Personal Care Services (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
These services benefit individuals who require assistance with activities of daily living (ADLs), including:
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.
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.
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.
- 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
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.
To join the PCS Stakeholder Group, call 919-855-4360 or send an email to PCS_Program_Questions@dhhs.nc.gov.
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