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 agreement start date. SA start date is the same as the assessment date in the ASSESSMENT DATE field on AHC1.

AGMT END DT

Enter SA agreement end date. SA end date is the same as the assessment date in the ASSESSMENT DATE field on AHC1.

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

Leave SACTAD NBR field blank.

RESP PARTY (Y/N)

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

PROC and MOD1-4 fields

Enter one line using procedure code T2025 for denial of CSG.

START/END DT fields

Enter one line with the line start and end dates the same as the SA start and end dates in the AGMT START/END DT fields on the ASA1 screen.

REQ TOT AMT

Leave the requested total amount field blank.

PROV NBR

Enter the county NPI or UMPI number on the line for denial of CSG following an initial PCA assessment. Use Provider Type 45 (County Human Service Agency), or 61 (County Public Health Nursing Org) provider number for CSG.

RSN CD

Enter appropriate reason code to trigger MMIS to add legal notice language to the service agreement letters for notice of denial.

PHONE

Enter phone number of assessor.

SPRVSN NURSE

Enter last and first name of assessor.

ASSESSMENT DATE

Enter date of assessment in MMDDYY format.

BEGIN DATE and END DATE

Leave begin and end date blank. MMIS auto-populates begin and end date fields.

PCA CD

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

CD fields

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

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

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

1. Document reason for denial of CSG.

2. Date and initial all comments.

1. Document reason for denial of CSG.

2. Date and initial all comments.

1. Document reason for denial of CSG.

2. Date and initial all comments.