Since the new Personal Care Assistance (PCA) service verification requirements went into effect on August 1, 2015, Minnesota HomeCare Association (MHCA) has reached out to the Minnesota Department of Health and Human Services (DHS) for clarification regarding some of the questions raised by our members.

The new law (256B.0705 Sec. 53 Subd 2) requires PCA providers to make random, unscheduled telephone calls for the purpose of verifying that the individual PCA is present at the client's location and the services are being provided.  During our call with DHS, they confirmed that the first round of services verification checks must be completed by October 31, 2015 (the end of the first 90 day cycle).

The requirements state that agencies must connect with both the PCA and client. If the agency is unsuccessful verifying the service within the scheduled 90 day time frame, DHS indicated that they would accept an agency sending out a Qualifying Professional (QP) to verify the service. However, DHS asks providers to follow intent /spirit of the unannounced calls before sending out a QP.

It is also important to know, agencies that submit claims for reimbursement for PCA services, must develop and implement administrative policies and procedures by which the agency verifies the services provided by a PCA. NOTE: If more than one PCA provides services to a single client, the agency must conduct a service verification for each PCA providing service and PCAs need to be verified at each client they serve. 

What is Required?

• For each service recipient, the agency must conduct at least one service verification every 90 days.
• Service verifications must occur on an ongoing basis while the agency provides PCA services to the recipient.
• During service verification, the agency must speak with both the PCA and the service recipient or recipient's authorized representative. 
• An agency must fully document the service verifications in a legible manner and must maintain the documentation on site for at least five years from the date of documentation.

For each service verification, documentation must include: 

The names and signatures of the service recipient or recipient's authorized representative; agency staff present with the PCA during the service verification and the staff person conducting the service verification. According to DHS, the PCA will only have to sign the time sheet that corresponds with the date and time of the provided service.

The MN Office of the Inspector General (OIG) may grant a variance to the service verification requirements if an agency uses an electronic monitoring system or other methods that verify a PCA is present at the location where services are provided and is providing services according to the prescribed schedule.  Agencies looking for a variance  may send requests via fax to Michelle Brown at 651-431-7569. At this time, there is no special request form; DHS asks that you simply write up your request and fax it in.

A provider update originally published on September 9, 2015 detailed PCA Verification, click here to review the update. According to our conversation with DHS, a revised provider update is currently being developed and will go out once complete. As of today, DHS has not indicated when that will be. Click here to view additional Q&A submitted by MHCA on behalf of our members. MHCA will continue to add additional information to tis page as we receive it from DHS.