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6. Service Plan

This is a guide on how to put services into the Service Plan of the PCSP.

For explanations of the different services, see the Services Explained guide

The following all need to be included in the PCSP:

  • All currently authorized services
    • along with requested changes to the services (Increases, Decreases and Termination)
  • Any other services the participant receives
    • i.e. Medicare and other payor covered services
  • Any new services being requested

PA Health and Wellness will make the final determination for hours.  Participant will be notified via determination letter from PHW.

Service Plan Breakdown

If services are not put in accurately PHW will decline the service or will not be able to make an appropriate authorization.

  • Service or Item Type – dictates the service/authorization to be made
    • Select Yes to enter the rest of the information
    • Select New Service if this is a new service the participant is requesting
    • Select Annual Review if this is an existing service
    • Select the appropriate service type
  • Service Details – A brief description of what the service provides. Be specific if possible.
  • Service Dates – Dates on when the service will be received.
    • See guide below on putting in dates for different scenarios (services staying the same as prior, new services, changes, terminations)
  • Service Amount/Frequency – the amount of service being authorized based on the frequency
    • Frequency and amount is specific to each service. See guide below.
  • Service Provider and Delivery – The provider chosen by the participant (if applicable) and delivery method
    • If the provider is Public Partnerships LLC. (PPL), select Participant Directed – Employer Authority
    • If the provider is any other agency, select Agency Option

Entries for common services

Personal Assistance Services (PAS)

Agency Option

Service Type: Personal Assistance Services
Service Details: State the ADLs and IADLs the participant requires caregiver assistance with
Service Dates: See guide below
Amount: Amount of hours CURRENTLY authorized (regardless of request/SPG tool) per week
Frequency: Weekly
Delivery: Agency Option
Provider: Agency Name, Agency phone number, 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 ADLs and IADLs the participant requires caregiver assistance with
Service Dates: See guide below
Amount: Amount of hours CURRENTLY authorized (regardless of request/SPG tool) per week
Frequency: Weekly
Delivery: Participant Directed – Employer Authority
Provider: Public Partnerships LLC – 877-908-1750

PCSP Input
Authorization spreadsheet layout

Personal Emergency Response System (PERS)

Existing Service

Service Type: Personal Emergency Response System
Service Details: Monthly Maintenance + description
Service Dates: See guide below
Amount: 1
Frequency: Monthly
Delivery: Agency Option
Provider: Agency Name

New Service

When putting in a new PERS unit request you will need to have 2 separate services.
1. Same as the prior Monthly Maintenance Request
2. Additional One Time Installation Request

Service Type: Personal Emergency Response System
Service Details: One Time Installation + description
Service Dates: Start Date – Date of assessment; End Date – One year minus a day from start date (Ex. 10/26/2021 and 10/25/2022)
Amount: 1
Frequency: One Time
Delivery: Agency Option
Provider: Agency Name


Home Delivered Meals

Service Type: Home Delivered Meals
Service Details: Description + diet requirements/preferences
Service Dates: See guide below
Amount: # of meals received per week (Max 14)
Frequency: Weekly
Delivery: Agency Option
Provider: Agency Name


Transportation Services

Non-Medical Transportation (MTM rides)

Service Type: Non-Medical Transportation
Service Details: Service description + average amount of round trips needed per week
Service Dates: See guide below
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
Service Dates: See guide below
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
Service Dates: See guide below
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
Service Dates: See guide below
Amount: 1
Frequency: Monthly
Delivery: Agency Option
Provider: Medical Assistance Transportation Provider (MATP) | 877-835-7412


Home Mods

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)
Service Dates: See guide below
Amount: 1
Frequency: One Time
Delivery: Agency Option
Provider: TBD


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:

  • Start Date: Date of assessment/visit
  • End Date: One Year from start date minus 1 day
  • 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.
Ex. Assessment done with participant on 8/12/2020

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:

  • Start Date: Date of assessment/visit
  • End Date: One Year from start date minus 1 day
  • Amount: The amount currently authorized (this does not have to 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 

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 an increase or decrease in a Non-PAS service are being requested, then the Service Plan in the PCSP should reflect the following:

  • 1st Entry
    • Start date: first date in current year that participant began receiving this service
      • (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed).  You will need to look at the authorizations in FP to determine the appropriate start date.
    • End date: Day of current visit with participant
    • Amount: Current amount of service approved
  • 2nd Entry
    • Start date: Day after your current visit with participant
    • End date: One year from the start date minus 1 day
    • Amount: Increase/decrease amount being requested

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:

  • Start date: Day of visit with the participant
  • End date: one year from date of visit, minus one day
  • Amount: will be left blank
    • 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
    • Start Date: Date of Visit
    • End Date: One year from date of visit, minus one day 
    • Amount: 1
    • Frequency: One time
  • Second Service: PERS Monthly Monitoring
    • Start Date: Date of Visit
    • End Date: One year from date of visit, minus one day
    • 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:

  • Start date: Day of visit with the participant
  • End date: one year from date of visit, minus one day
  • 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.

  • Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed). 
    • You will need to look at the authorizations in FP to determine the appropriate start date.
  • End Date: Date that service is requested to be terminated
  • Amount: Current amount of service approved
Ex. Participant is assessed on 8/12/20 and has picked a future date of 8/31/20 to stop meals.

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
    • Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed).  You will need to look at the authorizations in FP to determine the appropriate start date.
    • End date: Future date that new provider can begin, minus 1 day (SC may need to confirm this with new provider)
    • Amount: Current amount of service approved
  • 2nd Entry
    • Start date: Future day that new provider can begin (SC may need to confirm this with new provider)
    • End date: one year from the date of your visit minus 1 day
    • Amount: Current amount of service approved

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