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The PCS Program in Nevada

July 22, 2020

Introduction to PCS

Jeannie Hess spent her whole life caring for a family of four boys and one girl. She was a dedicated mother and a loving wife. But at 71 years of age, she suffered several health setbacks that made it nearly impossible for her to take care of herself alone in her home. She needed daily injections for diabetes and her medication ritual was complex. Sometimes she forgot to take her medication. 

Her daughter, Rebecca tried to manage her mother’s care while juggling a job at the local library, but found it increasingly difficult to support her own family while also caring for her mom.

This is a common set of issues that Nevada residents face every day and one that Personal Care Services of Nevada hopes to resolve by providing home care options statewide that solves problems for families.

The Personal Care Services (PCS) program is an important Medicaid development that has changed the lives of many elderly and disabled individuals in need of at-home care throughout the state of Nevada. 

Through this program, consumers (Medicaid recipients) can receive care from loved ones such as friends and family members who act as Personal Care Aides (PCAs). 

.This program makes it possible for eligible consumers to receive paid assistance with personal care from the people they trust most in their lives and it gives elderly and disabled individuals viable alternatives besides facility-based care.

This article discusses the PCS program in greater depth to help consumers, their designated representatives, and prospective PCAs better understand their roles and how to use this important Medicaid resource properly.

What is the Consumer Directed Personal Care Services Program? (PCS)

Personal Care Services (PCS) in Nevada is a Medicaid program that provides home care services to Medicaid recipients (also referred to as “consumers”) in need of assistance. 

This program is different from traditional at-home care agency services in that it permits consumers with qualifying health conditions or disabilities to receive assistance from a Personal Care Aide (PCA) who is a trusted friend of family member. 

As a consumer working with the PCS program, you (or a designated representative) must be willing to train and manage your Personal Care Aides (PCAs) yourself. A PCA provides basic care including assistance with meals, bathing, laundry, transportation, and whatever other tasks are required to facilitate daily living. 

PCAs allow qualifying Medicaid recipients to continue to live at home by providing them with the help they need to overcome their limitations.

Below are some of the main reasons why many Medicaid recipients choose to use Consumer Directed Personal Care Services for their home care:

·        The best caregivers are loved ones.

The PCS program was developed to respond to the fact that the best caregiver for any given patient tends to be the loved ones of elderly or disabled Medicaid recipients. Medicaid recipients who are in need of at-home care tend to feel most comfortable with trusted friends or family members. And often, these loved ones are willing to put a lot of high quality time and effort into providing care for the Medicaid recipient if they have the financial support to make that possible.

·        Relative caregivers can provide advanced levels of care without a nursing license or other certifications.

The PCS program was developed to provide a higher-quality of care to Medicaid recipients while financially supporting friends and relatives who naturally wish to provide personal assistance to the elderly and disabled. Under this program, loved ones can help with tasks that regular home care aides aren’t allowed to do. PCS aides can administer medication and dress wounds while traditional home care aides have a much more limited set of tasks they’re permitted to do. Normally, only registered nurses could provide this level of care at a much higher cost to the patient.

·        PCS encourages family members and friends to support each other.

As a PCA working through PCS in Nevada, you receive payment through a fiscal intermediary who works with Medicaid on behalf of the consumer. As a PCA, you would be responsible for assisting the consumer with Activities of Daily Living (ADLs) that will make it possible for them to continue to live at home. In exchange for your help, you will receive financial compensation.

Home Care Options in the State of Nevada

In Nevada, there are two different home-care options that Medicaid recipients can access depending on their situation:

·        Provider Agency Care

Provider Agency Care is the program that most people are familiar with when they think of home care. This option is ideal for patients (or their representatives) who either can’t or don’t want to manage their own Personal Care Aides. 

Provider care agencies don’t exist in all areas of Nevada, so not everyone has access to their services. Provider agencies provide an important service by connecting patients with Personal Care Aides who have been trained and are managed by the agency, but they aren’t ideal for everyone.

Provider Agency Care differs from Self-Directed care in that:

·       Under this system the patient or their personal representative delegates much of the decision-making to a provider service.

·       This service then hires, trains, and manages a Personal Care Aide of their choosing for the patient.

·       The service maintains the schedule and the delivery of services.

·       The service provides back-up aides on an as-needed basis.

·       This service is only available to residents in areas of Nevada where a home care agency is located.

Provider Agency Care is ideal for:

·       Individuals who don’t have a desire to manage or train their own personal care aides.

·       People who simply don’t have the time to properly manage personal care aides.

·       Individuals who don’t wish to have responsibility over their Personal Care Aides.

·       Individuals who prefer a lot of privacy and don’t want friends or relatives working for them or assisting them with Activities of Daily Living as Personal Care Aides.

·        Self-Directed Care (ISO)

Self-Directed Care is a personal care service that is available through Nevada’s PCS program. Because this is a state-run program that’s available in all areas of Nevada, home care is now available and accessible to all residents of Nevada. This is exciting because home care is almost always preferable over other types of institutionalized care.

