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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Personal Care Services (PCS) Frequently Asked Questions

Click on a question to find the answer

1. What are Consolidated Personal Care Services (PCS)?
2. Why the change in PCS?
3. What is the recipient Eligibility for Consolidated Personal Care Services (PCS)?
4. Who determines PCS program eligibility?
5. How does an individual meet the criteria for personal care services?
6. As a recipient of services, do I need to request an assessment for the new Personal Care Services benefit?
7. How will I be informed of my facilities Assessment time?
8. What happens if I am unable to keep my assessment time?
9. What does the eligibility assessment include?
10. Once each recipient has been assessed who do I contact regarding their PCS status?
11. How will I know if I qualify for the new Personal Care Services Benefit?
12. What happens if residents do not meet consolidated PCS requirements? 
13. I am not a current licensed home but would like to provide PCS? 
14. What are the upcoming training dates for Consolidated Personal Care Services? 

Question 1. What are Consolidated Personal Care Services (PCS)?

A. Consolidated Personal Care Services (PCS) are services available to individuals who have a medical condition, disability, or cognitive impairment and who demonstrate unmet needs for, at a minimum of three of the five qualifying activities of daily living (ADLs) with limited hands-on assistance; two ADLs, one of which requires extensive assistance; or two ADLs, one of which requires assistance at the full dependence level. The five qualifying ADLs are eating, dressing, bathing, toileting, and mobility.  

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Question 2. Why the change in PCS?

A. The Centers for Medicare and Medicaid Services (CMS) approved North Carolina’s State Plan Amendment revising the scope and nature of PCS. Effective January 1, 2013, Medicaid PCS for recipients in all settings, including licensed care home facilities (Adult Care Homes, Family Care Homes, 5600a and 5600c Supervised Living Homes), will be provided under a consolidated Personal Care Services (PCS) benefit.

Pursuant to North Carolina General Assembly Session 2011 House Bill 950, DHHS will apply for a Medicaid State Plan Amendment to implement the new consolidated PCS benefit and develop PCS policies for children under 21 years of age and for adults ages 21 years and older. 

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Question 3. What is the recipient eligibility for Consolidated Personal Care Services (PCS)?

A. Effective January 1, 2013, individuals must meet the program’s functional eligibility requirements as set forth in House Bill 950 to qualify for PCS services.  Adults 21 years and older with a medical condition, disability, or cognitive impairment who meet the functional eligibility requirements set forth in state law may qualify for up to 80 hours of PCS per month. In accordance with HB 950, errands will no longer be covered in the consolidated PCS program. 

Recipients who are already receiving PCS will also be able to continue to receive services through the new PCS benefit, if they meet the new eligibility requirements.  If you need help with ADLs, you may qualify for Personal Care Services (PCS). 

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Question 4. Who determines PCS program eligibility?

A. The Division of Medical Assistance (DMA) contracted with the Carolina’s Center for Medical Excellence (CCME) to conduct recipient eligibility assessments for all recipients seeking authorization for PCS, including current licensed home residents.  Transition assessments of current licensed home residents are scheduled to begin the week of July 23, 2012 and continue through November 2012.  CCME will begin contacting facilities the week of July 9, 2012 to verify residents who wish to be assessed and to schedule resident assessments.  CCME will use facility contact on file with DMA. Licensed home providers should update contact information as necessary. 

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Question 5. How does an individual meet the criteria for personal care services?

A. PCS are provided to beneficiaries who have a medical condition, disability, or cognitive impairment and demonstrate unmet needs for, at a minimum;

  1. Limited hands-on assistance with three of the five qualifying ADLs;
  2. Hands-on assistance with two ADLs, one of which requires extensive assistance; or,
  3. Hands-on assistance with two ADLs, one of which requires assistance at the full dependence level.

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Question 6. As a recipient of services, do I need to request an assessment for the new Personal Care Services benefit?

A. No. If you are currently receiving Personal Care Services (PCS) in an Adult Care Home or Group Home, your home provider will help you arrange for an assessment.  Your doctor must complete a form to authorize your assessment, and your home provider may assist with filling out the form.  A nurse from CCME will also contact your home provider to schedule your assessment. 

