Editors Note: This is the second post in a series we are calling “Wednesday Wisdom” Where we take you, our consumers, supporters, and readers inside of LIFTT to give a detailed picture of some portion of our programs and operations. This week Personal Care Assistance (PCA) program facilitator Lannette Brown reviews the qualifications for the LIFTT Community First Choice Self Direct Personal Assistance Program (CFC/SDPAS) also known as the Personal Care Assistant (PCA) program.
What qualifies a person to become a consumer of the LIFTT PCA program (CFC/SDPAS) program?
by Lanette Brown, LIFTT PCA Program Facilitator
LIFTT PCA Program Facilitator Lanette Brown
Allow me to start by saying that LIFTT’s PCA Program is one of the many CFC/SDPAS programs that exist around the country. It provides services to the members of the community who live with a disability. The acronyms CFC stands for Community First Choice and SDPAS for Self-Direct Personal Assistance Services. According to the Montana Department of Public Health and Human Services (DPHHS),[1] both CFC and SDPAS can be described as “programs designed to provide long-term supportive care in a home setting.” Thanks to CFC/SDPAS, elderly and disabled individuals can stay at home and avoid institutionalization. These services meet the specific needs of the recipient in a person-centered manner, meaning putting people and their families at the center of decisions and seeing them as experts, working alongside professionals to get the best outcome.[2] The services are provided by caregivers commonly referred to as personal care assistants (PCAs). It is the recipient of services who chose and train the PCAs according to their needs, living situation, and availability of caregivers.
First, to receive PCA services from LIFTT, the candidate must live in one of the 18 counties in Southeastern and South Central Montana that comprise LIFTT’s service area, Big Horn, Carbon, Carter, Custer, Dawson, Fallon, Garfield, Golden Valley, McCone, Musselshell, Powder River, Prairie, Richland, Stillwater, Wibaux, and Yellowstone.
Secondly, the individual in need of CFC/SDPAS services must call LIFTT and choose option number 3 of the telephone menu of options to talk to one of the team members of LIFTT’s PCA Program Valerie Rowlison, valerier@liftt.org or (406) 294-5208, Tabatha Smith, tabathas@liftt.org or (406) 294-5191, Kasey Mook, kaseym@liftt.org or (406) 606-1762 and/or Lanette Brown, lanetteb@liftt.org or (406) 294-5184
Thirdly, the candidate must have a health condition that limits their ability to perform activities of daily living
Fourthly, The candidate must be eligible to enroll with “standard” or “full” MEDICAID. I believe everybody knows this but would like to mention that MEDICAID is a federal and state healthcare program available to individuals who meet specific requirements. States run their MEDICAID programs independently and provide at least half of the funding for the program. Adult members of Montana families whose household countable income is less than 25% Federal Poverty Level (FPL) are eligible for standard MEDICAID. Adult members of Montana families whose household countable income is between than 25% and 138% FPL are eligible for Medicaid Expansion.[3] Full benefit MEDICAID coverage refers to the package of services, beyond coverage for Medicare premiums and cost-sharing, that certain individuals are entitled to when they qualify under eligibility groups covered under a state’s MEDICAID program.[4]
Fifthly, the candidate who wants to receive PCA services from LIFTT must know someone who can be their caregiver or personal care assistant (PCA).
Sixthly, provided the candidate meets the requirements listed above, they must be able to understand and complete paperwork or identify someone who can be their personal representative (PR).[5] The PR must be 18 years of age or older. LIFTT will need the PR’s full name, address, and telephone number, and the PR will have to communicate with one of the PCA Program team members whom we refer to as facilitators. Once the candidate is admitted to the program, he becomes a consumer and is assigned to one of the program facilitators.
Seventhly, CFC/SDPAS require hands-on assistance[6] with at least four of the following tasks: bathing, dressing, hygiene, positioning, transferring, mobility, meal preparation, eating, exercise, and medication reminders. After meeting these tasks, the following ones may be added: light house cleaning, laundry, shopping (for dietary & medical items only), community integration, correspondence assistance, and yard hazard removal. The medical escort service also requires hands-on assistance and can be allowed. Allow me to clarify that medical escort isn’t just for transportation, and this program isn’t a house cleaning or shopping or medical transportation program. There is very little time for these tasks.
Eighthly, during the application process, the PCA Program team members will ask the candidate to provide full name, address, telephone number where they can be always reached, MEDICAID number, and Social Security number. This information will allow LIFTT to access the Montana Access to Health Web Portal and verify the candidate’s Medicaid eligibility.
Ninthly, a primary diagnosis and other diagnoses must correlate with the need for hands-on assistance. Reminders do not require much time, so they don’t translate to a big need.
