PCA Program Changes
by Lance
Hegland
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.
