Non-Covered Services

1. Services not specified in service plan developed by county PHN
2. PCA services provided in the PCA’s home unless the PCA resides in member’s household
3. Sterile procedures
4. Injections of fluids into veins, muscles, or skin
5. IADLs for children under the age of 18, unless the child needs immediate attention for health and hygiene reasons.
6. Home maintenance or chore services
7. Homemaker services not as an integral part of assessed PCA services
8. Services provided by a county case manager who does not have a service agreement with PrimeWest Health
9. Services provided prior to October 1, 2024, by a member’s spouse, corporate guardian, parent, or stepparent (for members under age 18)
10. Services provided by a responsible party for a person who cannot direct his/her own care
11. PCA assessments and reassessments done by an RN from a PCPO or a home health agency
12. Services provided by an independently enrolled RN
13. Services provided by foster care provider of a person unable to direct his/her own care unless monitored with face-to-face visits by a county/state case manager at least every six months
14. Services provided and billed by a provider not enrolled with PrimeWest Health
15. Services provided by residential/program license holder in a residence for more than four people
16. Services provided to a person unable to direct his/her own care, whose responsible party is:
    1. An employee of provider
    2. Under contract with the provider
    3. Had any direct/indirect financial relationship with the provider/PCA
17. Services that are the responsibility of a residential or program license holder under the terms of a service agreement or administrative rules (includes foster care providers)
18. Staffing options in a residential or child care setting
19. Services solely as a child care or babysitting service
20. Application of restraints or implementation of procedures (MN Stat. sec. 245.825)
21. PCA services provided by a non-relative who owns or otherwise controls the living arrangement
22. Services not related to the person’s assessed need.
23. Attempts to control or discipline the person by limiting their access to something they need or want.
24. Purchase of goods and services (PCA only; for information about covered goods/services through CFSS, refer to the Goods and services through CFSS section of the CFSS Manual).
25. IADLs for people other than the person receiving services (e.g., a family member’s laundry or dishes).
26. Services that duplicate or replace services provided through other funding sources (e.g., durable medical equipment [DME], Individualized Education Program [IEP]).
27. Heavy housekeeping (e.g., repairs, flipping mattresses, deep cleaning).
28. Leisure, recreation and hobbies.

PW_11-19_580
Updated_12/23/2025