Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, Minn. Stat. §256B.0659, subd. 17a, Minn. Stat. §256.476, subd. 11, Minn. Stat. §256B.0913

Definitions

Overview

This page provides counties/tribal nations with program- and/or service-specific information about implementing the enhanced rate or budget for people at initial assessment or reassessment.

Counties/tribal nations and provider agencies working with a person who receives PCA through a managed care organization (MCO) must check with the MCO about how it manages the enhanced rate or budget.

Effective Jan. 1, 2022, the information on this page applies to people at initial assessment or reassessment who are eligible for at least 10 hours of state plan PCA per day and receive:

Refer to the specific sections on this page for information about:

Qualifying training

To qualify for the wage/benefit increase resulting from the enhanced rate/budget, workers need to complete qualifying trainings. The worker must submit documentation of training completion on the Minnesota Direct Support Worker Training site.

Tracking qualifying trainings

Counties/tribal nations are not responsible for tracking whether a worker has completed the qualifying trainings. A company contracted with DHS tracks this information and shares it with the worker and DHS.

PCA provider agencies and financial management services (FMS) providers should encourage workers to review DHS – Qualifying for the enhanced rate. It has information about how to register for qualifying trainings and submit documentation of completed trainings.

If a worker completed the qualifying trainings using a license or certification, their eligibility expires when that license or certificate expires. A worker is responsible to submit proof of continuing eligibility (i.e., an updated certificate or license or proof they completed another qualifying training) on the Minnesota Direct Support Worker Training website before their eligibility expires to remain qualified. If a worker fails to remain qualified, the provider agency/FMS provider will no longer receive the enhanced reimbursement.

The process to update the individual provider enrollment file can take up to 30 days after the DHS contractor verifies recertification. Workers should start the recertification process before their license or certification expiration date to avoid a lapse in enhanced reimbursement to the provider agency/FMS provider.

Passing on the increase

Traditional PCA and PCA Choice (including extended PCA)

Starting on the date the worker qualifies, the PCA provider agency must pass on the 7.5% enhanced rate in wages and/or benefits to the specific worker who both:

CSG

The FMS provider must work with the person to add the additional information to the service delivery plan to give the 7.5% enhancement to the specific worker who both:

For instructions, refer to the FMS provider responsibilities section below.

MMIS programming

In MMIS, the enhanced rate/budget is called “PCA complex.” To implement the enhanced rate/budget effective Jan. 1, 2022, counties/tribal nations must complete the following fields in MMIS:

Specific instructions for MMIS and implementation timelines vary depending on the program. For more information, refer to the applicable sections on this page.

Person’s responsibilities

Traditional PCA and PCA Choice

A person using PCA does not have any responsibilities related to the enhanced rate/budget.

CSG

Person who has a qualifying worker at assessment

If a person using CSG has a qualifying worker at the time of assessment, they are responsible to ask their worker to give a copy of administrator’s confirmation letter to the person and the county/tribal nation assessor.

Person who finds a qualifying worker after assessment

If a person using CSG finds a qualifying worker after assessment, they are responsible to:

1. Ask their worker to give a copy of administrator’s confirmation letter to the person and the FMS provider.

2. Work with their FMS provider to update their service delivery plan

PCA provider agency responsibilities

PCA provider agencies are responsible to:

FMS provider responsibilities

If an eligible person on CSG has a qualifying worker at the time of assessment, the FMS provider does not have responsibilities related to the enhanced budget.

If an eligible person identifies a qualifying worker after the assessor enters the assessment, the FMS provider follows the instructions in the modifying existing service agreements section lower on this page.

Lead agency responsibilities

The lead agency is responsible to conduct the assessment as usual and authorize eligible people at the enhanced rate/budget using the applicable instructions in this section for:

For people enrolled in an MCO, the MCO follows its own process for the enhanced rate/budget.

For people not enrolled in an MCO, the county/tribal nation must enter a valid value in the PCA complex field. If the county/tribal nation enters a PCA service agreement that does not have a valid value in the PCA complex field, the county/tribal nation will receive an edit to resolve.

