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Personal Care Services (PCS)

Attention:

Attention Adult Care Homes and other Residential providers of Medicaid Direct Personal Care Services (PCS):  

On Tuesday, January 16, 2024, at 3:00 – 4:00 PM, NCLIFTSS will host a PCS Stakeholder Meeting; use the link below to register:

North Carolina ACHs Meeting

Agenda topics will include: 

  1. The scheduling and conducting of initial and annual assessment appointments by Acentra Health.
  2. An analysis of the scoring of residential assessments completed by Acentra Health. 
  3. Requesting help from the NCLIFTSS call center. 
  4. An overview of the PCS realignment, Phase I and II, and how to register to participate in work sessions starting in late January 2024. 

To ensure your questions are addressed during the stakeholder meeting. Please send any questions you may have in advance of the meeting to the email address below with the subject “Stakeholder Meeting Question”.

PCS_Program_Questions@dhhs.nc.gov

Personal Care Services Overview

For eligible Medicaid beneficiaries, Personal Care Services (PCS) provides hands-on assistance, by paraprofessional aides, for the five qualifying activities of daily living (ADLs) which include eating, dressing, bathing, toileting, and mobility. The amount of approved service is based on an assessment conducted by an independent assessment entity to determine the beneficiary’s ability to perform their ADLs.

Personal Care Services (PCS) provides 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

Covered services include:

  • Assistance to help with qualifying ADL;
  • Assistance with medications that treat medical conditions that effect the qualifying ADL; and
  • Assistance with devices directly linked to the qualifying ADL.

Services NOT approved under PCS include:

  • Skilled nursing by LPN or RN
  • Respite care
  • Care for pets or animals
  • Yard work
  • Medical or non-medical transportation
  • Financial Management
  • Errands
  • Companion sitting

PCS Eligibility

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.

How to apply for PCS?

The individual’s primary care or attending physician, physician assistant, or nurse practitioner must make the referral for the individual to be assessed for PCS using the Request for Independent Assessment for Personal Care Services Attestation of Medical Need Form (Form 3051).

Acentra will review the form and schedule an assessment.

For more information, visit the DHHS Website.

For more frequently asked questions, visit - FAQs