Self-Directed Care differs from Provider Agency Care in the following ways:

·       Through Nevada’s Self-Directed Care program it’s possible for friends or family members to work directly for the Medicaid recipient (or a designated representative).

·       Using this model of care, the consumer rather than the home care agency retains control over the provision of care.

·       Through the support of an Intermediary Service Organization that works as a liaison to provide financial reimbursement and other types of support, you can schedule, train, and manage the provision of home care for yourself.

·       Medicaid recipients or their designated representative maintain control over their own care using this model. They hire, train, and manage their own Personal Care Aides.

·       The Intermediary Service Organization works with Medicaid to pay the Personal Care Aides.

·       The Intermediary Service Organization rather than the home care agency provides a source of support to the consumer but the Medicaid recipient must still schedule services, train Personal Care Aides, manage them, and develop their own back-up plan for the delivery of care.

Eligibility for the PCS

Eligibility for Nevada’s PCS program is relatively straightforward for consumers. In order to qualify you must:

1.     Either have full Nevada Medicaid or be eligible to receive it

2.     Require personal care-giving services in your home due to a health condition or disability

3.     Require assistance with Activities of Daily Living

4.     Be self-directing and able to manage personal care aides yourself OR

5.     Have a personal representative who is able to manage and direct care on your behalf.

How do you prove that you need a Personal Care Aide?

Your doctor may need to provide documentation to prove you have a need for a PCA. And a nurse may visit your home to talk with you and do an assessment of your health situation and home environment to determine whether or not you need assistance and how often that assistance will be needed. The final determination will be decided by a Managed Care Organization (MCO).

The MCO will take a look at the documentation and decide how much time you need from a PCA each week. Some consumers need 24 hour personal care while others require only a few hours per week. As a consumer, you can offer those hours to a trusted friend or family member so that they can be paid through a Medicaid fiscal intermediary for their time.

Does it cost anything?

Nevada’s PCS program doesn’t cost anything to the Medicaid recipient. The cost of having a Personal Care Aide is covered by Medicaid. With PCS everyone wins! 

Friends and family members who already provide care and support can be paid for their time and energy through this program. And Medicaid beneficiaries who would otherwise have to hire strangers as Personal Care Aides or go live in an assisted or long-term care facility can stay home and maintain an active lifestyle in their own community.

The Advantages of PCS vs. Regular Home Health Aides

Nevada’s PCS program has a number of advantages over the benefits offered by regular home health aide programs. Whereas regular home health aides are hired by Provider Agencies (where available) according to the perceived needs of the consumer, patients who are a part of the PCS program are able to choose their own caregivers. Patients (or their representatives) are also responsible for training their chosen caregivers according to their unique needs, which means that the care that is provided in the PCS program is highly individualized and personalized.

 

Home health aides are usually trained and certified by the state or other government organizations, and though they can provide excellent care, the patient doesn’t get the opportunity to train and instruct them personally. PCAs who work through PCS can often perform a broader array of tasks and legally provide a higher level of care than what regular home health aides are permitted to offer.

 

Some of the other advantages of hiring a PCA through the PCS program include:

 

·        Being able to hire a family member or friend as a caregiver

·        It doesn’t cost anything (because PCAs are reimbursed through Medicaid)

·        There’s a wider range of home care procedures and services possible (traditional home health aides are limited in the scope of care that they can provide; PCS caregivers are authorized to provide all the services of a registered nurse.)

·        Better overall care = significantly less turnover of health aides

·        Possibility to schedule care needs according to one’s own personal schedule

·        Less stress - for patients who are a part of the PCS program, hiring family means less financial stress and thus a calmer, healthier environment.

·        Fewer language and communication barriers. The ability to hire family members or friends who speak your language (literally and figuratively) makes receiving care a much more comfortable situation.

 

Who can be your paid caregiver under PCS?

Under the PCS program, a qualifying Medicaid recipient can hire a relative caregiver or even a friend. Relatives and friends do not need to be licensed or certified under the program.

Friends and family members who apply to be PCAs are not required to have any formal medical training or qualification in order to be able to provide care; in the PCS program, they are authorized to provide the same level and type of care that a registered nurse would be able to provide.

There are many benefits to hiring PCAs who are loved ones as opposed to strangers. When you hire a friend or a family member to care for you, they get paid for something they’re already doing! Providing love, support, and caregiving! 

A number of relatives or friends may be willing to dedicate even more of their time to you if they know that they’re receiving payment. These individuals can perform tasks that might otherwise require skilled nursing visits such as wound care assistance, insulin shots, or even tracheostomy suctioning.

Below we discuss some of the common relative-caregiver scenarios that occur under the PCS program in Nevada:

·        Children

         Adult children often step up to care for their parents when the need arises. Under the

         PCS program, Medicaid does allow adult children to be reimbursed for their time as        Personal Care Aides.

