Minnesota Minnesota

CFSS Policy Manual

CFSS Policy Manual


Eligibility for PCA/CFSS services

Page posted: 8/26/24

Page reviewed:

Page updated: 4/21/25

Legal authority

Minn. Stat. §256B.0651, Minn. Stat. §256B.0659, Minn. Stat. §256B.85, subd. 3, Minn. Stat. §252.32

Comparison of PCA and CFSS

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

To receive PCA/CFSS services, a person must meet all of the criteria listed on this page.

Differences

There are no differences in the access criteria for PCA and CFSS.

Definition

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.

Criteria

To receive PCA/CFSS services, a person must meet all of the following criteria:

1. Use one of the following Minnesota Health Care Programs:

  • · Alternative Care (AC).
  • · Home and community-based services (HCBS) waivers.
  • · Medical Assistance (MA).
  • · Pregnant people and people under the age of 19 who are on MinnesotaCare.
  • 2. Not live in any of the following settings:

  • · Hospital.
  • · Nursing facility.
  • · Intermediate care facility for persons with developmental disabilities (ICF/DD).
  • · Foster care setting licensed for more than six people.
  • Notes:

  • · A person planning to move to an allowable setting can access consultation services set-up in an institution before moving. For more information, refer to CFSS Manual – CFSS consultation services overview.
  • · There are additional guidelines for people living in some HCBS settings. For more information, refer to CFSS Manual – PCA/CFSS services in HCBS settings.
  • 3. Not live in housing owned or controlled by their PCA/CFSS provider agency. For more information, refer to CFSS Manual – PCA/CFSS provider-owned or -controlled housing.

    4. Be able to direct their own care (or have an RP/representative do so on their behalf), which means they can:

  • · Identify their own needs.
  • · Direct and evaluate worker tasks and accomplishments.
  • · Provide and arrange for their own health and safety.
  • 5. Receive an assessment, as described on CFSS Manual – Assessment for PCA/CFSS services, that determines at least one of the following is true:

  • · The person requires hands-on assistance or cueing and supervision to complete at least one activity of daily living (ADL) (refer to CFSS Manual – PCA/CFSS covered services).
  • · The person has a level I behavior (i.e., physical aggression toward themselves or others or destruction of property that requires an immediate response from another person).
  • 6. Not use the Family Support Grant (FSG) (refer to CBSM – FSG).

    Additional resources

    CFSS Manual – 45-day temporary start of PCA/CFSS services
    CFSS Manual – Assessment for PCA/CFSS services
    CFSS Manual – Extended PCA/CFSS services
    CFSS Manual – PCA/CFSS age-appropriate dependencies
    CFSS Manual – PCA/CFSS covered services
    CFSS Manual – PCA/CFSS exceptions to prior authorization
    CFSS Manual – PCA/CFSS services in HCBS settings
    CFSS Manual – PCA/CFSS units determination
    CFSS Manual – PCA communication to a person’s physician
    CFSS Manual – Reassessment for PCA/CFSS services
    CFSS Manual – Responsible party (PCA) and participant’s representative (CFSS)
    CFSS Manual – Transition from PCA and CSG to CFSS

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