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.

For a Medicaid Management Information System (MMIS) transition summary, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

This page describes MMIS instructions to make changes to a type B CFSS service agreement (SA) with a consultation services (T1023) line on the ASA3 screen using PCA1 security group for up to 183 days after the SA start date (i.e., the date in the agreement start date [AGMT START DT] field on the ASA1 screen). For information and instructions on the policies and procedures the county/tribal nation must follow, refer to CFSS Manual – Resource: CFSS mid-year changes for counties and tribal nations.

To move units (CFSS agency model) or dollars (CFSS budget model) between personal care, goods and services, PERS and FMS, the county/tribal nation follows:

1. The corresponding policy instructions on CFSS Manual – PCA/CFSS service delivery plan changes.

2. The instructions below to update the ASA3 and AHC3 screens.

ASA3 screen

To move units (CFSS agency model) or dollars (CFSS budget model) between personal care, goods and services, PERS and FMS, the county/tribal nation updates the line(s) for each changed service on the ASA3 screen.

Note: The combined total of the following lines cannot exceed the person’s total eligible units (CFSS agency model) or dollars (CFSS budget model):

Refer to DHS – CFSS SA calculators.

Personal care (T1019) line for the CFSS agency model

The county/tribal nation enters:

Personal care (T1019) line for the CFSS budget model

The county/tribal nation enters:

Goods and services (T5999) line

The county/tribal nation enters:

PERS installation (S5160) line

PERS installation (S5160) is a one-time cost.

If the person decides not to use their approved PERS installation, the county/tribal nation enters 0 in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields of the PERS installation (S5160) line.
Note: The person can only remove their PERS installation if they have not used it.

PERS monthly service (S5161) line

The county/tribal nation enters:

PERS equipment purchase (S5162) line

PERS equipment purchase (S5162) is a one-time cost.

If the person decides not to use their approved PERS equipment purchase, the county/tribal nation enters 0 in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields of the PERS equipment purchase (S5162) line.
Note: The person can only remove their PERS equipment purchase if they have not used it.

FMS provider fee (T2040 – UB and UA) line

The county/tribal nation enters:

Failed background study (T2040 – UB, UA and U6) line

If the person does not receive CFSS on a waiver/AC, the FMS provider submits a technical change request to DHS using CFSS Technical Change Request, DHS-6893K.

If the person receives CFSS on a waiver/AC, the county/tribal nation enters:

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

To add a service, the county/tribal nation follows:

1. The corresponding policy instructions on CFSS Manual – PCA/CFSS service delivery plan changes.

2. The instructions below to update the ASA3 and AHC3 screens.

ASA3 screen

To add a service, the person must decrease their units (CFSS agency model) or dollars (CFSS budget model) for at least one other service.

Note: The combined total of the following lines cannot exceed the person’s total eligible units (CFSS agency model) or dollars (CFSS budget model):

Refer to DHS – CFSS SA calculators.

The county/tribal nation:

1. Adds a line for each new service.

2. Enters the date they authorized the services in the start date (START DT) field of the line for each new service.

3. Completes each new line by following the corresponding instructions on DSD MMIS Reference Guide – ASA3 screen overview.

4. Follows the instructions below to update the line(s) for the service(s) the person will decrease.

Personal care (T1019) line for the CFSS agency model

The county/tribal nation enters:

Personal care (T1019) line for the CFSS budget model

The county/tribal nation enters:

Goods and services (T5999) line

The county/tribal nation enters:

PERS installation (S5160) line

PERS installation (S5160) is a one-time cost.

If the person decides not to use their approved PERS installation, the county/tribal nation enters 0 in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields of the PERS installation (S5160) line.
Note: The person can only remove their PERS installation if they have not used it.

PERS monthly service (S5161) line

The county/tribal nation enters:

PERS equipment purchase (S5162) line

PERS equipment purchase (S5162) is a one-time cost.

If the person decides not to use their approved PERS equipment purchase, the county/tribal nation enters 0 in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields of the PERS equipment purchase (S5162) line.
Note: The person can only remove their PERS equipment purchase if they have not used it.

FMS provider fee (T2040 – UB and UA) line

The county/tribal nation enters:

Failed background study (T2040 – UB, UA and U6) line

If the person does not receive CFSS on a waiver/AC, the FMS provider submits a technical change request to DHS using CFSS Technical Change Request, DHS-6893K.

