Transition from PCA to CFSS

DHS is in the process of replacing personal care assistance (PCA) and the Consumer Support Grant (CSG) with Community First Services and Supports (CFSS). For more information about this transition, refer to CFSS Manual – Transition from PCA and CSG to CFSS.

For a Medicaid Management Information System (MMIS) transition summary, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

Similarities

In both PCA and CFSS, the county/tribal nation:

Differences

In PCA, the county/tribal nation:

In PCA, the total units of all lines the county/tribal nation enters is the same as the total units for which the person is eligible.

In CFSS, the county/tribal nation:

In CFSS, the total personal care units (agency model) or dollars (budget model) the person uses might be lower than the total units or dollars for which they are eligible if the person chooses to purchase goods, services or personal emergency response systems (PERS).

Overview

The county/tribal nation enters lines for the person’s specific services on the ASA3 screen. This page describes how to enter a personal care line (T1019) for a PCA or CFSS service agreement (SA). For information and instructions about other ASA3 line types, refer to DSD MMIS Reference Guide – ASA3 screen overview.

Initial authorization

Person who currently uses PCA

When a person who currently uses PCA is eligible for and selects CFSS, the county/tribal nation authorizes six months of PCA, including a personal care (T1019) line, PCA worker supervision/training (T1019 – UA) line and consultation services (T1023) line. After the county/tribal nation approves the person’s CFSS service delivery plan, the county/tribal nation enters a new SA with the CFSS services.

Instructions to resolve MMIS exception code 323 error

MMIS may post exception code 323 when the county/tribal nation enters an SA for a person who currently receives PCA and whose person master index (PMI) number changed. If MMIS posts exception code 323, the county/tribal nation cannot edit the SA and must follow the instructions below based on the person’s circumstances:

Person who does not currently use PCA

When a person who is new to services is eligible for and selects CFSS, the county/tribal nation authorizes consultation services (T1023) only. After the county/tribal nation approves the person’s CFSS service delivery plan, the county/tribal nation adds lines for the other services the person selected.

Instructions to resolve MMIS exception code 323 error

MMIS may post exception code 323 if the county/tribal nation enters the following line types for a person who does not currently use PCA or CSG:

If MMIS posts exception code 323, the county/tribal nation cannot edit the SA and must follow the instructions below based on the person’s circumstances:

Line comments field (LI COMMENTS)

In the optional line comments (LI COMMENTS) field, the county/tribal nation enters additional clarifying information, if desired. This comment appears in the person’s letter and the provider’s letter.

Procedure code field (PROC)

In the procedure code (PROC) field, the county/tribal nation enters the personal care services procedure code (T1019).

Modifiers field (MOD1-4)

In the modifiers (MOD1-4) field, the county/tribal nation enters up to four modifiers to provide additional information needed for authorization and billing. The order of the modifiers does not matter.

PCA modifiers

In PCA, the county/tribal nation does not enter a modifier to indicate if the person uses traditional PCA or PCA Choice.

CFSS model modifiers

For each personal care line entered, the county/tribal nation enters the modifier for the model the person selected:

MMIS posts an exception code the county/tribal nation must resolve if the county/tribal nation:

Enhanced rate modifier

In both PCA and CFSS, the county/tribal nation enters the enhanced rate modifier (TG) if the person is eligible for the enhanced rate, regardless of whether they will use it. The county/tribal nation cannot use the enhanced rate modifier (TG) if the person is not eligible for the enhanced rate.

Claims-only modifiers

The county/tribal nation cannot enter the following claims-only modifiers:

The provider only uses these modifiers for billing purposes.

Start/end date fields (START/END DT)

In the start/end date (START/END DT) fields, the county/tribal nation enters start and end dates in MMDDYY format. Start and end dates indicate when the line starts and ends.

MMIS posts an exception code the county/tribal nation must resolve if the country/tribal nation enters start and end dates that:

Requested rate per unit field (REQ RATE/UNIT)

The requested rate per unit (REQ RATE/UNIT) field lists the requested reimbursement rate.

PCA and CFSS agency model

The county/tribal nation enters the appropriate rate found on DHS – CFSS codes and rates:

Note: The county/tribal nation does not enter shared care rates (1:2 or 1:3), even if the person uses shared care.

CFSS budget model

The county/tribal nation leaves the requested rate per unit (REQ RATE/UNIT) field blank. If the county/tribal nation edits this field, MMIS posts an exception code the county/tribal nation must resolve.

Requested total units field (REQ TOT UNITS)

The requested total units (REQ TOT UNITS) field lists the total number of units for the specific line.

