MassHealth Amends the Personal Care Attendant Program

MassHealth is amending the Personal Care Attendant program regulations to update and clarify
certain requirements of the MassHealth Personal Care Attendant (PCA) program. The
amendments promote the effective operation of the MassHealth PCA program and align with
the contractual updates and timeline for the procurement of the PCM agency network effective
January 1, 2020.

The revised regulations make the following updates and clarifications.

  • Permit evaluations and re-evaluations for PCA services to be reviewed, approved, and
    signed by the member’s physician, nurse practitioner, or physician’s assistant instead of
    requiring that PCA services first be ordered or prescribed by the member’s physician or
    nurse practitioner.
  • Permit re-evaluations of a member’s eligibility to receive PCA services to be conducted by
    licensed practical nurses under supervision of registered nurses.
  • Permit the use of an administrative proxy instead of a surrogate when members require
    assistance with performing administrative functions related to management of PCA
    services.
  • Require an assessment of a surrogate or administrative proxy’s ability to manage PCA
    services on behalf of members receiving PCA services.
  • Update the description of activities of daily living (ADLs).
  • Incorporate technical corrections to accurately reflect the program role of PCM agencies
    and fiscal intermediaries.
  • Reference requirements for types of functional skills trainings to be performed by PCM
    agencies.
  • Clarify when additional review of a member’s service agreement is required.
  • Make technical corrections and updates to the definitions to align with program updates.

These regulations are effective January 1, 2020. Click here to read the new regulations in full from MassHealth.

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