Minn. Stat. §256B.0659, subd. 12, 28 (4), 24 (2) (3) (5) (7)

PCA time and activity documentation: A written document recording PCA services provided to assist a person.

A PCA worker must document all time and activity provided to each person daily. Documentation:

Providers use the documents to bill Medical Assistance for authorized PCA services. Medical Assistance only pays for PCA time and activity authorized and described in the care plan.

Agencies may either:

All PCA time and activity documentation must contain, at a minimum, the following:

Provider information: Agency name, phone number

Recipient information: Name, Minnesota Health Care Programs identification (MHCP ID) number or date of birth, dates and location of the person’s stays in hospital, care facility or incarceration

PCA worker information: Name, Unique Minnesota Provider Identifier (UMPI)

Dates of service: Day, month and year of each service, in consecutive order

Service information: Arrival and departure times of each visit, including a.m. and p.m. notations

Shared services: Staff-to-recipient ratio and location of visit

All daily activities provided (same or similar categories): Dressing, grooming, bathing, eating, transfers, mobility, positioning, toileting, health-related needs, behavior observation and redirection

Instrumental activities of daily living (IADLs) (not allowed for people younger than age 18): Light housekeeping, laundry, meal preparation, other

Total time: Daily total time and total for timesheet

Fraud statement: Time and activity documentation must include a fraud statement. Directly above signatures, include the following language:
It is a federal crime to provide false information on PCA billing for Medical Assistance payment. Your signature verifies the time and services entered are accurate and that the services were performed as specified in the PCA care plan.

Acknowledgement and signatures: The person receiving services should draw a line through documented dates and times when they did not receive services. This is not required for web-based or electronic documentation.

Required signatures: Person receiving services/responsible party and PCA worker

Date(s) of signatures: Date(s) the form is signed by each party

The PCA provider agency is responsible to make sure time and activity documentation is:

The agency is responsible to:

1. Verify documentation of each PCA worker’s hours worked
2. Pay PCA workers based on the actual number of hours of services provided
3. Have a template with English translation available when using time and activity documentation in another language.