·        Parents

         Under certain circumstances, parents can be reimbursed as Personal Care Aides for      their children in the state of Nevada. In order for parents to qualify as PCAs, their children must be over 21 years of age and the child must actively choose the parent to   be their paid caregiver.

·        Siblings

Siblings are a common choice as PCAs under the PCS program in Nevada. Hiring a sibling can be a mutually beneficial situation for both parties.

·        Immigrant Friends of Family Members

Immigrants can qualify for reimbursement as Personal Care Aides as long as their legal status is current and they have all of the required papers to prove it.

Are any family members not able to be your caregiver?

Spouses cannot be Personal Care Aides for each other under the PCS program. Spouses are an exception to the relative-caregiver rule under PCS. One spouse cannot hire another spouse as a paid family caregiver under this program. However, individuals who are not legally married to their partner may be able to receive care from their partner under the PCS program.    

Applying for PCS in Nevada

To apply for PCS in Nevada, you will need to first start by calling the phone number for Nevada’s Medicaid fiscal agent (800-525-2395). To be able to apply for the program, you will need to meet some specific requirements and be able to hire a fiscal intermediary to manage payments to your caregiver(s) as well as other communications between yourself and the Medicaid program. FreedomCare is the best, most trusted fiscal intermediaries in Nevada. We can help anyone get through the PCS application process beginning to end!

Here are some of the steps you will need to complete during the PCS application process:

1.     Get an assessment -

 

 In this step, you will schedule and receive a home visit from a registered nurse. The nurse will assess your ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living) to determine the level and type of care that you need. Some individuals may also need to visit a doctor’s office to get an official physical assessment, but often, a home visit from a nurse is sufficient.

 

 Activities that may be assessed during this visit include your ability perform basic self-care activities such as bathing, going to the bathroom, getting dressed, and moving around your home. Other activities such as your ability to perform basic house cleaning activities, laundry, essential shopping, and meal preparation may also be assessed during this visit. This visit is intended to accurately assess the type of care that you need as well as the number of hours of care you are eligible to receive each week.

 

 Caregivers will only be compensated for the maximum number of hours dictated by the PCS program. Hours worked over the maximum number of care-giving hours deemed necessary will not be compensated by Medicaid.

 

2.     Hire a fiscal intermediary -

 

 Before you can hire a caregiver, you must first have a fiscal intermediary available to act as a liaison between you (or your representative) and Medicaid. FreedomCare is available statewide to all Nevada Medicaid recipients and is one of the most reputable fiscal intermediaries in the state.

 

3.     Choose your caregiver -

 

 Now it’s time to choose your caregiver! Whether it be your adult son, daughter, closest friend, sibling, or another relative, you are now able to elect to have them as your caregiver. Your chosen caregiver will also need to go through a few steps at this point to sign up as caregivers as a part of the PCS program. 

 

4.     Finish the enrollment process -

 

 When you’ve completed all the above steps, you’ll be able to officially enroll in the PCS program. With FreedomCare as your fiscal intermediary, we will come directly to your home to help you with the final steps of enrollment! After you’ve completed this step, you’re set and ready to go. Your caregiver, a friend or family member, will be able to be compensated for their time, and you’ll be able to receive high quality, loving care.    

Do I need Medicaid to sign up for the program?

Yes, all PCS applicants must first have Medicaid in order to be able to sign up. The PCS program is a state funded program available only to Nevada Medicaid recipients. Medicaid is a program specifically designed for individuals who are either in a low income bracket, medically needy, or both. If you don’t have Medicaid already, you will need to first apply for Medicaid before you will be able to sign up for the PCS program.

You may be eligible to receive Medicaid in Nevada if you:

·        Meet the asset and income requirements (these requirements vary depending on your living situation and other factors, so check in to see if you qualify)

·        Are a citizen or legal resident of the United States

·        Are a member of one of these groups of individuals:

·        Pregnant women and newborns

·        Adults aged 18-26 who were previously in the foster care system

·        Children under age 19 (through Nevada Check Up)

·        Women under age 65 who need treatment for breast or cervical cancer who are uninsured or under insured

·        Some child welfare cases

·        Parents as caretaker relatives of eligible individuals

·        The elderly

·        Disabled, blind, and working disabled individuals

·        Can provide all the necessary documentation requirements for the Medicaid application

Individuals who meet the eligibility requirements for Medicaid must be able to supply the following documents in order to be able to apply:

·        Proof of legal American citizenship or residency

·        Proof of residency in Nevada

·        Social Security Number

·        Proof of income and assets

·        Proof of age and/or disability (where applicable)

·        Other supporting information or documentation    

In Nevada, it’s possible to apply for Medicaid either in-person, over the phone, through the mail, or online. Most applications take about 1 month to be processed. Keep in mind that your application may take more or less time to be processed depending on your situation, and you may be asked for additional documentation during the application process. After you have successfully applied for Medicaid and received your Medicaid card, you will be able to apply to be a part of the PCS program!