Family-to-Family Health Information Center
To learn more about PCA changes and services, contact PACER's Family-to-Family Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.
PCA Assessment & Appeals Tips
- Understand PCA eligibility requirements! In order to receive PCA services, applicants must already be receiving Medical Assistance (MA) or be eligible to receive MA services. Read the DHS Instruction & Guidelines document to prepare.
- Be prepared! Keep a record of aggressive, Level 1 behaviors and any need for assistance with ADLs.
- Gather support! Get documents from doctors, teachers, therapists, care providers, etc. that demonstrate the person’s need for PCA services.
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Minnesota Personal Care Assistant (PCA) Changes
PCA Eligibility Requirements:
As of July 1, 2011, persons with:
- Level 1 behavior, or
- 1 activity of Daily Living (ADL) dependency, or
- 1 ADL dependency and Level 1 behavior
are only eligible for 2 units (30 minutes) of PCA services per day.
Persons who qualify as dependent in at least 2 activities of daily living (ADLs) will continue to receive services as they did prior to July 1, 2011, unless their condition or assessment changes.
To qualify you must be assessed as having :
- a dependency in 1 Activity of Daily Living and/or level 1 behavior is required to qualify for 30 minutes per day for PCA services; or
- a dependency in 2 ADLs is required to receive more than 30 minutes of PCA services per day under the home care rating system in effect since January of 2010.
Definition of Dependency and ADL:
- Dependency requires hands-on physical assistance, cuing, or constant supervision to complete the task.
- Activities of Daily Living (ADLs) include:
- Grooming
- Dressing
- Bathing
- Transferring
- Mobility
- Positioning
- Eating
- Toileting
Definition of Level 1 Behavior:
Level I Behavior is behavior that requires the immediate response of another person, has occurred in the last 12 months with supporting documentation from professionals such as doctors, nurses, teachers, therapists, etc., and involves at least one of the following:
- Physical aggression towards self
- Physical aggression towards others
- Destruction of property
PCA Reassessment:
Face-to-face reassessments will be scheduled between June 1, 2011 and November 30, 2011 for PCA recipients who have one of the following:
- Level I Behavior
- Dependency in only one ADL
- Level I Behavior and dependency on only one ADL
The Minnesota Department of Human Services (DHS) will follow the reassessment schedule and contact you to schedule a specific date and time for the reassessment. All other PCA recipients will follow their regular reassessment schedule. DHS sent a letter of notification to PCA recipients who may not qualify for PCA services following the July 1, 2011 changes, explaining the reassessment process.
Remember, you have the right to appeal any decision (whether termination or reduction of PCA services) within 30 days of receiving the decision from DHS. You may also request to have a Long-term Care Consultation (LTCC) at your reassessment to help you identify other services to meet your needs. Transition of services for those who no longer qualify for PCA services will occur between July 1, 2011 and December 31, 2011.
Additional PCA Resources:
Minnesota Department of Human Services
Personal Care Assistance (PCA) Program – gives an overview of PCA services.
PCA Phase II Project – provides details of the legislative changes, including timelines for reassessment and new criteria for eligibility.
PCA Assessment and Service Plan Instruction and Guidelines – outlines questions and details that determine eligibility and explains the assessment process to receive PCA services. This document is helpful for parents or guardians to read prior to an assessment.
DHS Frequently Asked Questions (FAQs)
Minnesota Disability Law Center
MN Disability Law Center: PCA Changes Web Resource – provides information and links to more information and legislation for PCA services.
Frequently Asked Questions (FAQs) about PCA – gives answers to questions involving eligibility, assessments, appeals, and termination of PCA services.
Other
MAZE: Insurance and Appeals – developed by the MN Department of Health, Children and Youth with Special Health Needs and has information on PCA appeals requirements and process.
2010 Minnesota Statues involving PCA Services: 256B.0625 and 256B.0659
To learn more about PCA changes and services, contact PACER’s Family-to-Family Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.
PACER's site offers many PDF files for download, which require