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1. Matchmaking Agency In Minnetonka Mills Nh
2. Matchmaking Agency In Minnetonka Mills Maine

Revised: May 8, 2019

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Overview

Personal care assistance (PCA) services provide assistance and support for persons with disabilities, living independently in the community. This includes the elderly and others with special health care needs. PCA services are provided in the Minnesota Health Care Programs (MHCP) member’s home or in the community when normal life activities take him or her outside the home.

Assessment for PCA Services

PCA services are participant-centered. Members must have an assessment for PCA services by an assessor through a lead agency (a county, tribal government or managed care organization). During the assessment, the assessor determines if:

If PCA services are assessed to be appropriate, most MHCP members have flexible use of their PCA services, allowing them to use the assessed services how and when they want within a six-month period. The member or RP also chooses whether they want to receive either or both of the following:

Members or RPs must also select the MHCP-enrolled PCA provider agency they want to provide their PCA services. When the member selects the PCA Choice option, the member must select an agency enrolled specifically to provide PCA Choice services.

Supervision for PCA Services

All members receiving PCA services are required to have qualified professional (QP) supervision services. The QP works for the PCA agency to provide oversight and evaluation of the individual personal care assistance service delivery, to ensure the member’s PCA service needs are met following the QP services policy.

The PCA agency is responsible for ensuring the QP:

If a member needs more than 96 units of QP services before a services authorization ends, the PCA agency may request additional units according to the QP supervision units increase policy.

Eligible Providers

MHCP enrolls and reimburses the following types of provider agencies to provide PCA services:

MHCP does not pay individual PCAs directly. MHCP does not require a PCPO or PCA Choice agency to have a license or certification to provide PCA services. However, PCA agencies with licenses or certifications must comply with the requirements of both the MHCP PCA program and whatever licenses or certifications they hold.

All agencies choosing to provide PCA services must meet MHCP PCA agency enrollment requirements described in more detail in the next section.

PCA Agency Enrollment

Agencies must do the following to enroll or maintain enrollment with MHCP to provide PCA services:

Verifying Credentials for Qualified Professionals (QPs)
The QP works for and is reimbursed by the PCA provider agency. MHCP does not enroll the QP as an individual provider to identify on claims. PCA provider agencies are responsible for verifying the credentials of the QP (see Legal References) and keeping verification of those credentials in their agency files. Prior to having the QP provide services, the PCA agency must:

Enrolling Individual PCAs
MHCP is the official registrar for enrolling and affiliating individual Minnesota’s PCA providers for the purpose of identifying the individual PCA who provides the services to members on both fee-for-service and managed care organization (MCOs) claims.

PCA agencies must enroll individual PCAs with MHCP and affiliate individual PCAs with their agencies. MHCP assigns a Unique Minnesota Provider Identifier (UMPI), which is a National Provider Identifier (NPI) equivalent, to the individual PCA during the enrollment process. The PCA agency uses the UMPI on the claim to report the individual as the person who rendered the services to the member. Prior to making the request, the PCA agencies must ensure that each individual PCA they employ:

MHCP also ensures the individual PCA provider is not on the OIG Exclusion list and passes the background study with the agency and shares this information with the MCOs on a weekly basis.

PCA provider agencies cannot have or enforce any agreements, requirements or non-compete clause prohibiting, limiting or restricting an individual PCA from working with a member or different PCA provider agency after leaving a PCA provider agency, regardless of the date the agreement was signed.

MHCP requires PCA agencies to comply with data and other information requests from the PCA Quality Assurance (QA) as written in the PCA QA policy.

Eligible Members

MHCP members with eligibility for one of the following MHCP programs are entitled to an assessment for PCA services to determine eligibility for PCA services:

Members not eligible to receive PCA services are those eligible for one of the following programs:

Covered Services

MHCP reimburses PCA covered services. MHCP may reimburse for assistance with self-administered medications or services outside of Minnesota when identified on the member’s assessment, service plan or care plan documents.

MHCP covers the travel time an individual PCA spends accompanying a member while that member is being transported to the destination where the individual PCA will assist the member in the community. PCA agency policies, procedures and agreements with members determine whether that agency allows an individual PCA employee to transport a member using the PCA’s or a member’s vehicle. PCA agencies must consult with their legal advisors or business consultants about the liabilities of transporting members.

For example: A member receives PCA services and needs assistance eating. The member is meeting family at a local restaurant and the individual PCA will assist the member. MHCP will cover the time the individual PCA spends accompanying the member from his or her community setting to the restaurant (and back). If the individual PCA meets the member at the restaurant, MHCP will not cover the individual PCA’s travel time.

Matchmaking Agency In Minnetonka Mills Nh

Noncovered Services

Authorization Requirements

All PCA services require authorization. Refer to PCA Referral for Assessment and the following information:

Billing

PCA agencies must follow general MHCP billing policies and guidelines in the Billing Policy section when submitting claims to MHCP. Refer to MHCP Billing Resources for methods of submitting claims to MHCP.

Documentation Requirements

PCA agencies must have all of the following documentation before submitting a claim to MHCP for reimbursement of PCA or QP services:

PCA agencies must have documentation supporting that the service has been provided for both individual PCA and QP services. MHCP requires PCA agencies to ensure that the individual PCA records all of the minimum required elements when completing the agency’s PCA time and activity documentation process. PCA agencies determine the documentation methods used for recording the QP’s time and activity.

PCA agencies must follow the direction of the Minnesota Department of Labor and Industry (DLI) when paying their individual PCA providers and QPs for services the PCA agency told them to provide.

Submitting PCA Claims

Submit claims for reimbursement of PCA services in the following manner:

For individual claims submission, follow the step-by-step instructions in the Completing a MN–ITS Interactive Professional (837P) claim for PCA Services. MHCP uses the following HCPCS codes and modifiers for reimbursement of PCA services.

Managed Care Members

PCA agencies providing PCA services to eligible members aged 65 and over who are enrolled in a health plan must follow the managed care organization’s rules and guidelines to enroll with, obtain authorizations or bill the health plan. Refer to the MCO PCA Resources for contact information and the health plan procedures.

For members enrolled in the Special Needs Basic Care program and the Families and Children program, follow fee-for-service guidelines to obtain authorizations.

Legal References

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Minnesota Statutes, 256B.0659 PCA Services
Minnesota Statutes, 256B.0625, subdivision 19c Qualified Professional