Medical, Dental & Pharmacy

Community First Services and Supports (CFSS)

Overview

Community First Services and Supports (CFSS) offer flexible options to meet the unique needs of PrimeWest Health members with disabilities. CFSS allows members greater independence in their homes and communities. This includes the elderly and others with special health care needs. CFSS services are provided in members’ homes or in the community when normal life activities take them outside the home. CFSS replaced personal care assistance (PCA) and the Consumer Support Grant (CSG) on October 1, 2024. PCA and the CSG will be phased out over time. Review the Minnesota Department Human Services (DHS)  CFSS Policy Manual for CFSS policy information.

Eligible Providers

PrimeWest Health enrolls and reimburses the following types of provider agencies to provide CFSS services:

  • Home health agencies
  • CFSS provider agencies
  • Consultation services providers
  • Financial management services (FMS) providers (CFSS financial tasks, billing, and employer-related responsibilities)
  • Personal emergency response systems (PERS) providers (review the PERS section of the CFSS Policy Manual for eligible provider requirements)

FMS and consultation providers must be enrolled with DHS to provide or bill for CFSS services. PrimeWest Health requires a Service Authorization from non-contracted providers to provide services to PrimeWest Health members.

CFSS Provider Agency Enrollment

Provider agencies must do the following to enroll or maintain enrollment with PrimeWest Health to provide CFSS services:

Home Health Agency Enrollment

Home health agencies that wish to provide CFSS should refer to the Home Health Agency Enrollment Criteria and Forms section of the MHCP Provider Manual for more information.

Enrolling CFSS Individual Workers

CFSS provider agencies and financial management services (FMS) providers must enroll individual CFSS workers with MHCP and affiliate workers with their provider agency or FMS. Before enrolling and affiliating a worker, the CFSS provider agency or FMS must ensure that each individual CFSS worker:

CFSS provider agencies submit claims to PrimeWest Health on behalf of their workers. PrimeWest Health pays the agency for CFSS services that individual CFSS workers provide to participants on both fee-for-service and managed care organization (MCO) plans. PrimeWest Health does not pay individual CFSS workers directly.

FMS providers submit claims to PrimeWest Health on behalf of the CFSS participant. Review the Financial management services (FMS) for CFSS section of the CFSS Policy Manual for more information.

Noncompete Ban

CFSS provider agencies and FMS providers cannot have or enforce any agreements, requirements, or noncompete clauses prohibiting, limiting, or restricting an individual worker from working with a member or different CFSS provider agency or FMS provider after leaving a CFSS provider agency, regardless of the date the agreement was signed.

Eligible Members

Members of the following programs are eligible for CFSS services:

  • Members enrolled in PrimeWest Senior Health Complete and MSC+ with or without waiver service programs
  • Have a MnCHOICES assessment completed and a MnCHOICES support plan developed with the county PHN/county case manager who specifies the CFSS services needed

Roles and Responsibilities

Lead agencies

CFSS services are person-centered. Members who participate in CFSS services must first request a lead agency (a county, Tribal government, or managed care organization) to conduct an assessment for CFSS services. A lead agency must conduct an assessment within 20 business days of receiving the request. During the assessment, the assessor determines the following:

  • The CFSS participants’ ability to direct their own care, or the need for a representative to act on their behalf.
  • CFSS services are appropriate to meet the CFSS participant’s assessed needs.
  • Amount of service units or dollars or both that the CFSS participant is eligible for.

Members must be reassessed for PCA/CFSS services in the following situations:

  • Annually before the end of their current service authorization.
  • When the member experiences a significant change in condition or health status.

Consultation providers

After the lead agency assesses the CFSS services to be appropriate, the participant or participant’s representative (responsible party) will choose a consultation services provider. The consultation services provider assists the participant (member). Refer to the CFSS consultation services provider requirements section of the CFSS Policy Manual for more information.

CFSS participants or participant representatives

Financial management services providers

An FMS provider is an organization that members use to help them with employer-related responsibilities, purchase goods and services, and complete other financial tasks. DHS contracts with all FMS providers for these services and enrolls them as PrimeWest Health providers. For more information about the services, refer to the Financial management services (FMS) provider requirements for CFSS section of the CFSS Policy Manual.

CFSS participants who use the CFSS agency model and do not purchase goods and services do not need to choose an FMS provider.

The following CFSS participants must choose an FMS provider:

  • Participants who use the CFSS budget model.
  • Participants who use the CFSS agency model who also purchase goods and services.

CFSS provider agencies

CFSS participants who use the CFSS agency model must choose a CFSS provider agency. For more information, review the PCA/CFSS provider agency requirements overview section of the CFSS Policy Manual.

