PCA Services

Accessing PCA Services

A person can recieve PCA Services through one of the programs described below. Think of these as "doors" for starting PCA Services, with each one differing in how it's administered. To find out about your eligibility for any of these services, contact your county.
There are four different ways you can access PCA Services:

1. Assistance with doing Activities of Daily Living (ADLs). These are things you do every day such as dressing, grooming bathing, eating, positioning, transferring, toileting and mobility.
2. Home and Community Based Waiver Programs. A waiver is an additional service that allows people to live in the community instead of going into or staying in an institutional setting. Contact your county social services agency to learn more about waivers. Types of waivers are:
   •  Community Alternative Care (CAC)
   •  Community Alternatives for Disabled Individuals (CADI)
   •  Elderly Waiver (EW)
   •  Mental Retardation/Related Conditions (MR/RC)
   •  Traumatic Brain Injury (TBI) Waiver
3. Alternative Care is for people who are over 65 but whose assets are too high to qualify for the Elderly Waiver.
4. Managed care programs, such as Prepaid Medical Assistance Program (PMAP) or Minnesota Disability Health Options (MNDHO), which are mandatory for people over age 65 but an option for people with disabilities under age 65.

Categories of PCA Service

There are four categories of service you can recieve in the PCA program:

1. Assistance with doing Activities of Daily Living (ADLs). These are things you do every day such as dressing, grooming bathing, eating, positioning, transferring, toileting and mobility.
2. If your PCA assessment determines that you have a need for assistance with Activities of Daily Living (ADLs), you may also use your PCA services for assistance with Instrumental Activities of Daily Living, or IADLs. IADL assistance includes meal planning and preparation, managing your finances, shopping for food, clothing and other items, homemaking tasks, communicating by telephone or other means, getting around and participating in community activities.
3. Assistance in Health Related Functions, which are services that must be delegated or assigned by a licensed health care professional such as a nurse or doctor. Health Related Functions must be provided under the direction of a Qualified Professional (QP) or a doctor. Examples of health related functions are special skin care, non-sterile catheter care, tube feedings and respiratory assistance.
4. Redirection and intervention for behavior issues which require observation and monitoring. For example, reminders to do activities of daily living or redirection of behavior that is potentially harmful to you or others.

Qualified Professional can be a Registered Nurse (RN), a Mental Health Professional, or a Licensed Social Worker. A Qualified Professional is responsible for:

• Assisting you in writing your care plan describing your needs and how a PCA will assist you
• Providing information to new PCAs about your needs for assistance
• Providing training to your PCAs on your health care needs
• Providing on-going monitoring of your PCAs to make sure things are going smoothly
• Telling your doctor or public health nurse about changes you may need in your PCA service

PCA Assessment

Assessment Information

An assessment must be completed to determine your needs for assistance. The assessment reviews the tasks and assistance that you need and assigns a unit of time for these activities. The home care program you are in determines who will do your assessment. Here is a list of people who can complete an assessment:

• County public health nurse for MA Home Care or MR/RC Waiver Program
• County case manager/service coordinator for CAC, CADI, TBI, EW Waiver Programs or AC Program
• Someone from your managed care plan (such as PMAP) if you are in a
  managed care program

This assessment should happen within 30 days after your contact someone about your need for PCA services. The assessment is dome before PCA services can start and every year after that.

If your condition changes and you think you need more assistance, you can request another assessment at any time.

The assessment will be done in your home and should take about one hour to complete. The assessment will include:

• Questions asked about the types of assistance needed
• Descriptions of different PCA program options
• Choice of PCA provider
• Choice of the type of PCA supervision
• Decisions about using the Shared Care option

During the assessment you will be asked questions about the types of assistance you need in the four categories of service.

• Activities of daily living (ADLs)
• Instrumental activities of daily living (IADLs)
• Behavior Needs
• Health-related issues

After you answer all of the questions, you will be asked to sign the assessment. Here is what will happen next:

For non-waiver consumers, the conty public health nurse will complete the forms and reccomentd a number of PCA units of care. The information will be sent to the state for review and approval. You and your agency will recieve a copy of the assessment from the county and a service agreement letter from the state.

For waiver & Alternative Care consumers, the service coordinator determines and approves a number of PCA units and submits the information to the state. You can ask for a copy of the assessment. You will recieve a service agreement letter from the state.

For managed care program consumers, contact your health plan to learn about your assessment.

Service Authorization
If the units of PCA services are approved, DHS will send you a service authorization verification. It will tell you how many service units you can recieve. Each unit of service is 15 minutes. Service authorizations are usually approved for a one-year period and will list your provider, who also will get a copy of your service authorization.

You can use the hours flexibly. In the above example, Francis averages 8 hours per day, but he can use the hours as needed. One day he may use 5 hours, another day he may use 10 hours. However, you cannot go over the total number of hours authorized for the year.

Appealing Service Unit Authorization Decisions
You may appeal a decision about your authorization for services or total units. For example, if your PCA service hours were reduced and you don't think they should have been, you can file an appeal.

Here is a summary of what is stated on the back of the service authorization notice about filing an appeal: (For the entire notice, please refer to the service authorization notice)

• No special forms are needed (a short letter is okay)
• Letter must be in writing
• Clearly state what your are appealing
• Send a copy of your authorization with your appeal letter

There is a 30-day time line from the day you get this notice to send your appeal letter
If you miss the deadline of 30 days, you still may be able to appeal. To appeal:

• Write an appeal letter
• State in the letter a valid reason why you did not appeal within 30 days
• Send in a copy of the authorization letter

The state will have to agree with you that you had a valid reason. If the state agrees with you, the timeline is then 90 days fron the day you recieve the authorization notice to appeal.

To keep your current services or hours during the appeal process:

• Send your appeal within 10 days of the date in the upper left hand corner of your notice
• Send your appeal before the effective date to the right of the notice

If you want to appeal, ask your County Social Services office to help you or write directly to:
Appeals Unit
Department of Human Services
444 Lafayette Road
St. Paul, MN 55155-3813

If you have questions, call (651) 296-5764