Resources for Personal

Care Services

A qualified beneficiary if that individual is currently hospitalized, in a medical facility, in a Skilled Nursing Facility (SNF), part of the Transition to Community Living Initiative, or in cases of an active Adult Protective Services (APS) case

Eligibility Requirements

• There is an active Adult Protective Services (APS) case.
• The beneficiary is currently hospitalized, in a medical facility or in a Skilled Nursing Facility (SNF).
• Is an individual in the transition to living community initiative.
• For an Adult Care Home (excluding 5600 facilities), the beneficiary must have a Pre-Admission Screening and Resident Review (PASRR) number. To learn more about this form and process, please go to www.ncmust.com/pasarr/pasarrsummary.jsp.
• The beneficiary is medically stable.
• The beneficiary has active or pending Medicaid.

• If eligibility requirements are met, a hospital discharge planner, skilled nursing facility discharge planner, LME/MCO Transition Coordinator, or Adult Protective Services (APS) Worker may request an Expedited Assessment by faxing the Request for Services form to 1-833-551-2602 followed by a call to Acentra Health at 833-522-5429.A hospital discharge planner, skilled nursing facility discharge planner, LME/MCO Transition Coordinator, or APS worker will need to have the beneficiary select a provider of services before PAs can be issued.
• Expedited Assessments for beneficiaries seeking placement in ACHs (not 5600s) will need a PASRR number.
• Once connected with Acentra Health, the request will be reviewed and immediately approved or denied by a Customer Service Team Member. If approved, the caller will be transferred to an Acentra Health nurse who will conduct a brief telephone assessment. If approved, the beneficiary will be immediately awarded temporary hours for PCS services.
• Acentra Health will then contact the beneficiary within 14 business days to schedule a complete assessment in person.

For any questions concerning the expedited assessment process, please contact Acentra Health at 833-522-5429.

DHB 3051 Training and DHB 3051 Expedited Process

ACH & PCS Provider Meeting-01/16/2024

FAQs from the January 16, 2024 ACH PCS Stakeholder Meeting

Acentra CSC Webinar Presentation

PCS 101 for Providers Training

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.

EVV Flyer 

IOD People First Brochure

1915 – a section in the Social Security Act enacted in 2017 for the purpose of allowing State Medicaid programs to provide home and community-based services under the Medicaid State Plan. Through the 1915(i) option, it is not necessary for a state to apply for a waiver to provide these services.

24x7 – A statement of availability of systems, communications, and/or supporting resources every hour (24) of each day (7 days weekly) throughout every year for periods specified herein. Where reasonable downtime is accepted, it will be stated herein. Otherwise, 24x7 implies no loss of availability of systems, communications, and/or supporting resources.

Activities of Daily Living (ADLs) – The physical functions that an induvial performs each day including bathing, dressing, mobility, toileting, and eating.

Adult Care Home (ACH) – Assisted living residencies having seven or more beds that provide 24-hour scheduled and unscheduled personal care services to all residents.

Change of Status Review – A re-assessment required because of a significant change in the recipient’s unmet need for assistance with ADL’s and other support services provided under the PCS program.

Continuous Quality Improvement (CQI) – The process of designing program monitoring and evaluation activities, identifying program problems and decencies, correcting, or remediating those problems and deficiencies, and continually improving the quality of care and services provided to Medicaid recipients under the PCS program.

DD – Developmental Disability

Department or DHHS: The North Carolina Department of Health and Human Services

Division of Health Services Regulation (DHSR) – The state agency responsible for licensing and regulating home care agencies, adult care homes, family care homes, and supervised living homes.

Family Care Home (FCH) – An assisted living residence having two to six beds that provides 24-hour scheduled and unscheduled personal care services to all residents.

Functional Limitation – a limitation in the individual’s capacity to perform ADL’s independently because of a physical, cognitive, or health-related impairment.

Health Home – Part of the managed-care model which provides a primary care physician for each recipient and all services are provided by the same provider.

Home Care Agency – A public or private entity licensed by the state to provide in-home personal care services.

HIPAA – Health Insurance Portability and Accountability Act of 1996 that provides a federal regulation for the protection and security of confidential health information.

IHPCS – In-Home Personal Care Services; Personal Care Services delivered by a Home Health or In-Home Care entity.

Instrumental Activities of Daily Living (IADLs) – Light housekeeping tasks directly related to the approved ADL assistance as approved by the Independent Assessment Entity and as specified on the recipient’s plan of care, such as clean up after a bath or meal.

Medically Stable – the recipient has reached a point in his or her medical treatment where a life-threatening or serious injury, disease, medical condition, or cognitive impairment has been brought under control and the recipient no longer requires medical care, services, supervision, or monitoring from a licensed health profession and can live safely at home under his or her current living conditions.

MI – Mental illness

Nursing Services – Professional services provided by a registered nurse (RN or a licensed practical nurse (LPN) under the supervision of a registered nurse.

PCS – Personal care services

Personal Care Aide – An individual who is a paraprofessional and who provides personal care services.

Physician Referral – The referral the recipient’s primary care physician or other referring practitioner sends to the Independent Assessing Entity to initiate an independent assessment that will determine the receptions qualifications for PCS.

PR (Private Residence) – A home or apartment privately owns or privately rented by the recipient, his or her family or unrelated individual who is providing a home for the recipient, and does not include any facility, group home or other living arrangement that provides room and board and other services under any public assistance program.

Program Re-assignment or Continuation Review – the reassessment of the PCS program participants conducted prior to the end of his or her current authorization period (review date or anniversary date) to determine if her or she continue to qualify for services and if the recipient does continue to qualify for services, to determine the amount of care to be provided for the following authorization period.

Provider – A public or private entity that I license as a home care agency, adult care home, family care home, special care unit, r supervised living home by the North Carolina Division of Health Services Regulation (DHSR) and enrolled with Medicaid to furnish PCS under this PCS program.

Provider Referral – the referral the independent entirety send to a recipient PCS provider of choice after the recipient is determined to qualify for PCS.

Recipient – An individual qualified for Medicaid who is receiving services under the Medicaid PCS program.

Special Care Unit (SCU) – a unit that specializes in caring for people with Alzheimer's and dementia.

State - The State of North Carolina and it’s agencies.

Supervised Living Home (SLH) – A group home of under seven beds that provides 24-hour living environment in a hon-hospital setting that includes room, board, supervision, and personal assistance for individuals receiving short-term transitional services for mental illnesses or developmental disabilities.