CFSS provider agencies must ensure the supervising professional has the appropriate licensing, certifications, and meets appropriate requirements.

CFSS provider agencies must follow the direction of the Minnesota Department of Labor and Industry (DLI) for individual CFSS workers who provide CFSS services. CFSS provider agencies are also responsible for the requirements found in the following:

PERS providers

People who receive CFSS services have the option to purchase personal emergency response systems (PERS) as an electronic backup system. A PERS provider is enrolled with PrimeWest Health to provide PERS services (installation and monitoring of the device). For more information, refer to the CFSS personal emergency response systems (PERS) section of the CFSS Policy Manual.

Service Delivery Models

The participant will choose between one of the following service delivery models.

CFSS agency model

  • The lead agency authorizes units (1 unit is 15 minutes of service) for the CFSS participant to the CFSS provider agency. The participant (member) or participant’s representative (responsible party) selects a CFSS provider agency that serves as the employer for the CFSS worker. This means the CFSS provider agency is responsible to recruit, hire, train, supervise, and pay CFSS support workers.
  • The CFSS participant and CFSS provider agency are responsible to monitor the effectiveness of the service delivery plan together.
  • If the CFSS participant will purchase goods or services, the participant must also select an FMS provider.

Tiered Reimbursement Rates for CFSS Agency Model

Reimbursement rates for CFSS services in the CFSS agency model increase based on the hours of service the worker has provided since July 1, 2017. CFSS provider agencies must use the increase in the reimbursement rate for wages and wage-related costs for the direct support worker. 

The tiered reimbursement rate table is listed on the DHS PCA and CFSS tiered rates and wage floors web page.

CFSS budget model

  • The lead agency authorizes dollars (the total budgeted amount of money) for the CFSS participant. The participant (member) is the employer of their support workers and will recruit, hire, train, and supervise their support workers. The participant will select an FMS provider to help with employer-related tasks.
  • The CFSS participant or the participant’s representative is responsible to monitor the effectiveness of the service delivery plan.

If a participant wants to switch CFSS service models:

  • The participant works with their consultation services provider to update their CFSS service delivery plan,
  • The consultation services provider submits the participant’s revised plan to the lead agency for approval, and
  • The lead agency approves the plan and either updates the participant’s service agreement (people receiving waiver or AC services) or submits the PCA/CFSS Request Form (DHS-4292) to request that DHS update the service delivery plan (person not receiving waiver or AC).

The CFSS participant or participant’s representative also chooses whether they want to receive the shared service option for PCA/CFSS, which allows the CFSS participant to receive services from the same individual CFSS worker, at the same time and in the same setting as another participant receiving CFSS services. Participants who share services must use the same service delivery model and the same CFSS provider agency or FMS.

Tiered Minimum Wages for CFSS Budget Model

The minimum wage is determined by the number of PCA and CFSS hours a direct support worker has provided since July 1, 2017. Direct support workers providing CFSS in the budget model must be paid at least the appropriate minimum wage on the tiered wage schedule starting January 1, 2025. The tiered wage table is listed on the DHS PCA and CFSS tiered rates and wage floors web page.

Financial management services (FMS) and CFSS provider agencies can view which tier direct support workers are in by logging into MN–ITS and downloading the Tiered Wage PCA/CFSS list. Instructions for how to access the list are located in the Provider Lists section of the MN–ITS User Manual.

Covered Services

The following CFSS services are eligible for payment from Medical Assistance:

  • PCA/CFSS covered personal care services
  • Travel time (personal care services)
  • Accompanying the CFSS participant into the community to provide covered CFSS personal care services
  • Driving the CFSS participant into the community, including to medical appointments
    • CFSS agency policies, procedures, and agreements with CFSS participants determine whether that agency allows an individual CFSS employee to transport a participant using the CFSS’s or a CFSS participant’s vehicle. CFSS agencies must consult with their legal advisors or business consultants about the liabilities of transporting CFSS participants. (Applies to agency model only.)
    • The service delivery plan documents the person’s chosen mode of transportation.
    • The provider agency or FMS must meet PCA/CFSS covered personal care services documentation requirements
  • Background study (personal care services)
    • For CFSS workers providing services through the budget model, the FMS provider can include the cost of the CFSS worker’s background study in a personal care (T1019) claim for covered CFSS services performed by that worker. If the background study fails, FMS providers can bill for the failed background study using a specific procedure code and modifiers.
    • The CFSS provider agency cannot bill for background studies under the agency model.
  • Purchased goods and services as defined in the CFSS Policy Manual
    • In both (agency or budget) models, if the participant wishes to purchase goods and services, the participant must work with the FMS provider to coordinate the purchase.
  • CFSS worker training and supervision
    • The lead agency authorizes a CFSS agency to use the CFSS worker training and development budget to flexibly pay for CFSS worker training and supervision by the supervising professional.
    • CFSS agencies can also use the CFSS worker training and development budget to evaluate the CFSS services.
    • In both the CFSS agency and budget models, the worker’s employer can use the CFSS worker training and development budget to pay the fees for a worker attending a class or workshop on topics related to the person’s assessed needs.
  • Personal Emergency Response Systems (PERS)
  • Consultation services
  • FMS services

Service Agreement

All CFSS services require a lead agency assessor to complete a service agreement.

