A person using PCA/CFSS can change their service delivery plan at any time. For more information, refer to CFSS Manual – PCA/CFSS service delivery plan changes.

A person using PCA/CFSS can change their provider at any time. They can choose freely from all providers enrolled with the state to provide PCA/CFSS services.

When a person chooses a new provider, their current provider must work with the new provider to coordinate the transfer of care.

For more information, refer to CFSS Manual – Changing PCA/CFSS providers.

Options/models

PCA

A person using PCA can choose to change service options (i.e., traditional PCA and PCA Choice) at any time, unless the person is disallowed from using PCA Choice.

For more information, refer to CFSS Manual – PCA/CFSS process to change service options/models.

CFSS

A person using CFSS can choose to change models (i.e., CFSS agency model and CFSS budget model) at any time, unless the person is disallowed from using the budget model.

A person who exits the CFSS budget model during a service plan year is disallowed from using the budget model for the remainder of the service plan year.

DHS or the managed care organization (MCO) can exit a person from the CFSS budget model if the person is not fulfilling their employer requirements.

For more information, refer to CFSS Manual – PCA/CFSS process to change service options/models.

Shared services

A person can begin or discontinue sharing PCA/CFSS services at any time.

For more information, refer to CFSS Manual – Shared service option for PCA/CFSS.

Flexible use

A person can change how they plan to distribute their units/dollars throughout the service plan year, within PCA/CFSS rules.

For more information, refer to CFSS Manual – Flexible use of PCA/CFSS services.

To address a person’s change in condition, a provider can request a temporary increase of PCA/CFSS services. The increase cannot exceed 45 days. If the person requires an increase of PCA/CFSS services for more than 45 days, the lead agency assessor must complete a new assessment.

For more information, refer to CFSS Manual – 45-day temporary increase of PCA/CFSS services.

In addition to an annual reassessment, the lead agency must reassess a person if they have a change in condition.

For more information, refer to CFSS Manual – PCA/CFSS change in condition or health status.

After a person exits their MCO, their PCA/CFSS provider has 30 days following the date of disenrollment to request a temporary authorization of fee-for-service PCA/CFSS.

For more information, refer to CFSS Manual – PCA/CFSS MCO disenrollment process.

A PCA/CFSS provider can choose to discontinue providing services to a person. A person can also choose to discontinue receiving services from a provider.

If the provider initiates the discontinuation, the provider must give the person a minimum of a 10-day notice (for PCA) or 30-day notice (for CFSS) and work with the person's new provider to ensure continuity of care. For more information, refer to CFSS Manual – Changing PCA/CFSS providers.

The lead agency must provide the person with a notice of action when they:

The notice of action must explain the reduction, termination or denial and the person's appeal rights. For more information, refer to CBSM – Notice of action.

Additional CFSS information

In CFSS, the consultation services provider must provide the person with a notice of action when the provider reduces or denies part or all of a person's plan. The notice of action must explain the reduction or denial and the person's appeal rights. For more information, refer to CBSM – Notice of action.