Federally approved BI, CAC, CADI, DD and EW waiver plans, Minn. Stat. §256B.0651, Minn. R. 9505.0290

A person can use their individual CDCS funds to purchase personal care assistance (PCA), Community First Services and Supports (CFSS) and/or home care services. The lead agency must authorize the PCA/CFSS and/or home care services:

This page explains the specific requirements and authorization/billing processes.

Authorizing PCA/CFSS services and home care separately from other CDCS goods and services:

Applies

This page applies to:

Does not apply

Extended PCA/CFSS and home care services through Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) and Elderly Waiver (EW)

This page does not apply to the following traditional waiver services:

For policy and authorization instructions, refer to CDCS Manual –Purchasing traditional AC/waiver goods and services under CDCS.

PCA/CFSS and home care through Alternative Care (AC)

This page does not apply to PCA/CFSS and home care services through AC. For policy and authorization instructions, refer to CDCS Manual – Purchasing traditional AC/waiver goods and services under CDCS.

Home health therapies

This page does not apply to home health therapies. If a person is using home health therapies, the lead agency does not include the cost in their CDCS budget.

To purchase PCA/CFSS and/or home care services, the person must:

The person and their providers must follow all policies for the PCA/CFSS and/or home care services the person will use, as described in:

For information about how purchasing PCA/CFSS and home care services affects the person’s CDCS budget, refer to CDCS Manual – Resource: CDCS budget impacts when purchasing PCA/CFSS, home care and extended waiver services.

The instructions for authorization vary based on the person’s circumstances.

Instructions for people not enrolled in an MCO

If a person not enrolled in an MCO selects PCA/CFSS and/or home care services:

1. The county/tribal nation authorizes the PCA/CFSS or home care services on separate lines from CDCS services.

2. The county/tribal nation uses the applicable service code and provider number on the service agreement, as described below.

3. The provider submits claims directly to DHS.

PCA

During the transition to CFSS, if the person is using PCA at the time of their assessment, the county/tribal nation follows the instructions for entering PCA services on DSD MMIS Reference Guide – ASA3 screen overview.

CFSS agency model

The county/tribal nation follows the instructions for CFSS on DSD MMIS Reference Guide – ASA3 screen overview.

CFSS budget model

The county/tribal nation follows the instructions for CFSS on DSD MMIS Reference Guide – ASA3 screen overview.

Note: The county/tribal nation must authorize all CFSS services (except consultation services) to the same financial management services (FMS) provider as the person’s CDCS services.

HCN

The county/tribal nation authorizes HCN services to the HCN agency and follows the instructions on CBSM – HCN.

Home health

The county/tribal nation authorizes home health services to the home health agency and follows the instructions on CBSM – Home health agency services.

Instructions for people age 65 or older and enrolled in an MCO

BI, CAC, CADI and DD waivers

If a person on BI, CAC, CADI or DD receives their PCA/CFSS and/or home care services through their MCO:

1. The county/tribal nation authorizes these services using the X5609 code.

2. The provider submits claims directly to the MCO.

EW

If a person on EW receives their PCA/CFSS and/or home care services through their MCO, the MCO follows its procedures.

Instructions for people younger than age 65 and enrolled in an MCO

PCA and CFSS

The county/tribal nation follows the instructions for PCA/CFSS on DSD MMIS Reference Guide – ASA3 screen overview.

HCN

The county/tribal nation authorizes HCN services to the HCN agency and follows the instructions on CBSM – HCN.

SNV and HHA

If a person on BI, CAC, CADI or DD receives their SNV and/or HHA through their MCO:

1. The county/tribal nation authorizes these services using the X5609 code.

2. The provider submits claims directly to the MCO.

CDCS Manual – Purchasing traditional AC/waiver goods and services under CDCS
CDCS Manual – Resource: CDCS budget impacts when purchasing PCA/CFSS, home care and extended waiver services
CBSM – HCN
CBSM – Home health agency services
CFSS Manual – PCA/CFSS services on a waiver/AC
DSD MMIS Reference Guide – ASA3 screen overview
PCA Manual