Service Plan of PCSP
The following all need to be included in the PCSP session in Function Portal:
- All currently authorized services
- Use the authorization spreadsheet for reference
- Use the guide below to document any requested changes to current services (Increases, Decreases and Termination)
- Any other services the participant receives
- i.e. Transportation services, DME/SME, and any other Medicare and other payor covered services
- Any new Medicaid services being requested
- Informal Support
PA Health and Wellness will make the final determination for services. Participants will be notified via a determination letter from PHW
Service Plan Breakdown
- Type of Service – the needed service
- The first Service will always default to Service Coordination
- There must always be a second service for any active participant
- Select the appropriate service type
- Service Amount/Frequency – the amount of service authorized based on the frequency
- Frequency and amount is specific to each service and should come from the Authorization sheets sent each day
- Service Details – A brief description of what the service provides. Be specific to the participant’s needs.
- Service Provider and Delivery – The provider chosen by the participant (if applicable) and delivery method
- If the provider is Tempus (PDO), select Participant Directed – Employer Authority for Delivery Type
- If the provider is anything other than Tempus, select Agency Option for Delivery Type
Entries for common services
Personal Assistance Services (PAS)
AGENCY OPTION
Service Type: Personal Assistance Services
Service Details: State the specific ADL’s and IADL’s the participant requires
Amount: Amount of hours CURRENTLY authorized (regardless of request/SPG tool) per week
Frequency: Weekly
Delivery: Agency Option
Provider: Agency Name, phone number, address, and agency NPI #
PARTICIPANT DIRECTED OPTION (PDO)
Service Type: Personal Assistance Services
Service Details: State whether it is Regular Time or Overtime and state the specific ADLs and IADLs that this participant requires caregiver assistance with, this should be different for every participant.
Amount: Amount of hours CURRENTLY authorized (regardless of request/SPG tool) per week
Frequency: Weekly
Delivery: Participant Directed – Employer Authority
Provider: Tempus (PDO) 844-983-6787
Personal Emergency Response System (PERS)
EXISTING SERVICE
Service Type: Personal Emergency Response System
Service Details: Monthly Maintenance + description
Amount: 1
Frequency: Monthly
Delivery: Agency Option
Provider: Agency Name, phone number, address, and NPI
NEW SERVICE
When putting in a new PERS unit request you will need to have 2 separate services.
1. One for Monthly Maintenance Request (see above)
2. Additional One Time Installation Request
Service Type: Personal Emergency Response System
Service Details: One Time Installation + description
Amount: 1
Frequency: One Time
Delivery: Agency Option
Provider: Agency name, phone number, address, and NPI
Home Delivered Meals
Service Type: Home Delivered Meals
Service Details: Description + diet requirements (ie. diabetic appropriate, etc), preferences, or restrictions (ie. allergies, cultural needs,etc)
Amount: # of meals received per week (Max 14)
Frequency: Weekly
Delivery: Agency Option
Provider: Agency name, phone number, address, and NPI
Transportation Services
NON-MEDICAL TRANSPORTATION (MTM RIDES)
Service Type: Non-Medical Transportation
Service Details: Service description + average amount of round trips needed per week
Amount: Average amount of trips needed per month (average amount of round trips x 8)
Frequency: Monthly
Delivery: Agency Option
Provider: Medical Transportation Management (MTM) | 888-561-8747
NON-MEDICAL TRANSPORTATION (SEPTA KEYCARD)
Service Type: Non-Medical Transportation
Service Details: Service Description + Zone ptp requires
Amount: 1
Frequency: Monthly
Delivery: Agency Option
Provider: Medical Transportation Management (MTM) | 888-561-8747
NON-MEDICAL TRANSPORTATION (CCT PASS)
Service Type: Non-Medical Transportation
Service Details: Service Description + Zone 2 + Utilizes CCT
Amount: 1
Frequency: Monthly
Delivery: Agency Option
Provider: Medical Transportation Management (MTM) | 888-561-8747
MEDICAL TRANSPORTATION (MATP)
Service Type: Other
Service Details: Service description
Amount: 1
Frequency: Monthly
Delivery: Agency Option
Provider: Medical Assistance Transportation Provider (MATP) | 877-835-7412
Adult Day Care/Center
Service Type: Adult Daily Living
Service Details: Service description
Amount: number of days attending per week
Frequency: Weekly
Delivery: Agency Option
Provider: Agency name, phone number, address, and NPI
Home Mods
Each requested Home adaptation requires its own service entry. Home mods should not be added to the Service Plan until after all Proof of Home Ownership documents are received.
