Providing Services for all Disabilities

This section will provide answers to the following questions

What is the PCA Program?
The Personal Care Attendant (PCA) Program is a MassHealth program that helps people with long-term disabilities live at home by providing funds to hire PCAs. PCAs can help with Activities of Daily Living (ADLs) such as:

• Mobility/Transfers
• Medications
• Bathing or grooming
• Dressing or undressing
• Range of Motion exercises
• Eating
• Toileting

PCAs can also help with Instrumental Activities of Daily Living (IADLs) such as:

• Shopping
• Laundry
• Meal Preparation
• Housekeeping

PCA time is not approved for activities such as recreation, babysitting, or vocational training. Nor is PCA time allowed for verbal prompting or cuing, or supervision.

The PCA program is a participant-directed program. This means that the individual with the disability is the employer. This is different from more traditional home health care programs in which an agency provides the worker. The PCA program is designed to give individuals with disabilities control over how their own personal care needs are met.


Who is eligible?
You may be eligible for PCA services if you are a MassHealth member and:

• You have a permanent or chronic disability that impairs your ability to perform ADLs and IADLs without physical assistance.
• You need physical assistance with two or more ADLs (see list above)
• Personal Care services are prescribed by your physician or nurse practitioner
• MassHealth determines that PCA services are medically necessary.

Your MassHealth coverage type must be Standard or Commonwealth.


How many hours of service will I get?
The Options program will help MassHealth decide whether you qualify for PCA services, and how many hours of service you need. Options will conduct an evaluation, which will describe your personal care needs in detail, and recommend how many hours of PCA services you need each week. After approval by your physician or nurse practitioner, this evaluation is sent to MassHealth, which makes the final decision about whether you are eligible and how many hours of PCA services will be approved for you. PCA services are usually approved for one year at a time.


I receive other services in my home. Can I still use PCA services?
PCA services can be used in combination with some other services, such as Visiting Nurse, Occupational or Physical Therapy, or Home Health Care services. When Options does your PCA evaluation they will take these other services into consideration.

Some other services may not be used together with PCA. These include Adult Foster Care and Group Adult Foster Care, and Homemaker services funded through the Mass. Rehabilitation Commission.

It is important that you inform your Skills Trainer of any other services in your home, so they can help you determine how these will coordinate with PCA services.


I live with my family. How will this affect my PCA services?
Our evaluation, and eventually your approval, will take into consideration your disability and your living situation, as well as your daily routine. If you live with family members they will be expected to assist with most household chores. For example, routine laundry, housekeeping, shopping and meal preparation should include the needs of the family member with the disability.


How are services determined for children?
Personal care services are based on needs that arise because of a disability which impairs an individual’s ability to perform activities of daily living independently. For very young children, who would not normally be independent in their activities of daily living (for example bathing, dressing, eating, toileting), PCA services will not generally be approved for activities that are considered routine child care. Options’-evaluation teams will take the child’s age into consideration when evaluating the need for PCA time.


My disability is progressing, how can I get more help?
The PCA program should reflect your current needs, so you should contact Options at (800) 924-7570 or (508) 880-7577 if your personal care needs change at any time. A change in your personal care needs might be due to your disability, or may be due to some other event, such as graduating from school, or moving into your own home.


Who hires the PCA?
If MassHealth approves PCA services for you, you must recruit, hire, fire, train and schedule your own PCAs. The personal care agency can help you by:

• offering skills training to help you learn how to do these tasks
• assessing whether you need a surrogate to help you with some or all of these tasks

Our Fiscal Intermediary program can do payroll processing and tax filing on your behalf, but you, the consumer, are still the employer of your PCAs.


What is a Surrogate?
If you cannot independently manage your PCA program, you may have the help of a surrogate. The surrogate is often a family member but may be any other person you choose who has the ability to manage the program. A surrogate can assist you with managing any part of the PCA program with which you have difficulty, but a surrogate does not necessarily run your PCA program for you. When you apply for PCA services your Skills Trainer will determine whether you are able to manage the program independently, what skills training you will need to learn how to manage the PCA program, and whether you will need any help from a surrogate.

If you do need help managing your PCA program, you, your Skills Trainer and your Surrogate will work together to develop a Service Agreement that describes the responsibilities of the Surrogate, and which elements of the program you will handle.

Our goal is to teach you to manage your PCA program as independently as possible. Your Service Agreement will be reviewed periodically, and can change over time as your skills and abilities change.


