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 the current CSG service agreement.

AGMT END DT

Enter SA end date. SA end date for CSG notice of reduction 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 the assessor has 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 the person has a responsible party.

LIVES WITH RESP PARTY (Y/N)

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

RESP PARTY NAME

Enter first and last name of the responsible party.

PROC and MOD1-4 fields

Enter procedure code T2025 (CONSUMER SUPPORT GRANT) and:

START/END DT fields

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

REQ TOT AMT

1. Multiply the 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 the CSG monthly amount on the current SA on the AHC3 screen for DHS reviewer.

PROV NBR

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

RSN CD

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

PROC and MOD1-4 fields

Enter procedure code T2025 with modifier UD (CSG with FSG) when person receives FSG.

START/END DT fields

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

REQ TOT AMT

1. Enter the annual FSG dollar amount in the requested total amount field.

2. Reduce the annual FSG dollar by calculating amount based on the number of months on the line when date span is less than 12 months.

3. Document the FSG monthly amount on the AHC3 screen for DHS reviewer.

PROV NBR

Enter the county (or FMS) NPI (National Provider Index) number or UMPI (Unique Minnesota Provider Index) number.

PHONE

Enter the phone number of the assessor.

SPRVSN NURSE

Enter the last and first name of the assessor.

ASSESSMENT DATE

Enter the date of the assessment in MMDDYY format.

BEGIN DATE and END DATE

Leave begin and end date for line item blank. MMIS auto-populates the BEGIN DATE and END DATE fields on the AHC1 screen after function key F9 is used.

NURSE VISIT

Leave the nurse visit field blank.

HOME HEALTH AIDE CD

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

PDN-RN CD

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

PDN-LPN CD

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

PCA CD

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

PC SUPERVISION CD

Enter an X in the CD field for supervision of PCA.

DIAGNOSIS 1

Enter the 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 an 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 Aug. 1, 2012, when code is Y (yes) or field is blank.

REF COMP

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

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

EN

Enter an X in the EN field if the person is on a ventilator a minimum of 6 hours per day for a minimum of 30 days. Leave EN field blank when EN does not apply.

PROV OWN/CTRL

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

ADDITIONAL COMMENTS

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

2. Document the FSG dollar amount for FSG line.

3. Document the reason for reduction in CSG monthly budget amount.

4. Document the PCA units/day, QP supervision hours/month if person were to return to PCA.

5. Date and initial all comments.

1. Document the reason for reduction in CSG monthly budget amount.

2. Date and initial all comments.

1. Document recommended dollar amount per month for home care rating EN.

2. Date and initial all comments.