What is Personal Care Services?

What is Personal Care Services?
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What is Personal Care Services?

The Medicaid Personal Care Services Program (PCS) is for qualified individuals that meet the following criteria:

Must be 21 years of age
Must be eligible for a full coverage Medicaid program
Must meet medical necessity regulations
Under Centennial Care, each member must choose a MCO (Managed Care Organization/Insurance Company). Each member will have access to Care Coordination services and will receive a Health Risk Assessment (HRA) that will help members work together with their MCO to create a Care plan. This HRA is a telephone call from their MCO. If the HRA shows that the member has medical, behavioral health conditions or long-term-care needs that require a higher level of Care Coordination, the member will receive a Comprehensive Needs Assessment (CNA). The CNA will be completed in the members residence.

The PCS program offers a range of services to Members who are unable to perform some or all activities of daily living because of a disability or functional limitation.

PCS services permit members to live in his or her home rather than at an institution and allow him or her to maintain or increase their independence.

Why does The Personal Care Services program

The two models are:

Member-Directed model and the Member-Delegated model.

In both models the Member:

May pick an attendant, which may be a family member
Must work with a Medicaid approved provider
Remains in the community and maintains their independence

In both models the provider is responsible for:

Submitting all billing to Medicaid
Making sure that all attendants have passed a Caregiver Criminal History Screening test

MEMBER-DIRECTED MODEL

MEMBER IS RESPONSIBLE FOR:

HIRING / TERMINATION OF CAREGIVER
SCHEDULING AND PLANNING SERVICES
AGENCY RESPONSIBLE FOR BUSINESS RELATED TRANSACTIONS

This model is ideal for Members who want to and are able to direct their own care.

The Member-Directed model is designed to allow the Member to be in charge of the delivery of services. The Member advertises if necessary, interviews and selects his/her own attendants, supervises the attendant in providing services, and terminates the attendant if necessary.

The Medicaid approved provider in this model is the “Fiscal Intermediary Agency” that helps the Member with all business related responsibilities.

The Member decides how the program can best fit their needs by setting their own hours, deciding how their services are provided and deciding how their attendants should be trained.

MEMBER-DELEGATED MODEL

AGENCY IS RESPONSIBLE FOR:

HIRING / TERMINATION OF CAREGIVER
SCHEDULING AND PLANNING OF SERVICES
ALL BUSINESS RELATED TRANSACTIONS

This model is ideal for Members who do not want to or are not able to direct their own care.

The Member-Delegated model is designed for the Member to “delegate” the delivery of services to the Medicaid approved provider.

The Medicaid approved provider in this model is the “PCO Agency.”

The PCO Agency is responsible for advertising and recruiting prospective attendants, interviewing, hiring and training according to program regulation.

The PCO Agency is responsible for quality assurance and is expected to closely monitor the Member’s services through monthly home visits and 24-hour emergency telephone access.