Ability Care Partners, Inc. (A Minnesota PCA Choice Provider)

PCA Choice Option Information

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 recipient more flexibility and responsibility to provide for their service needs. The recipient or responsible party finds their own staff, and chooses an enrolled PCA Choice Provider.

An overview of PCA Choice

The recipient or the recipient's responsible party, a qualified professional, if requested, and a PCA Choice provider form a team to help meet the recipient's needs.

The recipient (or responsible party) recruits and hires a PCA, and provides training and supervision for some types of care.
The qualified professional or the recipient's physician, when no qualified professional is chosen, assists in developing the care plan and provides supervision if needed.
The PCA Choice Provider provides fiscal support services including: MA billing; withholding federal and state taxes; and paying the PCA and qualified professional.

This option is offered to allow the recipient 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 related to the recipient, qualified professional, or the PCA;
able to make objective ("arm's length") decisions on behalf of the recipient about their services needs;
a joint employer of the PCA and qualified professional; and
pass a criminal background check. Owners with 5% interest or more, and managerial officials must also pass criminal background checks.

Recipient Eligibility Criteria

able to direct their own care, or have a responsible party;
recipient or responsible party must be knowledgeable about the recipient's health care needs and be able to communicate them effectively;
receive a face-to-face assessment by the county PHN.

PCA Choice Option Recipient/Responsible Party Responsibilities

chooses PCA Choice Option during the assessment process.
enters into a written agreement with a PCA Choice provider.
develops and revises a care plan with the assistance of the qualified professional or physician when no qualified professional (QP) is chosen.
recruits, hires, trains, supervises, and if necessary, terminates employment of their PCAs.
recruits and hires a qualified professional when chosen.
verifies qualified professional's credentials, Registered Nurse (RN) or a Mental Health Professional.
works with qualified professional or physician to assure recipient's health and safety needs are met.
verifies hours worked by PCA and qualified professional; submits time sheets to PCA Choice Provider.
terminates the PCA(s) and/or QP (if necessary along with the 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 recipient eligibility on a monthly basis using EVS;
maintain individualized care plan in each recipient's file;
document responsible party if recipient 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 recipient, PCA staff, and QP (if selected) before services begin.

Content of Written Agreement

duties of the recipient, 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 complaints
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 if one is chosen.

If a qualified professional is not chosen, the recipient or his/her responsible party must:

develop care plan in conjunction with recipient's physician;
orient PCA to recipient's needs for assistance
train PCA to provide hands-on assistance with special health care tasks with the help of the recipient's physician;
day-to-day supervision and evaluation of PCA;
communicate changes in PCA service needs to agency, physician, or others.

Responsibilities of the QP in the PCA Choice Option. If supervision is selected by the recipient (Recipient has a choice to have supervision from a QP or do their own supervision):

enter into a written agreement with the PCA Choice Provider and the recipient.
pass a criminal background check.
assist recipient or responsible party in developing/revising recipient's care plan to meet the recipient'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 recipient or responsible party.
help train PCA if requested by the recipient and is included in the written agreement.
report any suspected abuse, neglect, or financial exploitation to appropriate authorities.
Make a face to face visit at least one time per year.

If a qualified professional is not chosen, the recipient or his/her responsible party must develop the care plan in conjunction with the recipient's physician and assume responsibility for performing the supervision duties, and communicating with the county PHN and PCA Choice Provider.

PCA Choice Option Public Health Nurse Responsibility:
At the time of assessment, the recipient chooses PCA Choice Option using a PCA Choice Provider. PCA Choice always requires a face-to-face assessment. The recipient may choose PCA Choice at any time during the service agreement period. If the recipient 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 recipient 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:

the county PHN or the qualified professional determines that use of this option jeopardizes the recipient's health and safety;
the parties have failed to comply with the written agreement; or
the use of this option results in abusive or fraudulent billing for PCA services.

DHS decisions may be appealed by the recipient/responsible party. A provider may not appeal a denied PCA Choice request. The denial, revocation, or suspension to use PCA Choice will not affect the recipient's authorized level of services.