Personal Care Services (PCS)

About PCS

Personal Care Services (PCS) provides personal care services to individuals residing in a:

  • Private living arrangement
  • Residential facility licensed by North Carolina as an adult care home
  • Combination home as defined in G.S. 131E-101(1a).
  • 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

Eligibility

These services benefit individuals who require assistance with activities of daily living (ADLs), including:

  • Eating
  • Dressing
  • Bathing
  • Toileting
  • Mobility

To qualify for PCS, an individual must have a medical condition, disability or cognitive impairment, and demonstrates unmet needs for:

  • Three of the five ADLs with limited hands-on assistance
  • Two ADLs, one of which requires extensive assistance
  • Two ADLs, one of which requires assistance at the full dependence level

PCS program eligibility is determined by an independent assessment conducted by NC Medicaid or its designee, and is provided according to an individualized service plan.

Provider Forums

PCS presentation from LTSS Provider Forum - June 25, 2024

Tab/Accordion Items

Join the PCS Stakeholder Group, find meeting information or request a topic for discussion.

Dec. 10, 2024 - Provider Notice:
Announcement on the NCLIFTSS website and QiRePort:
Beginning April 1, 2025, processing requests for PCS using the old version of the DHB3051 form will be delayed while the provider corrects the request by using the current version of the DHB 3051, Request for Services and Instructions (DHB 3051).

Dec. 9, 2024 - Provider Notice:
NC Medicaid realigned how Personal Care Services (PCS) for individuals living in congregate settings are administered and reimbursed.
In accordance with SL 2019-240 Section 1(b), the realignment consists of a rate methodology change from 15-minute increments to a daily rate for individuals living in congregate settings. Effective Jan. 1, 2025, the unit of reimbursement will change from a 15-minute increment to a daily per diem.

Reimbursement will no longer be based on the actual time spent delivering the service on a specific day. Instead, reimbursement will be based on a calculated per diem (daily) rate.
Per diem rates will be based on the number of total units prior-approved by NC Medicaid for PCS services to each specific beneficiary for an authorized period.

The APPROVED DAILY UNITS will be calculated using the available PA information at the time of adjudication, according to the following formula: PA Approved Daily Units/Approved PA days, with the latter defined as “PA End date – PA Beg Date +1 Day.” For example, if a beneficiary’s PA allows 320 total units for a period that spans 30 days, the approved daily units would be 320/30 = 10.666. Providers will submit one line per date of service.

Two clinical coverage policies (CCPs) were implemented that describe the payment reimbursement methodology in Attachment A- Claims-Related Information. The two policies will be effective on Jan. 1, 2025, and will be posted to the NC Medicaid website.

The two CCPs are Personal Care Services in In-home settings (3L) and Personal Care Services in Congregate Settings (3L-1).

  • 3L-1, Personal Care Services in Congregate Settings covers providers billing with CPT 99509 HC- Adult Care Homes, 99509 TT - Combination Homes, and 99509 SC - Special Care Units.

Please click the links below to read the published Medicaid Bulletins for more information about the change. Information sessions are scheduled for Dec. 3 and Dec. 11 to learn more about this change.

The registration links to register for the webinars are below and included in the Medicaid Bulletins. 

Webinar Links: 
Dec. 3 at 2-3 pm – Registration link: https://attendee.gotowebinar.com/register/5797915472326932825
Dec. 11 at 2-3 pm – Registration link: https://attendee.gotowebinar.com/register/4194630706448172633
Medicaid Bulletins: 
Revised Reimbursement Methodology for Individuals Living in Congregate Settings Administered by Personal Care Service Providers
Policy Guidance for Personal Care Services Beneficiaries in Congregate and In-Home Settings 

Nov. 9, 2023 - Provider Notice: 
Requirements to comply with the 3L Clinical Coverage Policy
Annually, all enrolled Personal Care Services (PCS) providers authorized to render PCS must attest to their compliance with Clinical Coverage Policy 3L, Section 7.7, Internal Quality Improvement Program. Each provider must sign the Quality Improvement Attestation Form titled NC Medicaid 3136 on or before December 31 of each calendar year.  Instructional guidance can be accessed using the form NC-Medicaid 3136 I.  
Upon the completion of the attestation form, each provider must upload that form to the QiRePort portal. NC Medicaid will use the QiRePort portal to audit provider compliance with Section 7.7. All providers are required to use that portal to submit their signed attestation.