Who can I hire as a PCA?
As a consumer-directed program, the PCA program allows for great flexibility and control in who you can hire as a PCA. There are some restrictions however. The following individuals cannot be hired as PCAs:

• The Parent of a Minor Child, Including Adoptive and Foster Parents
• Spouse
• Legally Responsible Relative

Your PCAs must also be legally authorized to work in the United States, they must be able to understand and carry out your instructions, and they cannot be receiving pay for their PCA work time from any other agency.

It is your responsibility to check the references of prospective PCAs before you hire them.


How many hours each week can my PCAs work?
You must schedule your PCAs according to the number of hours approved by MassHealth, which is based on your evaluation. Your PCA schedule may change slightly from week to week, depending on whether you might have medical appointments that week, or other activities that do not take place every week.

Remember that your PCAs are subject to state and federal labor laws, including overtime rules. Unless your PCA lives in your home, they must be paid time-and-a-half if they work over 40 hours in a week.

Please be aware that your PCAs will not be paid for any work they do if there is no approval in place for that date, or if you have used up all your approved PCA hours.

PCA services cannot be used while you are a resident in a hospital or rehabilitation facility.


How do I schedule my PCA time?
Your PCA hours should be scheduled to provide the care that MassHealth has authorized, at the time that you need that care. We suggest you use your PCA evaluation as the basis for a daily schedule – for example combining morning care tasks into a block of time that meets your needs. It is up to you as to what time you want your PCAs to come to work, when to shower or go to bed, or when to do your shopping or laundry. Your PCA schedule should be set up to meet your own daily needs. Your Skills Trainer will work with you in this area to help you learn how best to schedule your time.


What are my responsibilities?
As a consumer of PCA services, you are responsible for:

• hiring, firing, training and scheduling your PCAs, or working with a surrogate to carry out these responsibilities
• completing and turning in activity forms to the fiscal intermediary
• following the rules of the PCA program
• making sure your PCAs are paid correctly and on time
• letting Options know if your personal care needs change
• letting Options know if you unexpectedly need overtime pay for one of your PCAs, or if a PCA must perform Jury Duty
• with your Options Skills Trainer, making a list of PCAs to contact if your regular PCAs are unavailable
• letting Options know if you move, change your phone number, or change your doctor.


What are the personal care agency’s responsibilities?
As your personal care agency, Options is responsible for:

• assessing your eligibility for the PCA program
• assessing whether you need a surrogate
• evaluating the kind and amount of services you need
• asking MassHealth for approval for PCA services
• teaching you to manage your PCAs
• teaching you how to complete your PCAs’ Activity Forms
• working out a service agreement with you that describes your responsibilities, as well as the responsibilities of the PCA, the fiscal intermediary, the PCA agency, and the surrogate (if any).
• helping you decide which employer option is better for you
• reviewing your service plan with you periodically
• conducting re-evaluations as needed, and submitting them to MassHealth at least 21 days before your current approval runs out.

Your PCA agency must meet with you in person for initial orientation and skills training, and at least quarterly in your first year of service. This is usually done by your Skills Trainer, who will be assigned to you when you apply for PCA services. All of Options’ Skills Trainers have voice mail, and this is usually the best way to reach them.


What if I have problems with PCA program staff or with a decision regarding my services?
The Options PCA program has a process for dealing with any complaints or concerns. Your Skills Trainer will explain the process to you and make every effort to help you resolve your complaint or problem.


How and when do I pay my PCAs?
When you are approved by MassHealth for PCA services you will receive paperwork showing the number of hours of service you are approved for, and the start and ending dates of your approval.

Every two weeks you will submit timesheets to the Fiscal Intermediary showing the hours your PCAs worked. Each payroll period begins on a Sunday and ends on a Saturday; PCAs will normally receive their paychecks the following Friday. Each new consumer is assigned to Schedule One or Schedule Two, usually based on the first letter of your last name.

You may choose to have the Fiscal Intermediary handle your PCA payroll and tax reporting obligations (Option One), or you may choose to handle these tasks yourself (Options Two).

Please see the Fiscal Intermediary pages for more details on the payroll process.
[insert link here to FI pages]


Will Mass Health pay my PCAs for overtime?
If MassHealth has approved more than 40 hours per week of PCA services for you, you are expected to hire at least two PCAs so that none of your PCAs have to work for you more than 40 hours in one week. MassHealth also expects you to have a back-up list of PCAs in case your scheduled PCA cannot work that day.

