Information and definitions about PCA Choice option. This information and more can be found at the Minnesota Department of Human Services web site.
An option for the PCA Program allowing the Consumer more flexibility and responsibility to provide for their service needs. The Consumer or Responsible Party finds their own staff, and chooses an enrolled PCA Choice Provider.
Overview of PCA Choice
The Consumer or the Consumer's Responsible Party, a Qualified Professional and a PCA Choice provider form a team to help meet the Consumer's needs.
- The Consumer (or Responsible Party) recruits and hires a PCA, and provides scheduling, training and general supervision.
- The Qualified Professional assists in supervision and creating the Consumer Care Plan based on the care assessment created by tbe Public Health Nurse.
- The PCA Choice Provider provides fiscal support services including: background study, human resources, insurance billing, tax witholding, workers compensation insurance, and payroll services.
This option is offered to allow the Consumer more choice and control over their services as well as decreased administrative overhead expense, which will allow the PCA to be paid a higher wage.
PCA Choice Provider Criteria
(Also known as a Fiscal Intermediary)
- Not berelated to the Consumer, Qualified Professional, or the PCA
- Able to make objective ("arm's length") decisions on behalf of the Consumer about their services needs
- A joint employer of the PCA and Qualified Professional
- Pass a criminal background check. Owners with 5% interest or more, and managerial officials must also pass criminal background checks
Consumer Eligibility Criteria
- Able to direct their own care, or have a Responsible Party
- Consumer or Responsible Party must be knowledgeable about the Consumer's health care needs and be able to communicate them effectively
- Receive a face-to-face assessment by the county PHN
- Contract with a Qualified Professional to supervise care at least every 6 months
Consumer/Responsible Party Responsibilities
- Chooses PCA Choice Option during the assessment process.
- Enters into a written agreement with a PCA Choice provider & Qualified Professional .
- Develops and revises a Consumer Care Plan with the assistance of the Qualified Professional based on the care assessment created by tbe Public Health Nurse.
- Recruits, hires, trains, supervises, and if necessary, terminates employment of their PCAs.
- Recruits and hires a Qualified Professional
- Verifies Qualified Professional's credentials
- Works with Qualified Professional or physician to assure Consumer's health and safety needs are met.
- Verifies hours worked by PCA and Qualified Professional; submits time sheets to PCA Choice Provider.
- Notifies county PHN of any change in condition or level of services needed.
PCA Choice Provider Responsibilities
- Enrolled in the Medical Assistance Program as a PCA Choice Provider;
- Maintain a surety bond and liability insurance;
- Notify DHS of cancellation or lapse of policy;
- Accounting principles used in accounting or financial system;
- Withhold and pay all applicable federal and state taxes;
- Arrange and pay unemployment insurance, taxes, workers' compensation, liability insurance, and other benefits, if any;
- Verify and keep records of hours worked by the PCA and QP;
- Develop and maintain agency policies specific to PCA Choice;
- Verify Consumer eligibility on a monthly basis using EVS;
- Maintain individualized care plan in each Consumer's file;
- Document Responsible Party if Consumer cannot direct own care;
- Apply for criminal background checks for each staff at time of employment;
- Apply for Hardship Waiver if PCA meets the criteria;
- Enter into a written agreement with Consumer, PCA staff, and QP (if selected) before services begin.
Content of Written Agreement
- Duties of the Consumer, PCA, QP, and PCA Choice Provider
- Salary and benefits for the PCA and the QP
- Administrative fee of the PCA Choice Provider and services paid for with that fee, including the background checks
- Procedures to respond to billing or payment grievances.
- Procedures for hiring and terminating the PCA and the QP
- Reimbursement for PCA service is made at the MA rate. Reimbursement not designated as the provider's administrative fee must be used to pay the salary and benefits of the PCA, and the Qualified Professional
Responsibilities of the QP:
- Enter into a written agreement with the PCA Choice Provider and the Consumer.
- Pass a criminal background check.
- Assist Consumer or Responsible Party in developing/revising Consumer's care plan to meet the Consumer's needs as indicated on the PHN assessment.
- Based on the PHN assessment, determine which tasks require QP supervision, and which can be safely supervised by Consumer or Responsible Party.
- Help train PCA if requested by the Consumer and is included in the written agreement.
- Report any suspected abuse, neglect, or financial exploitation to appropriate authorities.
- Make a face to face visit every 180 days (6 months).
Public Health Nurse Responsibility:
At the time of assessment, the Consumer chooses PCA Choice Option using a PCA Choice Provider. PCA Choice always requires a face-to-face assessment. The Consumer may choose PCA Choice at any time during the service agreement period. If the Consumer requests PCA Choice during a current service agreement period where the last assessment was a "service update," a new face-to-face assessment must be conducted. All subsequent assessments must also be face-to-face, as long as the Consumer receives services through the PCA Choice option.
Denial of PCA Choice Option:
DHS may deny, revoke, or suspend the authorization to use PCA Choice if:
- DHS terminates the PCA Choice Option
- Parties have failed to comply with the written agreement
- Qualified professional or Public Health Nurse determines the use of this option jeopardizes the consumer’s health and safety
- Use of the option has led to abusive or fraudulent billing for PCA services
