Covered Services

Four categories of PCA services are eligible for payment from Medical Assistance: 

  Activities of daily living (ADLs) 

  Health-related procedures and tasks 

  Observation and redirection of behaviors 

  Instrumental activities of daily living (IADLs) 

Activities of daily living (ADLs)

A PCA may assist the person with the following ADLs:

1. Dressing - Application of clothing and special appliances or wraps.
2. Grooming - Basic hair care, oral cares, shaving, basic nail care, applying cosmetics and deodorant, care of eyeglasses and hearing aids.
3. Bathing - Basic personal hygiene and skin care.
4. Eating - Completing the process of eating including application of orthotics required for eating, hand washing and transfers.
5. Transfers - Assistance to transfer the person from one seating or reclining area to another.
6. Mobility - Assistance with ambulation.
7. Positioning - Assistance with positioning or turning a person for necessary care and comfort.
8. Toileting - Helping person with bowel or bladder elimination and care. This includes transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the perineal area, inspection of the skin and adjusting clothing.

Health-related procedures and tasks

Under state law, a licensed health care professional may delegate health-related procedures and tasks to a personal care assistant when the following are present: 

1. Procedures and tasks meet the definition of health-related procedures and tasks.
2. A qualified professional who is a nurse trains and supervises the PCA.
3. PCA demonstrates competency to safely complete the procedures and tasks.

Examples of health-related procedures and tasks include:

  • Assistance with self-administered medications 
  • Interventions for seizure disorders, including monitoring and observation 
  • Range of motion to maintain a person’s strength and muscle functioning 

Observation and redirection of behaviors

A PCA service may include observation of a person who:

  • Has episodes of behaviors 
  • Needs redirection to remain safe in his/her environment 

Instrumental activities of daily living (IADLs)

A PCA may assist an adult with the following:

  • Accompany to medical appointments 
  • Accompany to participate in the community 
  • Assist with paying bills 
  • Communicate by telephone and other media 
  • Complete household tasks integral to the PCA services 
  • Plan and prepare meals 
  • Shop for food, clothing and other essential items 

Persons eligible for one of the above programs must meet the following criteria to qualify for PCA services:

  • Able to identify their needs
  • Able to direct and evaluate PCA task accomplishment
  • Able to provide for their health and safety or have a responsible party that is able to do so. 
  • Have a service plan developed with the county public health nurse that specifies the PCA services needed.
  • Have a stable medical condition.
  • Have an approved service agreement for PCA services from the Minnesota Department of Human Services
  • Live in their own home residence which is NOT a hospital, nursing facility, intermediate care facility, health facility licensed by the Minnesota Department of Health or foster care setting licensed for more than four residents.
  • Need PCA services to live in the community

In addition, PCA services may only be provided when determined medically necessary through the assessment process.

PCA services are available to persons enrolled in the following programs:

  • Alternative Care (AC) program
  • Community Alternative to Care (CAC) waiver
  • Community Alternatives for Disabled Individuals (CADI) waiver
  • Developmental Disability (DD) waiver 
  • Elderly Waiver (EW)
  • Traumatic Brain Injury (TBI) waiver

Client Rights:

  • May hire anyone 18 years old or older they want to work for them as a PCA worker, excluding parents of minors, spouses and the responsible party. Only requirement is to PCAs a background check that the PCA Choice organization submits to DHS licensing division. The individual hired also must be able to perform the duties necessary in providing assistance to the consumer.
  • Have the right to terminate the PCA worker.
  • Should assist with determining the rate of pay for the PCA workers.
  • Set the PCA worker schedule

Client Responsibilities:

  • Recruiting their own PCA workers, including developing a job description, interviewing, screening, advertising, etc.
  • Ensuring PCA workers are qualified to provide needed assistance to consumer.
  • Having a care plan specifying kinds of assistance needed. 
  • Obtaining doctor’s orders documenting need for a PCA
  • Setting their schedule and identifying when they need PCA
  • Scheduling PCA workers to cover their needs for assistance
  • Submitting time cards through the organization of documented hours worked
  • Training PCA workers. Consumers may get assistance for this if they choose PCA professional supervision at the time of their assessment for PCA hours.
  • Providing their own backup assistance in case their staff is unable to provide assistance.

*In the flexible use option, consumers must keep track of the hours they use so they don't run out of hours before the end of their service agreement.

The QP will assist you in:

  • Communicating changes in your needs to the provider, physician or others
  • Supervise PCAs to ensure that cares are provided correctly
  • Orient PCAs to personal cares and needs
  • Determine whether or not the goals of PCA services are being met
  • Develop and monitor a month to month plan of care
  • Review documentation of PCA services provided (hours worked by PCA)
  • Train PCAs to provide hands-on assistance with special health care tasks
  • Ensure that the personal care assistant is capable of providing the required personal care services through direct observation of the assistant's work or through consultation with the qualified recipient.
  • Ensure that the personal care assistant is knowledgeable about the plan of personal care services before the personal care assistant performs personal care services.
  • Ensure that the personal care assistant is knowledgeable about essential observations of the recipient's health, and about any conditions that should be immediately ought to the attention of the QP, PHN, or the attending physician.
  • Review, together with you, and revise, as necessary, the plan of personal care services at least once every 120 days after a plan of personal care services is developed. (initially within 14 days, each 30 days for the first 90 days and then at least every 120 days)
  • Ensure that QP records are kept.

All activities not assigned to the Qualified Professional are your responsibility.