Minnesota Minnesota

CFSS Policy Manual

CFSS Policy Manual


PCA/CFSS provider agency worker wage and benefit requirements

Page posted: 8/26/24

Page reviewed:

Page updated: 4/18/25

Legal authority

Minn. Stat. §256B.85

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

In both PCA and the CFSS agency model, the policies and procedures for worker wages and benefits are the same, as outlined on this page.

Differences

In the CFSS budget model, the person or their representative is responsible to follow responsibilities listed in the CFSS-specific section on CFSS Manual – PCA service options and CFSS models. This page does not include information about the CFSS budget model.

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.

Overview

PCA/CFSS provider agencies must follow all applicable local, state and federal laws related to worker wages and benefits. This page outlines additional policies provider agencies must follow.

For information about financial management services (FMS) provider requirements, refer to CFSS Manual – FMS providers for CFSS.

PCA/CFSS provider agency’s responsibilities

Each PCA/CFSS provider agency is responsible to:

  • · Determine 72.5% of its revenue from the PCA/CFSS rate (refer to the included costs section on this page).
  • · Pay PCA/CFSS wages and benefits equal to or greater than the sum total of 72.5% of the revenue from the rate for PCA/CFSS services.
  • · Document compliance with this policy (refer to the documentation section on this page).

    • Included costs

    The 72.5% applies to the aggregate amount the PCA/CFSS provider agency receives for all the covered PCA/CFSS services provided by all PCA/CFSS workers.

    The employer portion of PCA/CFSS wages and benefits in the 72.5% may include, but is not limited to:

  • · Wages for the worker’s time providing PCA/CFSS services.
  • · Insurance (e.g., health, dental, vision, life, health care savings account, long-term care, short- and long-term disability).
  • · Vacation, sick and overtime benefits.
  • · Wages for time providing non-billable services (e.g., attending training, transportation between people using PCA/CFSS services).
  • · Retirement benefits.
  • · Payroll taxes (e.g., FICA, FUTA, SUTA, Medicare, workers’ compensation).
  • · Tuition reimbursement and continuing education benefits.
  • · Mileage reimbursement.
  • · Uniform allowance.
  • · Wellness program benefits.

    • Limitations

    PCA/CFSS provider agencies cannot include PCA/CFSS wages and benefits that are program-related costs in the 72.5%. These costs may include, but are not limited to:

  • · Administrative staff wages and benefits.
  • · Business expenses (e.g., information technology, human resources, legal accounting).
  • · Cost of providing training (e.g., materials, paying/hiring a trainer).
  • · Recruitment-related expenses.
  • · Fees (e.g., licenses, background checks, trade association fees, organization memberships, city charges/fees, rental property inspection costs).
  • · Training for any staff other than direct care workers.
  • · Provider agency insurance and bonding (e.g., liability, property, vehicle, fidelity, surety).

    • PCA-specific information

    Qualified professional (QP) units are separate, so PCA provider agencies should not include them in calculations for the 72.5%. For more information, refer to PCA Manual – QP authorization.

    CFSS-specific information

    The CFSS worker training and development budget is separate, so the CFSS provider agency should not include it in its calculations for the 72.5%. For more information, refer to CFSS Manual – CFSS worker training and supervision.

    Documentation

    The PCA/CFSS provider agency must be able to show at least 72.5% of all paid claims for procedure code T1019 (excluding UA modifier) were spent on PCA/CFSS wages and benefits.

    The PCA/CFSS provider agency must document:

  • · Procedures used to determine and ensure 72.5% of revenue from the PCA/CFSS rate are used for PCA/CFSS worker wages and benefits.
  • · Wages and benefits paid to individual PCA/CFSS workers.

    • The PCA/CFSS provider agency must be able to provide this documentation to DHS upon request.

    Enhanced rate/budget

    PCA/CFSS provider agencies must follow DHS policies for paying workers who provide services that are eligible for an enhanced rate/budget. For more information, refer to CFSS Manual – PCA, CFSS and CSG enhanced rate/budget.

    Additional resources

    CFSS Manual – CFSS worker training and supervision
    CFSS Manual – FMS provider requirements for CFSS
    CFSS Manual – PCA service options and CFSS models
    CFSS Manual – PCA, CFSS and CSG enhanced rate/budget
    CFSS Manual – Transition from PCA and CSG to CFSS
    PCA Manual – QP authorization
    DHS – PCA and CFSS tiered rates and wage floors

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