As required by Session Law 2013-306, for all beneficiaries seeking additional hours authorized under Session Law 2013-306, the authorized provider must submit a Session Law 2013-306 PCS Training Attestation Form titled NC Medicaid 3085 before serving these beneficiaries. The completion of this attestation form confirms their aide training curriculum has been completed and the provider is qualified to support beneficiaries approved for additional hours. This attestation is only required when additional hours are being requested. Providers meeting this qualification will only need to upload this form once time in the QiRePort Portal. Instructional guidance can be accessed using the form NC Medicaid-3085 I.  

Instructions to electronically upload Forms 3136 and 3085 using the QiRePort Portal
At the PI Setup Menu:
1.    Click "Documents" and find your Provider Name/NPI#. (Note: Only providers with administrative rights will have access to the Setup menu to add the forms.)
2.    Select the Provider Name hyperlink, then select "Add Document," which will bring up the "Upload Record" screen.
3.    From there, select Document Type, Document Year and the Record. (Note: The NC Medicaid 3136 and/or 3085 forms(s) must first be saved to the computer or an external device to complete the upload.)
4.    Select "Done" and the system will place the uploaded document into the Provider Documents table for storage.
5.    Select "Save" to save the record and complete the upload.
Important information you need to know: 
•    Only individuals at the provider agency authorized with administrative rights can upload the Forms 3136 and 3085
•    Forms 3136 and 3085 are uploaded for each provider and are not beneficiary specific. 
•    Forms 3136 and 3085 are stored and maintained in the QiRePort portal. 
Resource and Technical support:  
For any questions on the administrative rights, documentation upload, or any other issues regarding the QiRePort Portal please contact VieBridge Support at 888-705-0970.
For PCS Questions please contact NC Medicaid at PCS_Program_Questions@dhhs.nc.gov, or 919-855-4360.
PCS webpage

Nov. 7, 2023 - Extending Beneficiary Prior Authorizations (PAs)

The following are the steps to be taken each month to extend Prior Authorizations (PAs) for beneficiaries whose annual assessments are delayed beyond their one-year anniversary.

  •  At the end of each month, the system checks for beneficiaries who have not had an annual assessment within the past year, and their authorization ends that month. (i.e., PAs ending 11/30/2023).
  • If a beneficiary meets this criteria, PA extensions are generated automatically by QiReport and transmitted to NC Tracks on the last day of the month. (i.e., PAs will transmit on 11/30/2023).
  • Providers should check NC Tracks 2 business days AFTER the last day of each month (not before), to verify the PAs are current for their beneficiaries. (i.e., Check NC Tracks 12/04/2023 for beneficiaries whose authorizations would have expired 11/30/2023).
  • A provider should ONLY contact Medicaid if it is determined that a PA was not extended for a beneficiary whose authorization expired the previous month (i.e., Provider checks PAs in NC Tracks on 12/04/2023 and the last PA in the system is 11/01/2023-11/30/2023).

Sept. 15, 2023 - On June 15, 2023, the North Carolina Department of Health and Human Services announced Keystone Peer Review Organization, Inc. (Kepro) was awarded the contract as NC Medicaid’s Comprehensive Independent Assessment Entity (CIAE). To prepare physicians, providers, and beneficiaries to access NCLIFTSS, a customer support center webinar has been scheduled for Sept. 20 from 2-3 p.m. Please use the link below to register to attend the customer support center overview. 

https://attendee.gotowebinar.com/register/8922776986806582880 

Sept. 8, 2023 - While NC Medicaid begins transitioning to the new Comprehensive Independent Assessment vendor, steps are being implemented to ensure Personal Care Services (PCS) beneficiaries do not experience a gap in their service provision.

One step NC Medicaid has implemented is the extension of all eligible Medicaid Direct PCS beneficiaries’ prior approval (PAs) while the annual assessments are scheduled by Kepro/Acentra. Scheduling of annual appointments will begin after October 2023.

If you have any questions, please email them. PCS_Program_Questions@dhhs.nc.gov.
We appreciate your patience.

Aug. 29, 2023 - NC Medicaid will host a virtual Personal Care Services (PCS) Stakeholder meeting on Wednesday, Sept.6, 2023, from 3 – 3:45 p.m. The purpose of the meeting is to introduce our new NC Linking Individual and Families for Long Term Services and Supports (NCLIFTSS) vendor, KEPRO, also known as Acentra Health. There will be time for questions and answers.

Registration is required and is available at the link below.
Register Here

After registering, you will receive a confirmation email with the link to join the webinar.  

July 19, 2023: Effective immediately- In order to streamline and make the DHB auditing process more efficient, all providers will be required to upload their NC Medicaid 3136 and NC Medicaid 3085 forms to the QiReport portal. When conducting compliance audits, this will be the only database used to verify the submission of these forms.

