Minnesota Minnesota

CFSS Policy Manual

CFSS Policy Manual


Minnesota Restricted Recipient Program (MRRP) for PCA/CFSS

Page posted: 8/26/24

Page reviewed:

Page updated:

Legal authority

Minn. Stat. §256B.0646, Minn. Stat. §256B.85, subd. 11 and 13, Minn. R. 9505.2165

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

The policies and processes for the Minnesota Restricted Recipient Program (MRRP) are the same for PCA and CFSS. There are no differences.

Overview

In both PCA and CFSS, DHS might place a person on MRRP if:

  • · The person’s use of PCA or CFSS results in abusive or fraudulent billing.
  • · The person used Minnesota Health Care Programs (MHCP) services beyond what was medically necessary.

    • There are restrictions to how a person on MRRP can use PCA/CFSS, as described on this page.

    DHS typically places people on MRRP for two years. Once a person is no longer on MRRP, the restrictions are no longer in place.

    Requirements

    A person on MRRP cannot use:

  • · PCA Choice or the CFSS budget model.
  • · More than one provider agency.
  • · Units flexibly throughout a six-month span (PCA) or service plan year (CFSS).

    • All other service options available to all people using PCA/CFSS are available to a person on MRRP, including, but not limited to:

  • · Traditional PCA or the CFSS agency model (refer to CFSS Manual – PCA service options and CFSS service models).
  • · Units flexibly within each month of their service authorization (refer to CFSS Manual – Flexible use of PCA/CFSS services).
  • · Shared care (refer to CFSS Manual – Shared service option for PCA/CFSS).
  • · Purchase of goods and services (CFSS only; refer to CFSS Manual – Goods and services through CFSS).
  • · Purchase of personal emergency response systems (CFSS only; refer to CFSS Manual – Personal emergency response systems through CFSS).

    • Lead agency’s responsibilities

    Person is on MRRP at assessment

    If a person is already on MRRP at the time of assessment, the lead agency issues a service authorization that:

  • · Is for traditional PCA or the CFSS agency model.
  • · Includes a separate line item for each month.

    • The rest of the process is the same.

    DHS places person on MRRP

    If DHS places a person on MRRP:

    1. DHS notifies the lead agency.

    2. The lead agency conducts a new assessment.

    3. The lead agency issues a service authorization that:

  • · Is for traditional PCA or the CFSS agency model.
  • · Includes a separate line item for each month.

    • The rest of the process is the same.

    Person’s responsibilities

    The person is responsible to comply with MRRP restrictions for the duration of their time on MRRP.

    PCA/CFSS provider agency’s responsibilities

    The PCA/CFSS provider agency must check the Medical Assistance (MA) status of all people they serve each month. If the provider agency discovers a person is on MRRP but not restricted to traditional PCA/CFSS agency model, the provider agency must inform DHS using PCA/CFSS Technical Change Request, DHS-4074A.

    For a person placed on MRRP because of their use of PCA/CFSS, the qualified professional (PCA) or supervising professional (CFSS) must monitor services on a monthly basis and report service usage to the PCA/CFSS provider agency.

    DHS’ responsibilities

    DHS must update the service agreement of a person on MRRP when the PCA/CFSS provider agency informs DHS that the person’s service agreement does not reflect their MRRP status.

    Note: If a person is enrolled in a managed care organization (MCO), the MCO follows its process when it receives information about a service agreement that does not reflect MRRP status.

    Right to appeal

    A person may appeal placement on MRRP by submitting a written request to the county/tribal nation or to the DHS Appeals Division. The person may use Appeal to State Agency, DHS-0033 to submit their appeal request to DHS.

    Note: If a person is enrolled in an MCO, they should contact their MCO for information about appeals.

    Additional resources

    Appeal to State Agency, DHS-0033
    CBSM – Appeals
    CFSS Manual – Transition from PCA and CSG to CFSS
    PCA/CFSS Technical Change Request, DHS-4074A

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