If the person receives CFSS on a waiver/AC, the county/tribal nation enters:

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

To remove a service, the county/tribal nation follows:

1. The corresponding policy instructions on CFSS Manual – PCA/CFSS service delivery plan changes.

2. The instructions below to update the ASA3 and AHC3 screens.

ASA3 screen

To remove a service, the person must increase their units (CFSS agency model) or dollars (CFSS budget model) for at least one other service.

Note: The combined total of the following lines cannot exceed the person’s total eligible units (CFSS agency model) or dollars (CFSS budget model):

Refer to DHS – CFSS SA calculators.

The county/tribal nation:

1. Enters the last date the person will use the service in the end date (END DT) field of the line for each service the person will remove.

2. Follows the instructions below to update the lines for the services the person will remove and increase.

Personal care (T1019) line for the CFSS agency model

The county/tribal nation enters:

Personal care (T1019) line for the CFSS budget model

The county/tribal nation enters:

Goods and services (T5999) line

The county/tribal nation enters:

PERS installation (S5160) line

PERS installation (S5160) is a one-time cost.

The county/tribal nation enters 0 in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields of the PERS installation (S5160) line.
Note: The person can only remove their PERS installation if they have not used it.

PERS monthly service (S5161) line

The county/tribal nation enters:

PERS equipment purchase (S5162) line

PERS equipment purchase (S5162) is a one-time cost.

The county/tribal nation enters 0 in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields of the PERS equipment purchase (S5162) line.
Note: The person can only remove their PERS equipment purchase if they have not used it.

FMS provider fee (T2040 – UB and UA) line

The county/tribal nation enters:

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

To add additional worker supervision/training funds for a person who does not receive CFSS on a waiver/AC, the FMS provider submits a technical change request to DHS using CFSS Technical Change Request, DHS-6893K.

To add additional worker supervision/training funds for a person who receives CFSS on a waiver/AC, the county/tribal nation follows:

1. The corresponding policy instructions on CFSS Manual – CFSS worker training and supervision.

2. The instructions below to update the ASA3 and AHC3 screens and force exception code 802.

ASA3 screen

The county/tribal nation:

1. Calculates the sum of the entry in the requested total amount (REQ TOT AMT) field of the worker supervision/training (S5116) line and the current rate listed under CFSS, worker training and development in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

2. Enters the result of step 1 in the requested total amount (REQ TOT AMT) field of the worker supervision/training (S5116) line.

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

Force exception code 802

After the county/tribal nation completes all needed changes and approves the SA, MMIS posts exception code 802. To force exception code 802, the county/tribal nation enters an F to replace the 4 after the 802 in the status (ST) field of the header on the ASA3 screen.

To add additional consultation services sessions, the county/tribal nation follows:

1. The corresponding policy instructions on CFSS Manual – CFSS consultation services overview.

2. The instructions below to update the ASA3 and AHC3 screens and force exception code 847.

ASA3 screen

The county/tribal nation:

1. Adds 6 to the entry in the requested total units (REQ TOT UNITS) field of the consultation services (T1023) line.

2. Enters the result of step 1 in the requested total units (REQ TOT UNITS) field of the consultation services (T1023) line.

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

Force exception code 847

After the county/tribal nation completes all needed changes and approves the SA, MMIS posts exception code 847. To force exception code 847, the county/tribal nation enters an F to replace the 4 after the 847 in the status (ST) field of the header on the ASA3 screen.

To change models, the county/tribal nation follows:

1. The corresponding policy instructions on CFSS Manual – PCA/CFSS process to change service options/models.

2. The instructions below to update the ASA3 and AHC3 screens.

ASA3 screen

The county/tribal nation:

1. Adds new lines for the service(s) the person will use in their new model (except consultation services), including all services the person will receive from the same provider. The county/tribal nation:

2. Ends all lines for services the person used in their previous model (except the consultation services line), including all services the person will receive from the same provider. The county/tribal nation:

Note: The combined total of the following lines for both models cannot exceed the person’s total eligible units (CFSS agency model) or dollars (CFSS budget model):

Personal care (T1019) line for the CFSS agency model

The county/tribal nation enters:

Personal care (T1019) line for the CFSS budget model

The county/tribal nation enters:

Goods and services (T5999) line

The county/tribal nation enters:

1. The total dollars the person plans to use (i.e., the dollars the person already has used and the dollars they will use during a coordinated transfer of care, if applicable) in the requested total amount (REQ TOT AMT) field of the goods and services (T5999) line.

2. The applicable reason code in the reason code (RSN CD) field of the goods and services (T5999) line based on the person’s circumstances:

PERS installation (S5160) line

PERS installation (S5160) is a one-time cost.

If the person used their PERS installation (S5160) line, the county/tribal nation takes no action.

If the person has not used their PERS installation (S5160) line, the county/tribal nation enters the denied (D) status code in the status code (STAT CD) field of the PERS installation (S5160) line.

PERS monthly service (S5161) line

The county/tribal nation enters the total number of months the person plans to use (i.e., the sum of the months the person already has used and the months they will use during a coordinated transfer of care, if applicable) in the requested total units (REQ TOT UNITS) field of the PERS monthly service (S5161) line.

PERS equipment purchase (S5162) line

PERS equipment purchase (S5162) is a one-time cost.

If the person used their PERS equipment purchase (S5162) line, the county/tribal nation takes no action.

If the person has not used their PERS equipment purchase (S5162) line, the county/tribal nation enters the denied (D) status code in the status code (STAT CD) field of the PERS equipment purchase (S5162) line.

FMS provider fee (T2040 – UB and UA) line

The county/tribal nation enters:

Failed background study (T2040 – UB, UA and U6) line

The county/tribal nation enters:

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

To change providers, the county/tribal nation follows:

1. The corresponding instructions on CFSS Manual – Changing PCA/CFSS providers.

2. The instructions below to update the ASA3 and AHC3 screens.

ASA3 screen

The county/tribal nation:

1. Adds new lines for the services the person will use with their new provider.

2. Completes the start date (START DT) fields of the new lines by entering the date immediately after the date in the end date (END DT) field of the lines for services authorized to the person’s previous provider.

3. Completes each new line by following the corresponding instructions on DSD MMIS Reference Guide – ASA3 screen overview.

4. Follows the instructions below to end all lines for services authorized to the person’s previous provider. The county/tribal nation does not end lines for services authorized to providers the person will continue using.

Consultation services (T1023) line

The county/tribal nation enters:

Personal care (T1019) line for the CFSS agency model

The county/tribal nation enters:

Personal care (T1019) line for the CFSS budget model

The county/tribal nation enters:

Worker supervision/training (S5116) line

The county/tribal nation enters:

Goods and services (T5999) line

The county/tribal nation enters:

PERS monthly service (S5161) line

The county/tribal nation enters:

FMS provider fee (T2040 – UB and UA) line

The county/tribal nation enters:

Failed background study (T2040 – UB, UA and U6) line

The county/tribal nation enters:

AHC3 screen

The county/tribal nation enters the following information in the additional comments (ADDITIONAL COMMENTS) field on the AHC3 screen:

If the county/tribal nation needs more space, they can enter comments in the additional comments (ADDITIONAL COMMENTS) field on the ADHS screen.

If a person using the CFSS agency model with goods, services and/or PERS or the CFSS budget model changes from receiving CFSS on a state plan (type B) SA to receiving CFSS on a waiver/AC SA, the assessor and county/tribal nation case manager must coordinate to:

1. Contact all providers to verify the units (CFSS agency model) or dollars (CFSS budget model) they need to bill for services provided on or before the end date of the state plan (type B) CFSS SA.

2. Calculate the units (CFSS agency model) or dollars (CFSS budget model) the person needs for each line type on the waiver/AC SA.
Note: The combined total of the following lines on both the state plan (type B) and waiver/AC SAs cannot exceed the person’s total eligible units (CFSS agency model) or dollars (CFSS budget model):

3. Enter the person’s CFSS services on the waiver/AC SA. They must use the units (CFSS agency model) or dollars (CFSS budget model) calculated in step 2 and follow the Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

4. End the state plan (type B) SA. If they cannot edit the state plan (type B) SA, they must continue to step 5.

5. Enter 580PWLMW64 in the override location (OVR LOC) field on the ASA2 screen of the waiver/AC SA to route the waiver/AC SA to DHS.
Note: The county/tribal nation only uses this override location (OVR LOC) field entry to change state plan (type B) CFSS SAs to waiver/AC SAs.

When DHS receives SAs routed to the 580PWLMW64 queue, DHS:

1. Ends the existing state plan (type B) SA.

2. Routes the waiver/AC SA to the county/tribal nation to finalize it.