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.

DHS must update the Medicaid Management Information System (MMIS) to allow counties/tribal nations to enter a CFSS service agreement (SA). Some fields have minor changes. For more information, refer to DSD MMIS Reference Guide – MMIS transition from PCA and CSG to CFSS.

During the transition from CSG to CFSS, the county/tribal nation follows the instructions below to enter a new SA in MMIS:

AGMT START DT

Enter SA start date.

AGMT END DT

Enter SA end date.

RECIP ID

Enter person’s PMI (Person Master Index) number.

DOB

Enter person’s birth date in MMDDYYYY format.

AUTH SIG (Y/N)

Type Y (yes) or N (no) to indicate if assessor signed the PCA Assessment and Service Plan (DHS-3244) form.

SACTAD NBR

1. Counties leave the SACTAD NBR field blank.

2. Tribal agencies enter SACTAD NBR (mandatory for tribal agencies ONLY).

RESP PARTY (Y/N)

Enter Y (yes) or N (no) to indicate if person has responsible party.

LIVES WITH RESP PARTY (Y/N)

Enter Y (yes) or N (no) to indicate if person lives with responsible party.

RESP PARTY NAME

Enter first and last name of responsible party.

FISCAL INT (Y/N)

Enter Y (yes) or N (no). Fiscal intermediary is required when provider is a PCA Choice Provider.

PROC and MOD1-4 fields

Enter CSG line(s) using procedure code T2025.

START/END DT fields

Enter the correct dates in MMDDYY format. Line start and end dates for CSG and FMS lines are the same as the AGMT START/END dates on the ASA1 screen.

REQ TOT AMT

1. Enter the recommended total amount for CSG.

2. Leave the REQ TOT AMT field blank when CSG combined PCA and HCN or HHA. DHS adds the correct dollar amount following the medical necessity review where the home care rating is determined.

PROV NBR

1. Enter the provider’s NPI (National Provider Index) number or the UMPI (Unique Minnesota Provider Index) number.

2. Enter FMS provider number on line for FMS (95% line).

3. Enter county provider number on line for lead agency. Counties should use Provider Type 45 (County Human Service Agency), or 61 (County Public Health Nursing Org) provider number for CSG.

4. Enter the county provider number on the T2025 line when NOT using FMS.

PHONE

Enter phone number of assessor.

SPRVSN NURSE

Enter last and first name of assessor.

ASSESSMENT DATE

Enter date of assessment.

PCA CD

Enter X in CD field in front of PC to indicate PCA.

PC SUPERVISION CD

Enter X in CD field for supervision of PCA.

DIAGNOSIS 1

Enter person’s primary diagnosis ICD-9-CM code.

DIAGNOSIS 2 and DIAGNOSIS 3

Enter second and third diagnosis code when information is available.

HOME CARE RATING

Leave home care rating field blank. MMIS enters EN home care rating when the worker enters an X in the EN field on AHC2 screen.

TOTAL TIME

Leave blank. MMIS does not enter time in the total time field when home care rating is EN.

CD fields

1. Enter an X in assessment CD (code) fields to indicate needed activity.

2. Leave CD fields blank when activity does not apply.

FSG

Enter N (no) person does not receive FSG (Family Support Grant). Exception code 886 posts effective Aug. 1, 2012, when code is Y (yes) or field is blank.

REF COMP

1. Enter Y (yes) in referral-completed field to indicate if assessor made referral(s) for other services.

2. Enter N/A (not applicable) when no referral for other services is required.

EN

1. Enter X in EN field if person is on a ventilator a minimum of 6 hours per day for a minimum of 30 days.

2. Leave EN field blank when EN does not apply.

PROV OWN/CTRL

Enter Y (yes), N (no) or U (uncertain) in provider owns or controls housing field.

ADDITIONAL COMMENTS

Find the EN (ventilator dependent) units/day and dollar amount in the PCA Assessment and Service Plan (DHS-3244) Section 3. Summary based on your assessment and:

1. Document the recommended dollar amount per month for home care rating EN.

2. Document the total time and recommended PCA units/day.

3. Document FSG monthly amount when requesting HCN or HHA.

4. Document the date to close the Home Care SA for HCN/HHA when cashing out HCN/HHA for CSG.

5. Date and initial all comments.

1. Document the recommended dollar amount per month for home care rating EN.

2. Date and initial all comments.

1. Document recommended dollar amount per month for home care rating EN.
2. Date and initial all comments.