PCA

For a person who currently uses PCA, the county tribal nation enters a six-month personal care (T1019) line and:

1. Divides the number in the total time (TOTAL TIME) field on the AHC1 screen by 15 to calculate the average units per day.

2. Multiplies the result of step 1 by the number of days from the start date of the line to the end date of the line.

CFSS agency model

The county/tribal nation enters the total units the person will use for personal care services, which depends on whether the person chooses to purchase other goods, services and/or PERS.

CFSS agency model without goods, services and/or PERS

If the person does not purchase goods, services or PERS, the county/tribal nation enters the total number of units the person will use. To find the total number of units the person will use, the county/tribal nation:

1. Divides the number in the total time (TOTAL TIME) field on the AHC1 screen by 15 to calculate the average units per day.

2. Multiplies the result of step 1 by the number of days from the start date of the line to the end date of the line.

CFSS agency model with goods, services and/or PERS

If the person purchases goods, services or PERS, the county/tribal nation enters the total number of units the person will use. To find the total number of units the person will use, the county/tribal nation follows the instructions on DSD MMIS Reference Guide – ASA3 screen overview.

CFSS budget model

The county/tribal nation leaves the requested total units (REQ TOT UNITS) field blank. If the county/tribal nation edits this field, MMIS posts an exception code the county/tribal nation must resolve.

Requested total amount field (REQ TOT AMT)

PCA and CFSS agency model

MMIS auto-populates the requested total amount (REQ TOT AMT) field based on the entries in the requested rate per unit (REQ RATE/UNIT) and requested total units (REQ TOT UNITS) fields.

CFSS budget model

In the requested total amount (REQ TOT AMT) field, the county/tribal nation enters the total dollars the person will spend on personal care services. To find the total dollars the person will spend on personal care services, the county/tribal nation follows the instructions on DSD MMIS Reference Guide – ASA3 screen overview.

Instructions to resolve REQ TOT AMT field error

The county/tribal nation may receive an error when they access the ASA3 screen of an approved SA with a personal care (T1019) line while MMIS is in change mode. The error:

To fix the error, the county/tribal nation must:

1. Tab to the requested total amount (REQ TOT AMT) field.

2. Enter a number equal to or greater than the number in the total used amount (TOT USED AMT) field.

3. Proceed to another screen in the person’s SA.

After the county/tribal nation follows these instructions, MMIS will revert the number in the requested total amount (REQ TOT AMT) field to the original entry.

Note: The county/tribal nation cannot use function key F9 to edit the SA while they fix the error. If the county/tribal nation uses function key F9 while they are on the ASA3 screen, they must repeat steps 1-3.

Provider number field (PROV NBR)

In the provider number (PROV NBR) field, the county/tribal nation enters the provider number for the provider the person will use for the service.

If the person has selected a provider, the county/tribal nation enters the provider’s National Provider Identifier (NPI) number or Unique Minnesota Provider Identifier (UMPI) number.

In PCA or the CFSS agency model, the county/tribal nation enters the provider number for the person’s provider agency.

In the CFSS budget model, the county/tribal nation enters the provider number for the person’s financial management services (FMS) provider.

If the person has not selected a provider, the county/tribal nation enters:

For more information, refer to DSD MMIS Reference Guide – Finalize a type B service agreement for PCA/CFSS.

Find a provider number in MMIS

If the person’s service delivery plan does not list the provider number, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

Provider name field (PROV NAME)

MMIS auto-populates the provider name (PROV NAME) field when the county/tribal nation presses function key F9. This field lists the provider name based on the provider number the county/tribal nation enters in the provider number (PROV NBR) field. The county/tribal nation cannot edit this field.

Shared services field (SHR)

MMIS auto-populates the shared services (SHR) field. If the county/tribal nation edits this field, MMIS overwrites their entry.

Frequency field (FREQ)

The county/tribal nation cannot edit the frequency (FREQ) field.

Reason code field (RSN CD)

In the reason code (RSN CD) field, the county/tribal nation enters legal notice language to add to the SA when needed. If the county/tribal nation makes changes specific to personal care, they enter the appropriate reason codes in this field. For more information, refer to DSD MMIS Reference Guide – ASA3 screen overview.

MMIS reason code text

For a list of MMIS reason codes, refer to DSD MMIS Reference Guide – Type B home care service agreement MMIS reason codes.

Navigation

If the county/tribal nation needs to enter more lines, they press function key F11 to display the next blank line. MMIS displays only two lines per page.

After the county/tribal nation enters all lines, they press a transmit key to advance to the AHC1 screen.