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Personal Care Assistance

Discontinue as provider of PCA services

Page posted: 02/04/10

Page reviewed:

Page updated: 04/19/11

Description

Process to use when a provider chooses to discontinue PCA services for a recipient.

Policy

The provider discontinuing services must release T1019 units not used so DHS may enter a service agreement for the new provider.

The provider cannot bill for services provided after the last date of service documented on the change request.

PCA Provider Agency Responsibilities

Fee-for-service:

Provider faxes the Personal Care Assistance Technical Change Request, DHS-4074A, (PDF) to DHS indicating:

  • • Technical change or correction to an existing services agreement
  • • Service agreement number
  • • Type of request
  • • Last date of service by the current provider
  • • Number of T1019 units released
  • • Other required information
  • Waiver: Contact the case manager.

    Managed Care: Contact the care coordinator.

    Recipient Responsibilities

    The recipient/responsible party is responsible to choose another PCA provider agency.

    Lead Agency Responsibilities

    Fee for service: The lead agency is responsible to offer resources for locating PCA provider agencies.

    Waiver: The case manager is responsible to:

  • • Locate PCA provider agencies
  • • Provide assistance with the transition on the authorization
  • Managed Care: The care coordinator is responsible to provide the assistance per health plan policy.

    DHS Responsibilities

    Fee for service:

    DHS staff will:

  • • Review the last billing/claims date
  • • End the line item for the provider on the service agreement based on the last billing/claims date
  • • Enter notes on the ADHS screen to indicate the number of units released over the daily average and the original end date of the agreement
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    Updated: 7/20/17 1:36 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 7/20/17 1:36 PM