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Personal Care Assistance

Health plan (PMAP) disenrollment process

Page posted: 02/04/10

Page reviewed:

Page updated: 04/27/11

Legal Authority

Minn. Stat. §256B.0652, subd. 14 (5)

Description

Process used by PCA provider agency to request PCA authorization when a person is disenrolled from a prepaid Medical Assistance plan (PMAP).

Policy

DHS will authorize fee-for-service PCA to continue for up to three months with proof of the health plan authorization for services.

A provider has 30 days following the date of PMAP disenrollment to request a temporary authorization of fee-for-service PCA.

The temporary authorization is valid for up to 90 days. Authorization beyond 90 days from disenrollment requires a face-to-face assessment by the lead agency.

PCA Provider Agency Responsibilities

On a monthly basis, the provider must confirm eligibility for Medical Assistance and determine the payor by checking the MN-ITS.

Notifications to DHS

Within 30 calendar days of the disenrollment, the provider must:

  • • Complete and fax a PCA Technical Change Request (DHS-4074A) (PDF) to DHS
  • • Include a copy of the current PMAP authorization
  • If it is likely the person will not reenroll within 90 days, the provider must send a Referral for PCA Services (DHS-3244P) (PDF) to the lead agency as soon as possible.

    Notifications to the lead agency or health plan

    DHS will not authorize temporary or long-term services unless the recipient has a current assessment. If an assessment is due, the provider must notify the health plan and/or the lead agency regarding the need for an assessment.

    Recipient Responsibilities

    A person is responsible to maintain eligibility for MA and PMAP.

    Lead Agency Responsibilities

    The lead agency must conduct an assessment within 30 days of a request from the provider or recipient. These situations include:

    1. The managed care assessment or authorization has expired prior to the end of the 90-day period.
    2. The recipient will not be re-enrolling in managed care before the temporary authorization ends.

    Once the lead agency receives the Referral for PCA Services the lead agency is responsible to:

  • • Schedule and complete the reassessment within 30 days
  • • Enter the assessment data into MMIS
  • • Resolve edits
  • DHS Responsibilities

    DHS staff will process the request.

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    Updated: 9/16/13 10:43 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 9/16/13 10:43 AM