Personal Care Services (PCS)

The beneficiary or family member will want to provide the Request for Independent Assessment for Personal Care Services Attestation of Medical Need Form (Form 3051) Request for Services and Instructions (DHB 3051) to their primary care or attending physician to complete. Once complete, the form will need to be faxed to Acentra at 833-521-2626.

Once the form is received, it will be processed within 2 days. If information is missing, Acentra will work directly with the referring physician to obtain the necessary information required for processing. If Acentra is unable to obtain the necessary information, the request will be denied and a letter sent to the beneficiary. The beneficiary is welcome to reapply at any time once the necessary information is obtained.

If the form is complete with all required information, then the beneficiary can expect a phone call within 2 weeks to schedule the assessment. If the beneficiary resides in an Adult Care Home, Acentra will call the home.

The more information that can be provided at an assessment, the better. It is recommended that individuals who care for the beneficiary on a regular basis be in attendance in order to speak to their ability to perform the activities of daily living on a regular day. It is also important to have any medical documentation that can speak to the beneficiary’s physical abilities as well as all of their medications.

The beneficiary will be asked to demonstrate their ability to perform the various activities of daily living. The beneficiary and caretakers should plan for the assessment to last 1-2 hours.