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.

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.

Follow-Up Training On COVID+ Report Template for In-Home Providers under Special Bulletin #93

On May 29, 2020, NC Medicaid released 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. Medicaid hosted its first training on the COVID+ Report Template for In-Home Providers on Wednesday, June 3, 2020.

Additional information regarding NC Medicaid's response to COVID-19 can be found here.

Transition Dates Announced for NC Medicaid’s Comprehensive Independent Assessment Entity - Sept. 18, 2023
New Web Address for PASRR Application - Nov. 23, 2021
SPECIAL BULLETIN COVID-19 #200: Correction to Personal Care Services Public Health Emergency Uniform Rates for December 2021 - Nov. 18, 2021
SPECIAL BULLETIN COVID-19 #199: Temporary Provider Rate Increases and Clinical Policy Changes Extended - Nov. 16, 2021
Electronic Visit Verification Soft Launch Ends for PHPs - Oct. 21, 2021
Electronic Visit Verification Hardship Advance Update - Oct. 21, 2021
Implementation of Short-Term Solution for Adult Care Home Providers Delivering Personal Care Services --Aug. 20, 2021
Prior Authorizations Covered When a Beneficiary Transitions to NC Medicaid Direct - Aug. 4, 2021
What Providers Need to Know After the July 1, 2021 Full Launch of Electronic Visit Verification - Aug. 4, 2021
Electronic Visit Verification Payment Issues Identified - July 22, 2021
Personal Care Services Beneficiary Managed Care Disenrollment Process and Updated Referral Form - July 15, 2021
Electronic Visit Verification Updates - June 28, 2021
Electronic Visit Verification Implementation Update: Beginning of EVV Claims Adjudication, Alt EVV and Other Topics - June 9, 2021
Electronic Visit Verification Implementation: Claim Adjudication Based on EVV Data Begins June 1, 2021 - April 30, 2021
Electronic Visit Verification Implementation Update: Alternate EVV Solution Deadline for Compliance - April 16, 2021
Electronic Visit Verification Implementation: Extension of Pay and Report Period - March 29, 2021

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

September 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

September 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:

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.)
Select the Provider Name hyperlink, then select "Add Document," which will bring up the "Upload Record" screen.
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.)
Select "Done" and the system will place the uploaded document into the Provider Documents table for storage.
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