As outlined in Clinical Coverage Policy 3L, all PCS providers should comply with certain documentation requirements. The Quality Improvement Attestation Form (NC Medicaid 3136) is due each year by December 31, for each NPI. This form is to be submitted by all providers to attest to their compliance with Clinical Coverage Policy 3L, Section 7.7, Internal Quality Improvement Program. Providers can find instructions using form NC-3136 I.

Additionally, providers who are serving beneficiaries seeking additional hours under Session Law 2013-306 must also submit Session Law 2013-306 PCS Training Attestation Form (NC Medicaid 3085) to NC Medicaid before serving these beneficiaries. NC Medicaid's Personal Care Services (PCS) program committee requires that providers attest to their aide training curriculum by submitting this completed form. Providers can access PCS Training Attestation Form instructions using form NC Medicaid-3085 I.

This form should only be submitted by providers who are serving beneficiaries seeking additional hours under Session Law 2013-306. As a reminder, this is not an annual form; it is due before the provider provides care for beneficiaries seeking additional hours under Session Law 3013-306, and only needs to be submitted once per agency.
 
NC Medicaid 3136 and 3085 Form Upload Instructions
Below we describe how to electronically upload the NC Medicaid 3136 and 3085 forms using QiRePort.

This submission will allow NC Medicaid to electronically store and maintain completed forms received for each provider. The NC Medicaid 3136 and 3085 forms will be uploaded by the provider following the same rules used by the supporting document functionality. (Note: The difference between this process and the supporting document functionality is the 3136 and 3085 forms are uploaded for each provider and are not beneficiary specific.)

To upload forms electronically, providers with administrative rights should start at the PI Setup Menu:

  1. Click "Documents" and find your Provider Name/NPI#. (Note: Only providers with administrative rights will have access to the Setup menu to add the forms.)
  2. Select the Provider Name hyperlink, then select "Add Document," which will bring up the "Upload Record" screen.
  3. From there, select Document Type, Document Year and the Record. (Note: The NC Medicaid 3136 and/or 3085 forms(s) must first be saved to the computer or an external device to complete the upload.)
  4. Select "Done" and the system will place the uploaded document into the Provider Documents table for storage.
  5. Select "Save" to save the record and complete the upload.

For additional questions, providers should contact: 
NC Medicaid at PCS_Program_Questions@dhhs.nc.gov, or call 919-855-4360.
 
Dec. 17, 2021: Attention All Providers planning to use or currently using Electronic Visit Verification (EVV). NC Medicaid is conducting a short survey to help us better understand what EVV systems are already being used in North Carolina and to get information on how the use of EVV has been working for providers so far. Please take a moment to complete our brief survey to provide the state with insight on the EVV Program. The survey will be open through Jan. 15, 2022. 

Click on the survey link and you will be redirected to the NC Medicaid EVV webpage where you can complete the survey. This webpage also contains in-depth educational resources for review at your convenience.

Nov. 23, 2021: RSVP experienced system issues from 1:15 p.m. on Nov. 18, 2021, to approximately 11:15 a.m. on Nov. 19, 2021. If you tried to submit RSVP referrals during that time and were unsuccessful, please resubmit your RSVP by 5 p.m. on Nov. 23, 2021, and indicate in the note that you are resubmitting due to issues on Nov. 18, and that the PCS approval date should be Nov. 18 rather than the current date. 

If you have already submitted a RSVP after the system issues were resolved on Nov. 19, do not submit a duplicate. Instead please contact Stacey Lee at stacey.lee@dhhs.nc.gov and include the RSVP number for further assistance.

Sept. 25, 2020: In compliance with Section 12006 of the 21St Century Cures Act (the Cures Act), P.L. 114-255, added Section 1903(l) of the Social Security Act (SSA). Section 1903(l) that requires the use of an electronic visit verification (EVV) system for personal care services (PCS) and home health care services (HHCS) that require an in-home visit by a provider for states participating in the Medicaid program. Programs subject to the EVV requirement are: State Plan Personal Care (PCS)  [In-Home], CAP/DA, CAP/C, Self-directed Personal Attendant Care Services, Innovations Waiver, TBI Waiver, and the 1115 Managed Care Demonstration Waiver. 

Electronic Visit Verification (EVV) is a method used to verify visit activity for services delivered as part of home- and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them, NC will implement EVV effective Jan. 1, 2021. NC DHHS awarded a contract on September 24, 2020 to Sandata Technologies, LLC to be the state’s EVV vendor. 

The Department will provide additional information in the coming weeks regarding the onboarding of Sandata, and dates and times of provider and beneficiary training. Medicaid will host Webinars in the next two weeks to provide the details of the implementation plan for each of the affected program groups. Our process will ensure that Medicaid LTSS continues without disruption to our providers and beneficiaries.

On April 24, 2020, the Department of Health and Human Services, Division of Health Benefits (Department) cancelled award of the Comprehensive Independent Assessment Entity (CIAE) Services contract to Keystone Peer Review Organization, Inc. (KEPRO).  

The contract was awarded to KEPRO on Jan. 30, 2020.  On Feb. 28, 2020, Liberty Healthcare Corporation (Liberty) protested award of CIAE RFP #30-190367-DHB to KERPO. The Department held a protest meeting with Liberty on April 16, 2020.  Following the protest meeting, the Department cancelled the award pursuant to Section II.B.6.b of the RFP. 

The Department is in the process of extending existing contracts for independent assessments and has not yet determined the timeframe for issuing a new RFP for CIAE services. 

On Jan. 30, 2020, NCDHHS awarded Keystone Peer Review Organization, Inc. (KEPRO) the contract for Comprehensive Independent Assessment Entity (CIAE) services. KEPRO was selected based on a thorough and fair evaluation of responses submitted to the Request for Proposal released by the Department in March 2019. Due to a protest filed by the incumbent vendor, the State has voluntarily agreed to stay movement to the new CIAE vendor until a date after the protest meeting is held and a decision on the protest is made by the Department. 

NC Medicaid is evaluating the delayed implementation plan, and its impact on PCS, CAP/C and CAP/DA programs to help identify mitigation strategies for the programs during the interim. NC Medicaid will engage affected providers on those mitigation strategies. More information is anticipated by mid-April. PCS, CAP/C and CAP/DA providers should continue to conduct business as usual until further notice. 

Please continue to send all PCS Requests for Services to Liberty Healthcare of North Carolina until further notice. 

PCS Monthly Reports

Personal Care Services Forms

Fee Schedules

Referral Screening Verification Process-RSVP

Adult Care Homes Information

Personal Care Services Unit
Phone: 919-855-4360
Email: PCS_Program_Questions@dhhs.nc.gov

NC LIFTSS/ Acentra Health
Phone: 833-522-5429
Fax: 833-521-2626
https://ncliftss.acentra.kepro.com/
 

To join the PCS Stakeholder Group, call 919-855-4360 or send an email to PCS_Program_Questions@dhhs.nc.gov.

PCS Per Diem Rate Methodology

Tuesday, Oct. 25, 2022: Stakeholder Meeting

Tuesday, July 26, 2022: Stakeholder Meeting

Wednesday, April 20, 2022: Stakeholder Meeting

Friday, May 21, 2021: Stakeholder Meeting

Feb. 18, 2021: PCS Stakeholder Meeting 

Fall 2018 PCS Provider Training

Spring 2018 PCS Provider Training

Assessing the Eating Needs of PCS Beneficiaries

Pettigrew vs. Brajer

Office of Compliance and Program Integrity

PCS Revised Payment Adjustment (NC Session Law 2013-306)

NC Session Law 2013-306 - SPA 13-009

Archive

Tab/Accordion Items

In response to COVID-19, NC Medicaid is taking the following precautions regarding independent assessments conducted to determine eligibility for Personal Care Services (PCS), including changes to annual reassessments, initial assessments, expedited assessments, change of status assessments, assessments conducted during an appeal, and EPSDT short term requests. See SPECIAL BULLETIN COVID-19 #30: Personal Care Services Assessments.

See SPECIAL BULLETIN COVID-19 #58: Personal Care Services Additional Policy Allowances, for information on Supervisory Visits in beneficiary primary private residences, requirements for physician referral, PCS conducted outside of beneficiaries’ primary private residence, documentation requests to determine PCS authorization and Service Plan requirements.

See SPECIAL BULLETIN COVID-19 #68: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients regarding NC Medicaid directing increased financial assistance to North Carolina Skilled Nursing Facilities (SNF) and Adult Care Homes (ACH) to support addressing the increased costs of caring for COVID positive (COVID+) residents in a congregate care setting.

See SPECIAL BULLETIN COVID-19 #73: Personal Care Services Telephonic Assessments Update, for up-to-date information on initial and annual telephonic assessments for PCS beneficiaries.   

See SPECIAL BULLETIN SPECIAL BULLETIN COVID-19 #88: Additional Temporary Rate Increases for Skilled Nursing Facilities, LTSS Personal Care Service Providers and Home Health Providers to support Strengthening Infection Prevention Activities.

See SPECIAL BULLETIN COVID-19 #93: Targeted Rate Increase, Additional Hours and Associated Reporting Requirements for In-Home Personal Care Services (PCS) Providers under State Plan PCS and CAP/C and CAP/DA Programs.

See SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients.

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This page was last modified on 04/16/2025