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

There are no similarities between PCA and CFSS on the ASA3 screen for goods and services.

Differences

Goods and services are not available in PCA. This page only applies to CFSS.

The county/tribal nation enters lines for the person’s specific services on the ASA3 screen. This page describes how to enter a goods and services (T5999) line for a CFSS service agreement (SA). For information and instructions about other ASA3 line types, refer to DSD MMIS Reference Guide – ASA3 screen overview.

The county/tribal nation only enters a goods and services (T5999) line if the person plans to purchase goods and services. The county/tribal nation cannot enter more than one goods and services (T5999) line with overlapping dates. For more information, refer to CFSS Manual – Goods and services through CFSS.

In the optional 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.

In the PROC field, the county/tribal nation enters the goods and services procedure code (T5999).

In the MOD1-4 field, the county/tribal nation enters modifiers to provide additional information needed for authorization and billing. 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:

In the 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. The dates must be within the agreement start and end dates (AGMT START/END DT fields) on the ASA1 screen.

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

The county/tribal nation leaves the REQ TOT UNITS field blank. If the county/tribal nation edits this field, MMIS overwrites their entry.

In the REQ TOT AMT field, the county/tribal nation enters the total amount for the goods and services the person plans to use. The county/tribal nation finds this information in the person’s approved CFSS Individual Service Delivery Plan, DHS-6893P.

In the PROV NBR field, the county/tribal nation enters the provider number for the person’s FMS provider for both the CFSS agency and budget models.

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

If the person uses the CFSS budget model, the county/tribal nation must enter the same provider number on the goods and services (T5999) line and the following line types with overlapping dates, if applicable:

If the person has not selected an FMS 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).

MMIS auto-populates the 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 PROV NBR field. The county/tribal nation cannot edit this field.

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

The county/tribal nation cannot edit the FREQ field.

In the 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 goods and services, 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.

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.