Federally approved BI, CAC, CADI, DD and EW waiver plans, Minn. Stat. §256B.0659, subd. 1(g), Minn. Stat. §256B.85, subd 2(l)

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

For both PCA and CFSS:

Differences

In PCA, neither state plan nor extended PCA covers the purchase of goods or back-up systems.

In CFSS, state plan covers the purchase of goods and back-up systems. However, extended CFSS can only be used for services and cannot be used to purchase goods or back-up systems.

Extended PCA/CFSS services: Waiver services that follow Medical Assistance (MA) state plan PCA/CFSS policies but are allowed to exceed the state plan limits on amount, duration and frequency based on a person’s assessed need.

The lead agency may only authorize extended PCA/CFSS services when all of the following conditions are met:

All policies and limitations on CFSS Manual – PCA/CFSS covered services apply to extended PCA/CFSS services, except for the amount and duration of the service.

Extended PCA/CFSS services are available on the following waivers:

CFSS-specific information

The person can only use extended CFSS units for personal care services from the CFSS personal care worker.

In the CFSS budget model, extended CFSS units convert into dollars at the same rate as state plan units.

Extended PCA/CFSS services are not available on the Alternative Care (AC) program. People on the AC program use state plan PCA/CFSS services. For information about the AC program, refer to CBSM – AC.

CFSS-specific information

The person cannot use extended CFSS hours/dollars to purchase goods, services or back-up systems.

Note: In PCA, neither state plan nor extended PCA covers the purchase of goods, services or back-up systems.

All providers who deliver extended PCA/CFSS services must meet the same qualifications as providers who deliver state plan services. The following sections provide specific information and links for each provider type.

PCA/CFSS provider agencies

The PCA/CFSS agency provider must:

For information about provider qualifications, refer to CFSS Manual – PCA/CFSS provider agency requirements overview.

Consultation services providers (CFSS only)

For extended CFSS, the consultation services provider’s qualifications and responsibilities are the same as usual. For more information, refer to CFSS Manual – CFSS consultation services provider requirements.

Financial management services (FMS) providers (CFSS only)

For extended CFSS, the FMS provider’s qualifications and responsibilities are the same as usual. However, the FMS provider must not bill the state for goods or back-up systems using extended waiver funds. For more information, refer to CFSS Manual – FMS provider requirements for CFSS.

The case manager authorizes both state plan and extended PCA/CFSS services on the same service agreement using the MnCHOICES Support Plan. The case manager must:

For information about limits and HCPCS procedure codes, refer to DHS – CFSS codes and rates.

Services through a managed care organization (MCO)

BI, CAC, CADI and DD

To authorize extended PCA/CFSS services for people on BI, CAC, CADI and DD waivers who are age 65 or older and enrolled in an MCO, the county/tribal nation case manager must:

1. Enter placeholder HCPCS procedure code X5609 in MMIS for the state plan PCA/CFSS services for which the MCO is responsible for authorizing. When using this code, the case manager must indicate all of the following:

2. Follow the authorization instructions for extended PCA/CFSS services outlined above.

For more information, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

EW

To authorize extended PCA/CFSS services for people on EW who are enrolled in an MCO, the care coordinator follows the MCO’s procedure, unless the person receives case management through a tribal nation. Contact the case manager at the tribal nation for more information and also refer to CBSM – Tribal administration and management of HCBS programs.

Extended PCA/CFSS hours do not count toward the person’s eligibility for the enhanced rate/budget. However, if the person is eligible for 10 or more hours of state plan PCA/CFSS and has a qualifying worker, the enhanced rate/budget also applies to the person’s extended PCA/CFSS rate.

For more information, refer to: