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.

COVID-19 Information for PCS

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.

Medicaid Bulletin Updates

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

Policy Manuals

Clinical Coverage Policy 3L
PCS Provider Manual

PCS Stakeholder Group

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

Announcements

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.

Resources

PCS Monthly Reports