The Consolidated Personal Care Services (PCS) program is a Medicaid State Plan benefit designed to provide personal care services to individuals residing in a private living arrangement, or a residential facility licensed by the State of North Carolina as an adult care home, or a combination home as defined in G.S. 131E-101(1a).G.S. 131E-101(1a); or resides in a group home licensed under Chapter 122C of the General Statutes and under 10A NCAC 27G .5601 as a supervised living facility for two or more adults whose primary diagnosis is mental illness, a developmental disability, or substance abuse dependency.
Consolidated Personal Care Services (PCS) is available to individuals who has a medical condition, disability, or cognitive impairment and demonstrates unmet needs for, at a minimum 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.
PCS program eligibility is determined by an independent assessment conducted by the Division of Medical Assistance or its designee; and shall be provided in accordance with an individualized plan of care.
DMA Clinical Policy & Programs
Home and Community Care-Personal Care Services
Phone 919-855-4340
E-Mail: PCS_Program_Questions@dhhs.nc.gov
Important Links
NC Tracks: Are You on Track for July 1? Effective July 1, 2013, Computer Sciences Corporation-NCTracks (CSC-NCTracks) will be the new claims system for the N.C. Department of Health and Human Services. Any references to HP Enterprise Services on this Web page will be diverted to CSC-NCTracks. Make sure your DHHS claims will be paid after the MMIS conversion. For a checklist of actions you can take to prepare for the conversion, go to http://www.ncmmis.ncdhhs.gov
(NOTE: This new version of the spreadsheet, updated on May 8, 2013 - is simply annotated to make it easier for providers to understand. The previous spreadsheet will also be accepted.)
Maintenance of Service On December 28, 2012 The Center for Medicaid and Medicare Services agreed to allow DMA to provide Maintenance of Service (MOS) using the current hours for Special Care Unit beneficiaries. The approval of 161 hours for SCU beneficiaries applies only to Maintenance of Service (MOS) hours issued while the beneficiary goes through the appeal process. The appeal must have been filed by Jan. 30, 2013. The highest level of service a beneficiary receiving Personal Care Services (PCS) can receive is 80 hrs regardless of setting.
QIReport Licensed facility PCS providers who are registered on the QIReport provider interface will see notices for Maintenance of Service (MOS) if CCME has received notification of a beneficiary appeal. Providers do not need to respond to these notices. If a beneficiary’s appeal was resolved prior to January 1, 2013 through mediation, the MOS notice will be followed immediately by a notice of settlement. However, settlements reached prior to January 1, 2013 will be effective January 1, 2013 and MOS will not apply. Providers who are not registered for the provider interface will receive only the notice of settlement with the hours agreed to by the beneficiary at the time of the mediation. Neither the MOS notice nor the settlement notice require provider response to CCME.
Approval of N.C. Medicaid State Plan Amendment for Personal Care Services
On November 30, 2012, The Centers for Medicare and Medicaid (CMS) approved North Carolina Medicaid State Plan Amendment (SPA) NC 12-013 with an effective date of January 1, 2013. On December 3, 2012, the Division of Medical Assistance (DMA) and The Carolinas Center for Medical Excellence (CCME) began issuing decision notices to beneficiaries currently receiving PCS in licensed facilities. DMA anticipates that all current PCS beneficiaries will be notified of their eligibility to transition to the new PCS program within approximately three weeks.
PCS Webinar: PowerPoint Presentation - January 10, 2013 Overview of the appeals process, QiReport functionality and updates on PCS transition as it relates to Licensed Home Care Providers and Licensed Adult Care Home Providers
Personal Care Services (PCS) Stakeholder Information
PCS Stakeholder Group
Purpose:
To provide the opportunity for stakeholders in North Carolina who have an interest in the development and implementation of the Personal Care Services to collaborate and share their recommendations. The NC Department of Health & Human Services (DHHS) meet on a regular basis with community stakeholders to engage and seek their input. The meetings are conducted face to face and by teleconference. The meetings are designed to share project status, gather input and identify next steps.