State plan PCA not on a waiver/AC (type B service agreement)

If the person is eligible

To authorize the enhanced rate in MMIS for an eligible person, the county/tribal nation must do all the following:

1. Enter a Y indicator in the PCA complex field on the ALT4 screen of the long-term care (LTC) screening document (not applicable if county/tribal nation is not entering a screening document).

2. Enter a Y indicator in the PCA complex field on the ASA2 screen in the service agreement.

3. Enter the T1019 TG modifier code on the PCA line items on the ASA3 screen on the service agreement using the new state-set enhanced rate.

If the person is not eligible

If the person is not eligible for the enhanced rate, the county/tribal nation must do all the following:

1. Enter an N indicator in the PCA complex field on the ALT4 screen of the LTC screening document (not applicable if county/tribal nation is not entering a screening document).

2. Enter an N indicator in the PCA complex field on the ASA2 screen on the service agreement.

State plan PCA on a waiver/AC (including extended PCA)

If the person is eligible

To authorize the enhanced rate in MMIS for an eligible person, the county/tribal nation must do all the following:

1. Enter a Y indicator in the PCA complex field on the ALT4 screen of the LTC screening document to correspond with field 100a on the LTC Screening Document, DHS-3427 (PDF).

2. AC/EW only: If adding the enhanced rate on the service agreement creates a budget that exceeds the current AC/EW case mix cap:

3. Enter a Y indicator in the PCA complex field on the ASA2 screen in the service agreement.

4. Enter the applicable modifier code (state plan is T1019 TG and extended PCA is T1019 UC TG) on the PCA line items on the ASA3 screen on the service agreement using the new state-set enhanced rate.

Note: Extended PCA hours do not count toward eligibility for the enhanced rate. However, if a person is eligible for 10 or more hours of state plan PCA and has a qualifying worker, the enhanced rate also applies to the person’s extended rate.

If the person is not eligible

If the person is not eligible for the enhanced rate, the county/tribal nation must do all the following:

1. Enter an N indicator in the PCA complex field on the ALT4 screen of the LTC screening document.

2. Enter an N indicator in the PCA complex field on the ASA2 screen on the service agreement.

CSG

If the person is eligible

To authorize the enhanced budget for an eligible person who has already identified a qualifying worker, the county/tribal nation must do all the following:

1. Enter a Y indicator in the PCA complex field on the ASA2 screen on the service agreement.

2. Enter the regular budget amount on the T2025 line item on the ASA3 screen on the service agreement.

3. Complete PCA Request Form, DHS-4292 to request an enhanced budget. On DHS-4292, the county/tribal nation should:

4. Enter a note on the service agreement to document that the county/tribal nation has submitted DHS-4292 to request the enhanced budget because the person has a qualifying worker.

If the person is eligible but has not yet identified a qualifying worker, the county/tribal nation must:

1. Enter a Y indicator in the PCA complex field on the ASA2 screen.

2. Enter the regular CSG budget.

If the person and FMS provider identify a qualifying worker during the approved service agreement span, the person and FMS provider can initiate the process of requesting the enhanced budget. For information about this process, refer to the modifying existing service agreements section on this page.

If the person is not eligible

If the person is not eligible for the enhanced budget, the county/tribal nation must enter an N indicator in the PCA complex field on the ASA2 screen on the service agreement and authorize the regular CSG budget.

Modifying existing service agreements

Exceeding current AC/EW case mix cap

For AC/EW only, if adding the enhanced rate on the service agreement creates a budget that exceeds the current AC/EW case mix cap, the lead agency must request an exception to the case mix budget by following the budget exception process for AC/EW.

CSG

If person on CSG identifies a qualifying worker after the assessor enters the service agreement:

1. A DHS contractor notifies the worker that they completed the qualifying training.

2. The worker shows the notification to the person who receives CSG.

3. The person who receives CSG gives the notification to their FMS provider.

4. The FMS provider uses PCA Technical Change Request, DHS-4074A to request the enhanced budget from DHS. On DHS-4074A, the FMS provider should:

Once DHS receives the 4074A form, DHS will check to see if the person who receives CSG is eligible, update the eligible person’s budget and generate a service agreement letter through MMIS. The person and FMS provider will add the additional information to the plan to give the qualified worker(s) a 7.5% wage or benefit increase.

Reassessments