Service Type: Home Adaptations
Service Details: “Home adaptations evaluation is required …” then state the barrier the home mod is meant to overcome (ex. participant cannot go up and down steps to the second floor where the bedrooms and bathrooms are)
Amount: 1
Frequency: One Time
Delivery: Agency Option
Provider: TBD
Durable Medical Equipment (DME)
Each DME and SME requires their own service entry. DMEs and SMEs should NOT be added to the PCSP until AFTER they are being received.
Service Type: Specialized Medical Equipment and Supplies
Service Details: description of item including size if applicable
Amount: 1
Frequency: One Time
Delivery: Agency Option
Provider: Provider name, phone number, address, and NPI
Specialized Medical Equipment (SME)
Each DME and SME requires their own service entry. DMEs and SMEs should NOT be added to the PCSP until AFTER they are being received.
Service Type: Specialized Medical Equipment and Supplies
Service Details: description of item including size if applicable and average amount being used per day.
Amount: average amount needed per day
Frequency: Daily
Delivery: Agency Option
Provider: Name and phone number of provider
Exceptional Durable Medical Equipment
Any item that is custom to the participant (i.e. it cannot be used straight out of the box) and the cost is equal to or greater than $5,000 is considered Exceptional DME (EDME) and is required to be added to the PCSP and an SRT must be completed
Service Type: Exceptional DME
Amount: 1
Frequency: One Time
Delivery: Agency Option
Provider: Provider name, phone number, address and NPI of chosen provider or TBD
Informal Support
Service Type: Other
Service Details: ADLs and IADLs that informal support assists with AND description of how/when informal support confirmed their role. Ex. “During assessment, Example verbally stated they are willing, able, and available to provide informal support”
Amount: Amount of hours Informal support agreed on per week
Frequency: Weekly
Delivery: Agency Option
Provider: Full name and phone number of Informal supporter(s)
Service Format based on scenarios
Services Staying the same as prior Service Plan
If SC has completed an assessment with a participant and services and providers are all staying the same as last assessment, then the Service Plan in the PCSP should reflect the following:
- Amount: The amount currently authorized
- If PHW makes a change to the PAS hours that will be approved moving forward (e.g. increase or decrease), at the next visit with the participant the SC will update the PCSP Service plan to reflect what is currently approved.
Increase/Decrease Procedure
FOR PAS
If SC has completed an assessment with a participant and the hours for PAS indicated by the new assessment are either an increase or a decrease from what the participant has currently, then the Service Plan in the PCSP should reflect the following:
- Amount: The amount currently authorized (this will not match the SPG Tool)
- If PHW makes a change to the hours that will be approved moving forward (e.g. increase or decrease), at the next visit with the participant the SC will update the PCSP Service plan to reflect what is currently approved.
FOR NON-PAS
If SC has completed an assessment with a participant and an increase or decrease in a Non-PAS service are being requested, then the Service Plan section of the PCSP in Function Portal should reflect the following:
- Amount: Increase/decrease amount being requested (ie. 14 meals per week) and specify the end date in the details if appropriate
New service request
FOR PAS
If SC completes an assessment with the participant and a request is made for PAS and the participant does not currently have PAS hours, then the Service plan in the PCSP should reflect the following:
- Amount: will be “0”
- PA Health and Wellness will make the final determination of hours.
- At next visit with the participant SC will update assessment to reflect currently authorized PAS hours
FOR PERS
For a PERS installation, you need to also make two separate services.
- First service: PERS installation
- Amount: 1
- Frequency: One time
- Second Service: PERS Monthly Monitoring
- Amount: 1
- Frequency: Monthly
FOR EVERY OTHER SERVICE
If SC completes an assessment with the participant and a request is made for a Non-PAS service (e.g. HDM’s, transportation, etc) and the participant does not currently have that service, then the Service plan in the PCSP should reflect the following:
- Amount: amount that is being requested
Ending a Current Service
DO NOT just leave the service off of the service plan
If SC has completed an assessment with a participant and it has resulted in a request to end a service that is already in place.
- Amount: amount of service approved will be “0” and specify the end date in the details of that service
Change in Provider
This will result in two separate entries on the PCSP for the same type of service
If SC has completed an assessment with a participant and a change in any type of provider is being requested, then the Service Plan in the PCSP should reflect the following:
- 1st Entry
- Amount: Current amount of service approved
- Specify the end date for the 1st Provider in the Service Details
- 2nd Entry
- Amount: Current amount of service approved
- Specify the start date for the 2nd Provider in the Service Details