130 Mass. Reg. 422.420

Current through Register 1520, April 26, 2024

Section 422.420 - PCA Program: Member Responsibilities

(A) As a condition of receiving MassHealth PCA services, the member must:

(1) complete and sign the standard consumer agreement supplied by the fiscal intermediary;

(2) complete and sign all employment forms required by the fiscal intermediary; and

(3) complete and sign activity forms and submit them to the fiscal intermediary in the form and format as required by the MassHealth agency, including through the use of EVV, and in accordance with the instructions provided and time frame specified by the fiscal intermediary or the MassHealth agency;

(4) ensure that information submitted on the activity forms for each pay period correctly identifies who provided the PCA services, and the correct hours and dates that the PCA services were provided; and

(5) employ and schedule for PCA services in the following manner:

(a) employ PCAs for no more than the number of PCA hours authorized by the MassHealth agency in accordance with 130 CMR 422.416(E), and only to provide physical assistance with ADLs and IADLs as described in the personal care attendant evaluation submitted by the PCM agency and authorized by the MassHealth agency;

(b) not schedule an individual PCA to work in excess of the weekly hour limit, unless authorized to schedule a PCA to work additional overtime hours pursuant to 130 CMR 422.418(A); and

(c) schedule PCAs and coordinate with PCAs to use EVV as required by the MassHealth agency and pursuant to 130 CMR 422.419(C)(5).

(6) hire, terminate, schedule, and train PCAs;

(7) employ PCAs who meet the requirements of 130 CMR 422.404(A)(1);

(8) inform PCAs of PCA program requirements, including the requirement to use EVV as required by the MassHealth agency and pursuant to 130 CMR 422.419(C)(5), and the requirement to have PCA payments direct deposited into the PCA's bank account;

(9) cooperate with the MassHealth agency and the PCM agency during assessments, evaluations, and reevaluations;

(10) notify the fiscal intermediary of the date of hire and the date of termination of the member's personal care attendants and of a personal care attendant's change of address;

(11) notify the MassHealth agency and the fiscal intermediary of the member's change of address and telephone number, if any;

(12) notify the PCM agency when there is a change in the member's medical condition or living situation that may require an adjustment in the number of PCA hours per week authorized by the MassHealth agency;

(13) contact the PCM agency to request authorization to schedule an individual PCA to work in excess of the weekly hour limit according to conditions described in 130 CMR 422.418(A)(2)(c);

(14) contact the PCM agency to request payment for juror service for a PCA in accordance with 130 CMR 422.418(B);

(15) contact the PCM agency to request authorization to schedule an individual PCA to work in excess of the weekly hour limit according to conditions described in 130 CMR 422.418(A)(2)(a) and (b);

(16) work with the PCM agency to establish and maintain a current list of available PCAs, who can be contacted when an unforeseen event occurs that prevents the member's regularly scheduled PCA from providing PCA services;

(17) work with the fiscal intermediary and the PCM agency to resolve any issues or complaints;

(18) review and sign the evaluation or reevaluation prepared by the PCM agency in accordance with 130 CMR 422.422(C) and (D);

(19) comply with all applicable state and federal labor laws including, but not limited to, federal and state child labor laws;

(20) comply with all applicable MassHealth regulations;

(21) participate in functional skills training as required by the MassHealth agency including, but not limited to, participating in in-person comprehensive functional skills training on at least a quarterly basis during the first year of approved PCA services and at least annually thereafter, and other functional skills training as applicable in accordance with 130 CMR 422.421(B);

(22) if assessed by the PCM Agency to require a surrogate or administrative proxy in accordance with 130 CMR 422.422(A)(1)(b), locate and appoint a surrogate or administrative proxy to assist the member in performing the PCA management tasks or related administrative functions that the member is unable or unwilling to perform as described in the service agreement in accordance with 130 CMR 422.423(A)(1) and (2). In appointing a surrogate or administrative proxy, the member must select a surrogate or administrative proxy who is not the member's PCA or an employee or contractor of the member's PCM agency or fiscal intermediary, and who must live in proximity to the member and be readily available to perform the tasks described in the service agreement. A member may not appoint both a surrogate and an administrative proxy; and

(23) cooperate with the MassHealth agency, the PCM agency, and the Fiscal Intermediary for the implementation and use of EVV.

(B) The MassHealth agency reserves the right to:

(1) terminate PCA services if a member fails to comply with any of the requirements listed in 130 CMR 422.420(A);

(2) terminate PCA services if a member's surrogate becomes unavailable, or the MassHealth agency requires the member to replace the current surrogate, and another surrogate cannot be identified within 30 days of the PCM agency's notification to the member and the MassHealth agency in accordance with 130 CMR 422.422(B);

(3) require a member who is receiving PCA services to obtain a surrogate or administrative proxy to continue to receive PCA services if the PCM agency or the MassHealth agency determines, based on an assessment conducted in accordance with 130 CMR 422.422(A), that the member is not able to manage the PCA program independently. The MassHealth agency will terminate PCA services if the member does not obtain a surrogate or administrative proxy within 30 calendar days of the date of the PCM agency's assessment, and the PCM agency will refer the member to an appropriate service provider;

(4) require a member to replace the surrogate or administrative proxy if the surrogate or administrative proxy is not performing PCA tasks on behalf of the member in accordance with MassHealth regulations and after intervention from a skills trainer pursuant to 130 CMR 422.419(A)(17)(g); and

(5) recover costs of overtime from the member for any activity time scheduled by a member and performed by an individual PCA that is in excess of the weekly hour limit without an authorization from the MassHealth agency for the member pursuant to 130 CMR 422.418(A).