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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
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