Personal Care Services (PCS) are for people residing in a:
- Private living arrangement
- Residential facility licensed by North Carolina as an adult care home.
- Combination home as defined in G.S. 131E-101(1a). A combination home is a nursing
home that offers one or more levels of care, including any combination of skilled nursing,
intermediate care and adult care homes. - Group home licensed under Chapter 122C of the General Statutes and under 10A NCAC
27G.5601 as a supervised living facility for two or more adults whose primary diagnosis
is mental illness, a developmental disability or substance use dependency.
Eligibility
These services benefit Tailored Plan eligible people who require assistance with activities of
daily living (ADLs) and/or instrumental activities of daily living (IADLs), including, but limited to:
- Eating
- Dressing
- Bathing
- Toileting
- Mobility
- Light housekeeping
- Meal preparation
- Shopping
To qualify for PCS, an individual must have a medical condition, disability or cognitive
impairment, and demonstrate unmet needs for the following:
- Three of the five ADLs with limited hands-on assistance
- Two ADLs, one of which requires extensive assistance.
- Two ADLs, one of which requires assistance at the full dependence level.
PCS program eligibility is determined by an independent assessment conducted by an Alliance
registered nurse face-to-face with the individual and is provided according to an individualized
service plan.
The Request for PCS Assessment Form should be completed by the member’s Primary Care Provider. The completed form should be submitted to Alliance via fax (919-651-8776) or email ([email protected]).
Alliance Workflow
EPSDT Short-term Increase Requests
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a federal Medicaid requirement that requires the state Medicaid agency to cover services, products, or procedures for Medicaid beneficiary under 21 years of age if the service is medically necessary health care to correct or ameliorate a defect, physical or mental illness, or a condition [health problem] identified through a screening examination** (includes any evaluation by a physician or other licensed clinician).
Members under 21 may be eligible for additional temporary PCS hours through EPSDT. Please refer to the request form and instructions for additional information.
EPSDT Short-term Increase Request Form-NC Medicaid
EPSDT Short-term Increase Request Form Instructions
PCS Training Attestation
In accordance with Session Law 2013-306, providers serving beneficiaries seeking additional hours of PCS due to Alzheimer’s or other memory care complications are required to have caregivers with training or experience in caring for individuals who have a degenerative disease characterized by irreversible memory dysfunction that attacks the brain and results in impaired memory, thinking and behavior, including gradual memory loss, impaired judgment, disorientation, personality change, difficulty learning and the loss of language skills.
Alliance Health requires that providers attest to their aide training curriculum by submitting the Alliance Health PCS training attestation form.
PCS Training Attestation Form Instructions
For a more comprehensive look into PCS processes from client assessment to billing, please review our PCS Provider Training slide deck and FAQs for PCS Providers. You can also view the Personal Care Services (PCS) Training video.
