PCA Program Changes

On June 28, 2005, the Minnesota Department of Human Services (DHS) announced two important changes impacting personal care assistant (PCA) services reimbursed under Medicaid/Medical Assistance (MA), MinnesotaCare, the Alternative Care Program, and certain waivered service programs (i.e., any Minnesota Health Care Program).

Background Studies

First, the new law prohibits a PCA from working unsupervised with any client of a home care or PCA Choice agency until that agency has submitted a background study of that PCA and received a notice from DHS stating the results are “clear.” Previously, PCAs could begin working unsupervised as soon as the agency submitted the request for a background study—the PCA didn’t have to wait until the results were returned.

This change closes a loophole used by individuals with prior criminal convictions or documented abusive behavior. For example, John Doe has been convicted of a felony two years ago, is looking for a temporary job to help ends meet, knows his background study results will not be known for two to three weeks, and begins working as a PCA. Two or three weeks later, his background study results are received indicating he is prohibited from working in the field; he is immediately fired from his PCA position. However, he has already been working unsupervised, consumers have been exposed to risks.

Yet, the change may present new challenges. Judy Elling, the Program Administrator for Twin Cities based PCA Choice provider named People Enhancing People (PEP), recently attended the August 12 DHS PCA Provider Focus Group and offers valuable insights and suggestions. She points out that, “Any new PCA or existing PCA [switching to a different provider organization, perhaps as a result of a client’s choice to move to a different agency] cannot have unsupervised direct contact with a client until they have cleared the background study. Only an individual with a cleared background check can provide the supervision (a parent, family member, or responsible party can not supervise the PCA)…The PCA Choice law allows consumers to be the supervisor/manager of their PCAs, however this new background study law takes that right away when a consumer hires a new PCA [or switches agencies]. It is understood and agreed that the law is important for the protection the most vulnerable people in our communities. However, by not allowing the parent or a consumer to be the supervisor for a PCA without a cleared background study, it is taking away the empowerment provided to the parent and consumer from the PCA Choice law.”

Elling indicated that the law provides the DHS Licensing Division access to all Minnesota county court databases and, according to DHS representatives at the Provider Focus Group, this Division will be conducting daily searches of these databases against all new and existing PCAs. This enables DHS to see if any PCAs have committed an offense which may reverse the original background clearance. When a particular PCA’s clearance is revoked, the Licensing Division will immediately notify organizations employing that PCA and ensure the PCA prevented from providing any further direct care.

She goes on to say, “Every organization a PCA is employed with must get a background study clearance for that [particular] PCA. The DHS background study costs each organization $20. This process is costly and time consuming for the DHS Licensing Division and provider organizations. It also produces increased workloads and backlogs in the processing of the background studies.” She proposes allowing a PCA to use the results of a single background study for up to 12 to 18 months with any provider organization; a simple verification process given the second PCA service change announced by DHS: the use of PCA Provider Numbers.

DHS – PCA Registration

In the past, home health care agencies, PCA Choice agencies, and other personal care provider organizations (PCPOs) have been required to enroll with DHS to obtain a provider identification number. This identification number is required during the billing process; the agency submits a reimbursement claim for services provided to each client. Under the new system, each PCA must also enroll with DHS to receive their own personal identification number. Beginning no later than January 1, 2006, agencies will be required to use these personal identification numbers to indicate which PCA provided which block of services. If a PCA does not have a provider number, DHS will not give payment for those services until the PCA receives one. Therefore, PCAs have been very strongly encouraged to enroll with DHS as soon as possible.

Requiring personal provider numbers for PCAs will help DHS identify and investigate cases where PCAs may bill for more hours than they actually worked. For example, say John worked for ABC Agency and XYZ Agency. His timesheets at ABC indicate he worked with one of their clients 12 hours a day Monday, Tuesday, and Wednesday. And, his timesheets at XYZ indicate he worked with one of their clients 12 hours a day Monday, Tuesday, and Wednesday. Each agency thinks he only worked 12 hours a day – no problem. But, DHS may catch the fact that he billed 24 hours a day for three consecutive days and investigate further.

Next, the numbers will provide useful research data, such as, how many clients does an average PCA provide service to during a typical month? This information will be extremely valuable for decision-makers and advocates when evaluating and adjusting PCA programs.

Potential Issues

Both changes are definitely a step in the right direction. But, many questions remain regarding if we are ready to take those steps, especially together. First, have the home health care and PCA Choice agencies had enough time to become registered, trained, comfortable, and efficient using the new DHS online background study system? The online system could return background study results in less than three working days. The previous paper system could take as long as three weeks before results were received. Agencies still relying on the paper system could experience staffing shortages while new PCAs sit on the sidelines waiting for their background study results.

Second, is DHS able to process individual PCA provider enrollment forms and issue identification numbers fast enough to prevent a backlog? If a PCA is waiting for a provider number, meaning the agency must wait to bill for services provided by that PCA, will the agency delay scheduling that PCA?

Third, are the provider enrollment forms appropriate and easy to understand? Typically, doctors, chiropractors, agency owners, or a trained member of their administrative staff completes these forms. At time when recruiting PCAs is already difficult, are we creating more challenges—a bottleneck?

Only time will tell.