A service agreement allows the provider to provide services and then bill PrimeWest Health to receive payment. PrimeWest Health will only pay for services listed on the service agreement; however, an approved service agreement is not a guarantee of payment.

For PrimeWest Health to pay claims, the following criteria must be met:

  • Providers must be actively enrolled and have current credentials to provide the approved service(s).
  • The CFSS participant must maintain their PrimeWest Health eligibility for the service agreement to be valid.
  • Providers are responsible for ensuring the service agreement and/or Service Authorization is/are accurate when received. 
  • Providers must verify program eligibility for each CFSS participant each month through the MHCP phone-based eligibility verification system (EVS) or online via MN–ITS.

CFSS Service Agreement changes

County case managers and care coordinators update service agreements for people who receive Waiver and CFSS services.

Depending on the CFSS service delivery model, either the agency model provider or the FMS provider must send the Referral for Reassessment for PCA/CFSS Services (DHS 6893B) to the lead agency for the members who wants to continue receiving CFSS past their approved authorization span. This referral must be made 60 days before the end date of the member’s current Service Authorization.

Billing

All CFSS provider types must follow general PrimeWest Health billing policies as well as the guidelines outlined in the Billing Policy Overview section of the MHCP Provider Manual when submitting claims to PrimeWest Health.

Documentation

CFSS provider agencies and FMS providers must have documentation supporting that a CFSS worker provided a CFSS service. PrimeWest Health requires CFSS provider agencies to ensure that the individual CFSS worker documents all of the minimum requirements by completing the agency’s PCA time and activity documentation process. CFSS agencies determine the documentation methods used for recording time and activity.

CFSS provider agencies

CFSS provider agencies must have all the following documentation on file before submitting a claim to PrimeWest Health for reimbursement of a CFSS claim:

  • A copy of the CFSS participant’s CFSS Assessment (DHS-6893A) or the MnCHOICES CFSS assessment
  • A service agreement for CFSS services
  • CFSS time and activity documentation for all individual CFSS support workers delivering services to the member. Refer to Electronic visit verification for more information.
  • Any CFSS worker training and supervision
  • A written agreement signed by the agency and CFSS participant or participant’s representative
  • Shared services agreements signed by all CFSS participants sharing CFSS services (if applicable)

FMS providers

FMS providers must have the following documentation:

  • A written agreement signed by the agency and CFSS participant or participant’s representative.
  • Shared services agreements signed by all CFSS participants sharing CFSS services (if applicable).

Refer to the Financial management services (FMS) documentation and reporting for CFSS section of the CFSS Policy Manual for more information.

Consultation providers

Consultation providers must keep documentation for services they provide. Refer to the CFSS consultation services provider requirements section of the CFSS Policy Manual for more information.

Submitting CFSS claims

Bill only for services already provided and approved on the Service Authorization.

When submitting claims for CFSS services, do the following:

  • Bill on 837P claim format. Refer to MHCP MN–ITS 837P Professional User Guides for more information.
  • Enter a diagnosis code when submitting claims for CFSS services. Use the most current and approved diagnosis code on the Service Authorization.
  • Enter the approved Service Authorization number in the claim. Note: Services that require a Service Authorization cannot be billed on the same claim as services that do not require a Service Authorization.
  • Enter one line per date of service, per HCPCS or procedure code and modifier combination.
  • T1019 code requires the UMPI/NPI of the rendering CFSS worker(s) on the service line per date of service.
  • Refer to Long-Term Services and Supports Service Rate Limits for a complete list of CFSS codes and modifiers. Some modifiers are claim-only and are not required to be on a Service Authorization.
  • Follow PCA, CFSS and CSG enhanced rate/budget directions for all people eligible for the enhanced rate. CFSS provider agencies and FMS providers can verify that a worker is qualified for the enhanced rate by following the steps listed in the Provider Lists section of the MN–ITS User Manual.

Out-of-network providers should refer to the Out-of-Network Facility Registration Requirements section of the PrimeWest Health Provider Manual for more information on submitting claims. 

 

Updated_06/09/2026