Why is DHS making the change from PCA to CFSS?

The Affordable Care Act allows DHS to implement changes that will give people more choice and control over how they use services. This change makes available the new options described in the video, What is Community First Services and Supports?, and on the Community First Services and Supports webpage.

What is Community First Services and Supports? (VIDEO)? 

What are the two CFSS service models?

• Agency Model: Service model in which the lead agency authorizes units to the person and the person selects a CFSS provider agency to employ workers. This service model is similar to the traditional PCA service option.
• Budget Model: Service model in which the lead agency authorizes dollars to the person and the person employs their workers. The person selects an FMS provider to assist with employer-related tasks.

CFSS agency and budget models (VIDEO)

What are the similarities between the agency and budget models?

• The person directs care.
• The person selects a consultation services provider.
• The person writes their CFSS service delivery plan.
• The lead agency approves the CFSS service delivery plan.
• Spouses and parents of minors may be paid to provide services.
• People using CFSS may serve as the CFSS worker for others.
• Ability to purchase goods, services and PERS.
• Covered and non-covered services are the same.

What are the different roles involved in CFSS?

• Lead agency: Oversees and coordinates the delivery of services to people. Authorizes CFSS plans, updates service agreements and coordinates with providers.
• Consultation services provider: Educates and helps people write the service delivery plan, if desired, and reviews the plan. Provides ongoing support.
• Financial management services (FMS) provider: Supports people who use the CFSS budget model to fulfill their responsibilities in being the employer of their workers. Facilitates the purchase of goods/services for people in CFSS agency and budget models.
• CFSS provider agency: Recruits, hires, trains, supervises and pays the support workers for people who receive CFSS services.

What are the differences between the agency and budget models?

In the agency model:

• The lead agency authorizes service units.
• The person selects a CFSS provider agency.
• The CFSS provider agency is the employer of the person’s workers.

In the budget model:

• The lead agency authorizes dollars.
• The person selects an FMS provider.
• The person is the employer of the workers, if applicable.
• The person’s CFSS workers are part of the SEIU Healthcare Minnesota and Iowa bargaining unit, if applicable.

May people use their units flexibly?

All people who use PCA and CFSS have flexibility in how they use their units. For example, if a person’s assessment information says they are eligible for five hours a day, that is an average. They do not need to use exactly five hours a day.

Most people who use CFSS may use their units flexibly within their service plan year. Units from one service plan year do not carry over to the next year.

If a person is still completing the transition from PCA to CFSS, the lead agency authorizes six months of PCA services that the person may use flexibly in those six months.

People on the Minnesota Restricted Recipient Program or people denied flexible use by their lead agency or DHS may only use their units flexibly within each month.

May people choose their PCA/CFSS workers?

In PCA Choice and the CFSS budget model, the person recruits and hires CFSS workers. They must meet all the requirements to be a CFSS worker.

People in the CFSS agency model may describe preferences they have about their workers or suggest specific workers to their provider agency.

May people unable to direct their own care use PCA/CFSS?

If a person cannot direct their own care, a participant’s representative may direct care on their behalf. In PCA, this role was called the responsible party. The requirements for participant’s representatives are the same as those for a responsible party. People who must have a participant’s representative are:

• People under 18.
• People with a court-appointed guardian.
• People the assessor determines cannot direct their own care.

The participant’s representative does everything the person would typically do, including directing care and signing documents.

Who may serve as a PCA/CFSS worker?

All PCA/CFSS workers must meet minimum program requirements and be competent to meet the person’s individual needs. Minimum program requirements for all PCA/CFSS workers:

• Pass a background study.
• Pass a standardized training and test.
• Be enrolled with DHS and affiliated with the person’s PCA agency, CFSS provider agency or FMS provider.

Additionally, all PCA/CFSS workers must:

• Be able to do the tasks in the care plan/service delivery plan.
• Be able to communicate with the person and their provider(s).

Beginning Oct. 1, 2024, a person’s PCA/CFSS worker may be the person’s:

• Parent, stepparent or legal guardian (for a minor).

A PCA/CFSS worker cannot be the person’s:

• Paid legal guardian.
• Responsible party/participant’s representative.

A person’s PCA/CFSS workers may be the person’s friend, neighbor or other relative not listed above if they meet the requirements.

Additionally in CFSS, people who use CFSS may serve as CFSS workers for others if they meet all the requirements.

Community First Services and Supports (CFSS) Policy Manual

Community First Services and Supports (CFSS) resources

Community First Services and Supports (CFSS) resources

Community first services and supports (CFSS)

Community first services and supports (CFSS)