If there is an unexpected event that prevents your regularly scheduled PCA from working, and the only PCA you can find to cover will need to work for you more than 40 hours that week, you may request overtime pay for that PCA.


How do I request overtime pay for my PCAs?
You must contact Options immediately to request overtime pay for a PCA. If it is a weekend, evening or holiday, you should leave a message on the Options Voice Mail at (800) 924-7570 or (508) 880-7577.

The following information is needed to request approval for the overtime:

• The work week for which the overtime is requested
• The name of the PCA who worked overtime
• The total hours of overtime requested
• What was the unforeseen event that caused the overtime request?
• A list of the PCAs you contacted
• Your regular PCA schedule

If the overtime use was caused because a PCA quit or was fired, MassHealth will also want to know what steps you have taken to recruit a new PCA. Options staff will contact MassHealth to request approval for overtime pay. MassHealth will let you, Options and the fiscal intermediary know in writing whether it has approved your request for overtime pay. MassHealth will still pay the regular rate if your request for overtime pay is not approved.


Will my PCA be paid for Jury Duty?
MassHealth will pay your PCA for Jury Duty, if they served during their regularly scheduled PCA work time. If another PCA fills in for the regular PCA, they will also be paid for their work, and MassHealth can add PCA time to your approval to cover the time that the two PCAs’ pay overlaps. Please speak with your Options Skills Trainer to learn how to request Jury Duty pay, or call the Options office at (800) 924-7570 or (508) 880-7577.


Will MassHealth pay for PCA assistance at night?
If MassHealth approves PCA services for you at night, it will pay your PCA for at least 2 hours of time for providing you with direct assistance with ADLs at night, whether the PCA provides services for 15 minutes or 100 minutes. If the PCA routinely assists you for more than 2 hours at night, you may request approval for more time at night. MassHealth will pay for night time assistance by rounding it up to the nearest hour. For example, if your PCA provides you with 2 hours and 50 minutes of assistance at night, your PCA will be paid for 3 hours. Night hours are from 12:00 midnight to 6:00 a.m.


What if one of my PCAs gets injured on the job?
If you selected Option One, call your fiscal intermediary immediately. If you selected Option Two, follow your workers’ compensation insurance company’s instructions. For both options you can get information about workers’ compensation insurance and coverage by calling the Department of Industrial Accidents at (617) 727-4900.


What if I have questions about my legal responsibilities as an employer?
MassHealth, your personal care agency and your fiscal intermediary cannot give legal advice, but there are many other organizations that can help with your questions. Click Here for a list of organizations that can help you in your role as an employer. They may mail you information or give you advice over the telephone.


What if I need more information?

Call your fiscal intermediary if you:

• have questions about your Activity Forms that can be answered over the telephone
• have questions about the employment forms sent to you by the fiscal intermediary that can be answered over the telephone
• need Activity Forms
• have questions about paying your PCAs

Call your Personal Care Agency if you:

• have questions about hiring, firing, training or scheduling your PCAs
• have questions about the process of requesting overtime pay, or need to request overtime pay for one of your PCAs
• need more skills training to assist you in managing your PCA services
• have questions your fiscal intermediary cannot answer by telephone.

Other helpful resources:

Department of Industrial Accidents (617) 727-4900

Disability Law Center (800) 872-9992

Disabled Persons Protection Commission (800) 426-9009

Internal Revenue Service (800) 829-1040

Greater Boston Legal Services (617) 371-1234

Southeastern Mass. Legal Assistance
New Bedford office: (508) 979-7150
Fall River office: (508) 676-6265
Taunton office: (508) 880-6704
Attleboro office: (508) 576-6807

Legal Services for Cape, Plymouth, and Islands Hyannis office: 800-742-4107
Plymouth office: 800-585-4933

Mass. Attorney General’s Office – Fair Labor Hotline (617) 727-3465
Southeastern Mass. Office (508) 990-9700

US. Dept of Labor – has offices in Boston and Taunton. (866) 487-9243

Mass. Commission Against Discrimination (617) 994-6000

Mass. Dept. of Revenue – Customer Service (800) 392-6089

Mass. Division of Unemployment Assistance and Division of Career Services
1-877-626-6800 or

Mass. Office on Disability (800) 322-2020

Social Security Administration (800) 772-1213

PCA Union 1199SEIU