Tenthly, the candidate must identify a primary Doctor who will prescribe the CFC/SDPAS services.
Eleventhly, the Consumer/Member or PR needs to be able to: (a) direct their own services, (b) read and understand the paperwork, (c) respond to request for information, (d) sign off on Service Delivery Record (SDR) sheets for accuracy, and (e) direct their PCA.
Twelfthly, it is the Consumer/Member/PR who hires, trains, and fires their caregivers. They also need to know someone that can back up that primary PCA if there is an emergency such as illness, accident, or vacation.
After obtaining the information and talking with the Consumer/Member/PR, LIFTT will send them a copy of the CFC/SDPAS booklet, program information sheet, and LIFTT brochure. They are asked to call their PCA Facilitator immediately after reading the information to confirm if they are still interested in participating in the CFC/SDPAS program. The PCA Facilitator then completes the process by entering the information into LIFTT’s database program called CIL Suite and adds the PCA service to the consumer’s file.
All the information collected during the application process is presented to LIFTT’s PCA Program team for consideration, The team makes sure the candidate is someone who will be a good fit for the CFC/SDPAS program and will be able to work with LIFTT. If all PCA Team members agree to bring the candidate into the program, the process continues. If LIFTT decides not to approve the application, one of the PCA Facilitators will call the candidate to notify them about the decision and provide them with the names and telephone numbers of other agencies that provide CFC/SDPAS services. When authorized by the candidate, we will send these agencies this information collected during the application process.
It happens that candidates may fail to get back to LIFTT. In this case, LIFTT follows up with them via telephone up to three (3) times. If they do not respond, and LIFTT is unable to reach them the process stops. If they respond and want to continue, LIFTT completes a CFC/SDPAS Member Referral sheet and faxes it to Mountain-Pacific Quality Health (MPQH).[7] The MPQH nurse has ten (10) working days to complete a pre-screen/interview with the consumer, develop their profile outlining the tasks the candidate is authorized to have completed by their personal care assistant (PCA), and establish how much time the PCA is allowed to use to complete those tasks over a two-week period. Once this paperwork is sent to LIFTT, the PCA Facilitator reaches out to the Consumer/Member/PR to set up a day and time to complete the intake process and welcome the individual as a consumer of the PCA program or CFC/SDPAS program.
If you need additional information or would like to complete an application, please do not hesitate to contact me at lanetteb@liftt.org or (406) 294-5184.
[1] https://dphhs.mt.gov/sltc/csb/#:~:text=The%20Community%20First%20Choice%20and,to%20remain%20in%20their%20homes accessed December 2022.
[2] https://healthinnovationnetwork.com/system/ckeditor_assets/attachments/41/what_is_person-centred_care_and_why_is_it_important.pdf accessed December 2022
[3] https://dphhs.mt.gov/assets/2021biennialreports/MedicaidinMontana2021.pdf accessed December 2022
[4] https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MedicareMedicaidEnrolleeCategories.pdf accessed December 2022
[5] Under the Rule, a person authorized (under State or other applicable law, e.g., tribal or military law) to act on behalf of the individual in making healthcare-related decisions is the individual’s “personal representative.” Section 164.502(g) provides when, and to what extent, the personal representative must be treated as an individual for purposes of the Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/personal-representatives/index.html#:~:text=Under%20the%20Rule%2C%20a%20person,the%20personal%20representative%20must%20be accessed December 2022.
[6] Hands-On Assistance — the physical assistance of another person without which a person would be unable to perform one or more of the activities of daily living (ADL). Some long-term care (LTC) insurance policies define the inability to perform an ADL without hands-on assistance as a trigger for policy benefits. https://www.irmi.com/term/insurance-definitions/hands-on-assistance#:~:text=Hands%2DOn%20Assistance%20%E2%80%94%20the%20physical,a%20trigger%20for%20policy%20benefits. Accessed December 2022.
[7] https://www.mpqhf.org/corporate/ accessed December 2022.
About Living Independently for Today & Tomorrow (LIFTT): LIFTT is a Montana 501(c)3 corporation organized as a Center for Independent Living (CIL). With team members based in Billings, and Glendive, LIFTT provides people with disabilities with programs and services that help empower them to break down the physical, bureaucratic, and cultural barriers that prevent them from being fully independent participants in their lives and communities throughout 18 counties in southeastern and southcentral Montana: Big Horn, Carbon, Carter, Custer, Dawson, Fallon, Garfield, Golden Valley, McCone, Musselshell, Powder River, Prairie, Richland, Stillwater, Wibaux, and Yellowstone. For more information, please visit liftt.org or download our mobile app on Apple or Google Play.