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Question 7. How will I be informed of my facilities Assessment time?

A. Currently, assessment times are projected and subject to change.  Each facility has been provided a projected time and the timeline is available at this site: http://www.ncdhhs.gov/dma/pcs/Projected_Assessment_Timeline.pdf

CCME will contact facilities a minimum of two (2) weeks in advance to schedule resident assessments.

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Question 8. What happens if I am unable to keep my assessment time?

A. Contact CCME at 919-461-5500 to reschedule  

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Question 9. What does the eligibility assessment include?

A. Functional Eligibility assessments of current licensed home residents will be conducted using a standardized process and assessment tool provided and approved by DMA. The assessment will incorporate observation, interview, and recipient demonstration of ADLs and associated IADLs, interviews with home staff, and review of facility records. 

Completion of resident assessments will require that the assessor review some or all of the following residents records:

  • Resident confidentiality statement or agreement
  • Emergency medical release, or HIPAA form
  • Guardianship documents, if applicable
  • Resident admission records
  • FL-2 or MR-2
  • Medication Administration Record (MAR)
  • Physicians orders
  • 3050R
  • Person Centered Plan
  • Service Plan
  • Aide Task List
  • Supervision Notes

Please be prepared to present or allow assessors to access these facility records as needed. Assessors will also verify license number and date. 

NOTE: Also needed during the assessment for each resident is a completed Medical Attestation form. A completed Medical Attestation from, verified and signed by the licensed care home physician or designee, will be required for every resident who undergoes an independent eligibility assessment.  Completion of the Medical Attestation form is initiated by the resident’s licensed home provider and forwarded to the attesting practitioner for verification and completion.  The completed and signed attestation form should be returned to the licensed home provider for presentation to the CCME independent assessor at the time of the residents scheduled assessment.

Both the Medical Attestation form and the Independent Assessment will be required to determine recipient PCS eligibility and authorized service level. 

Providers are encouraged to initiate completion of Medical Attestation forms for all Medicaid residents immediately to ensure the completed form is available at the time of each resident’s scheduled assessment.  The form can be found here: http://www.ncdhhs.gov/dma/pcs/PCS_Medical_Attestation_COMM_DMA3065.pdf

Instructions are available at:: http://www.ncdhhs.gov/dma/pcs/pcs_medical_attestation_Instructions.pdf

In order to ensure that PCS services continue on January 1, 2013, current licensed home residents must have a completed independent assessment that demonstrates PCS qualification is met and have submitted a completed attestation form to CCME by the close of the transition assessment period.

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Question 10. Once each recipient has been assessed who do I contact regarding their PCS status?

A. Questions regarding eligibility assessments for the consolidated PCS program may be directed to the CCME Independent Assessment Help Line at 1-800-228-3365, or to PCSAssessment@thecarolinascenter.org.  CCME website is www.carolinascenter.org

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Question 11. How will I know if I qualify for the new Personal Care Services Benefit?

A. After your assessment, you and your home provider will receive a letter called a “Notice of Decision.” The notice will tell you whether you qualify for the new Personal Care Services benefit. If you qualify, the notice will tell your approved service level and time period.  If you do not qualify, the notice will tell you why and explain how to appeal the decision. You should receive the notice within a few months of your assessment but no later than November 30, 2012. 

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Question 12. What happens if residents do not meet consolidated PCS requirements? 

A.  In accordance with Federal regulation, maintenance of service will be available for recipients whose proper request for continuation of PCS has been denied and the recipient has filed a timely appeal. 

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Question 13. I am not a current licensed home but would like to provide PCS? 

A.  Potential providers can enroll using the Online Provider Enrollment Application https://www.nctracks.nc.gov/provider/providerEnrollment/index.jsp
The enrollment process includes credentialing, endorsement, and licensure verification to ensure that all providers are in good standing in the community.  Applicants must meet all program requirements for which they are seeking enrollment before they can be enrolled as a Medicaid Provider.

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Question 14. What are the upcoming training dates for Consolidated Personal Care Services? 

A. Please find all updates, past, and current training dates at the Division of Medical Assistance website http://www.ncdhhs.gov/dma/

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