Name of Manual - Blue Cross and Blue Shield of Minnesota

Elderly Waiver
Program (continued)
Coding Policies and Guidelines (Home Health, Home Infusion, Hospice)
Minnesota Health Care Programs
Group numbers for members who have coverage with Minnesota
Health Care Programs are as follows:
Product Name ID #s / Group Numbers
Blue Advantage
(PMAP and MSC+)
MinnesotaCare
Expanded
ID #s begin with “XZG8” / All group
numbers that begin with PP0
ID #s begin with “XZG8” / All group
numbers that begin with PP1
SecureBlue ID #s begin with “XZS8” / All group
numbers that begin with PP2
Program Purpose
Minnesota’s PCA program is designed to support people of all
ages with disabilities to live independently in the community.
PCAs provide home-based services to people who need help with
activities of daily living and health-related functions (under
direction of an RN or qualified professional such as a Social
Worker or Psychologist). PCAs may provide hands-on assistance,
supervision, cueing, redirection and intervention for behavior
including observation and monitoring. PCA services can be linked
to medical or behavioral health diagnoses and are considered a
home care service.
Eligibility for PCA Services
There are three basic requirements for eligibility:
1. The patient must be eligible for, or receiving, Prepaid Medical
Assistance Program (PMAP) or MinnesotaCare Expanded
benefits (for pregnant women or children under age 21).
2. The patient must have a physician’s statement of need stating
that PCA services are medically necessary.
3. The patient must be able to make decisions about their care or
have a person designated as a Responsible Party (RP) who can
make decisions about the patient’s care. (The RP must
participate in the planning and directing of PCA services. The
RP cannot be the PCA and must be 18 years or older, available
for the patient and/or PCA, and monitor care a minimum of
one time per week.)
Note: General Assistance Medical Care (GAMC) members and
adults enrolled in MinnesotaCare (except pregnant women)
are not eligible for PCA services. CareBlue SM (HMO SNP)
members are eligible for PCA services but their services are
paid by the State of Minnesota and not BluePlus.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)
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