Choice or the CFSS budget model cannot use multiple provider agencies or financial management services (FMS) providers.

Differences

There are no differences in this policy for PCA and CFSS.

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 person who uses traditional PCA or the CFSS agency model can use more than one provider agency. Each provider agency must have a separate line item on the person’s service agreement. The provider agencies can bill for the same type of service on the same day.

If a person using the CFSS agency model purchases goods and services, they can use multiple provider agencies for their direct care services. However, they cannot use multiple FMS providers for their goods and services.

A person who uses PCA Choice or the CFSS budget model cannot use multiple provider agencies or FMS providers.

Instructions

Assessment/reassessment

If a person knows which agencies they want to use and how to distribute the units between the agencies at assessment/reassessment, the lead agency enters the information into the person’s service agreement.

Changes during service plan year for people not on a waiver/Alternative Care (AC)

If a person not on a waiver/AC removes a provider agency, adds a provider agency or alters the ratio of their units between provider agencies, all provider agencies must work together to divide the total approved PCA/CFSS units between the provider agencies.

After this collaboration happens, all provider agencies must submit PCA Technical Change Request, DHS-4074A or CFSS Technical Change Request, DHS-6893K with the following information:

DHS will update the person’s service agreement with the new distribution of units after confirming each provider agency’s form includes the same information.

Changes during service plan year for people on a waiver/AC

A person on a waiver/AC must request changes from their lead agency case manager. The case manager will make the necessary changes on the person’s service agreement.

Managed care organization (MCO)

A person enrolled in an MCO must follow the MCO’s procedure for authorizing multiple providers.

A person who uses PCA/CFSS services may also be eligible for:

SNV and HHA for people not on a waiver/AC

A person not on a waiver/AC must have separate assessments to determine their eligibility for PCA/CFSS and SNV and HHA.

Person using SNV and/or HHA adds PCA/CFSS

If a person currently using SNV and/or HHA wants to start using PCA/CFSS, the county/tribal nation must:

DHS will merge the information in MMIS and approve the service agreement.

Person using PCA/CFSS adds SNV and/or HHA

If a person currently using PCA/CFSS wants to start using SNV and/or HHA, a home health agency must:

The DHS contractor will review the request. If the DHS contractor approves the request, they will merge the information in MMIS.

For more information about this process, refer to CBSM – SNV and CBSM – HHA.

HCN for people not on a waiver/AC

A person not on a waiver/AC must have separate assessments to determine their eligibility for PCA/CFSS and HCN.

Person using HCN adds PCA/CFSS

If a person currently using HCN wants to start using PCA/CFSS, the county/tribal nation must:

DHS will merge the information in MMIS and route the service agreement to the DHS contractor for review.

The DHS contractor will review the request and take the appropriate action:

Person using PCA/CFSS adds HCN

If a person currently using PCA/CFSS wants to start using HCN, a home care agency must:

The DHS contractor will review the request and take the appropriate action:

The HCN and PCA/CFSS agencies must communicate about the distribution of units and request changes, if necessary, by sending PCA Technical Change Request, DHS-4074A or CFSS Technical Change Request, DHS-6893K.

For more information about this process, refer to CBSM – HCN.

SNV, HHA and HCN on a waiver/AC

For a person on a waiver/AC, the person’s case manager must:

For more information about this process, refer to CBSM – SNV, CBSM – HHA or CBSM – HCN.

Services through an MCO

A person age 65 or older who receives PCA/CFSS and home care services through an MCO must follow the MCO’s procedure for authorizing a combination of PCA/CFSS and home care services.