February 2017 Update

MassHealth has put in place rules to manage PCA overtime. The PCA overtime rules limit the number of hours that PCAs can work providing MassHealth PCA services to 50 hours each week unless there is an overtime approval from MassHealth.

If you have an individual PCA that works more than 50 hours each week and you do not have an overtime approval for the PCA, you should contact your PCM agency immediately.

MassHealth reviews PCA Overtime Request Forms to provide overtime approvals for consumers who need a PCA to work more than 50 hours each week.

 

Printable formats

Frequently Asked Questions

  1. What are the PCA overtime rules?
  2. Will the PCA overtime rules reduce the number of PCA hours I can get?
  3. What do I have to do now?
  4. What happens if my PCA continues to work more than 50 hours each week?
  5. What hours does MassHealth count under the PCA Overtime Management?
  6. How do I know if the PCA Overtime Management rules affect me?
  7. What is my Personal Care Management (PCM) Agency?
  8. What if I don’t know who my PCM is or how to contact them?
  9. What if I am in One Care or SCO?
  10. How do I find out if my PCA works more than 50 hours?
  11. If my PCA works more than 50 hours a week for more than one member, who needs to apply for overtime?
  12. What if I need my PCA to work more than 50 hours a week because of an emergency and no other PCA can provide my care? What if I need help applying for PCA overtime?
  13. What if I need help applying for PCA overtime?
  14. Where can I get the PCA Overtime Request Form?
  15. Can I get a copy of the form in large print and braille?
  16. How do I fill out the PCA Overtime Request Form?
  17. How long will it take to get an answer about my PCA overtime request?

 

1. What are the PCA overtime rules?

The PCA overtime rules limit the number of hours that PCAs can work providing MassHealth PCA services to 50 hours each week. The PCA overtime rules apply if the PCA works for you, or for you and other members.

2. Will the PCA overtime rules reduce the number of PCA hours I can get?

No. The PCA overtime rules do not change or reduce the total number of PCA hours you can get.

MassHealth will determine the total number of PCA hours you can receive. The prior authorization process has not changed. This policy has no impact on your authorized hours of PCA services.

3. What do I have to do now?

If you have a have a PCA that works for you, or for you and other MassHealth members, and you haven’t submitted a PCA overtime request form pdf format of Personal Care Attendant Overtime Request Form
doc format of                             Personal Care Attendant Overtime Request Form                , please contact your PCM agency to do so. If you don’t know who to call, please call MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648). They can help you find your PCM agency.

4. What happens if my PCA continues to work more than 50 hours each week?

If you have a PCA that works more than 50 hours each week and you do not have an overtime approval from MassHealth, you and your PCA will receive a letter warning you that you are not in compliance with the PCA overtime management rules.

The warning letter will remind you that PCAs may not work more than 50 hours each week without an overtime approval. This letter will also let you know that you have 30 days to adjust your PCA’s schedule or obtain an approval from MassHealth to schedule your PCA to work overtime.

If you do not come into compliance with the PCA overtime management rules within those 30 days, you may receive additional warning letters and further information about additional steps that MassHealth may take.

Contact your PCM agency if you need help. You can meet with your PCM Skills Trainer in-person, or they can help you over the phone.

5. What hours does MassHealth count under the PCA Overtime Management?

All hours on a PCA’s activity sheet (timesheet) are counted. If a PCA works for more than one member in a week, hours on the activity sheet (timesheet) for each member are counted.

6. How do I know if the PCA Overtime Management rules affect me?

The rules affect you if you have an individual PCA who works more than 50 hours a week providing MassHealth PCA services for you, or for you and other MassHealth members.

If you aren’t sure if the rules affect you, contact your PCM agency. If you don’t know who to call, please call MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648). They can help you find your PCM agency.

7. What is my Personal Care Management (PCM) Agency?

Your PCM is the agency that evaluated you to determine your eligibility for the PCA program. They may have provided you with skills training to hire and work with your PCA. They also conduct annual PCA reviews.

When you contact your PCM, tell them you are calling to speak to your skills trainer about the PCA overtime rules.

8. What if I don’t know who my PCM is or how to contact them?

Call MassHealth Customer Service at 1-800-841-2900. A Customer Service Representative will look up your PCM and provide you with the name and phone number. The Representative will also call your PCM for you while you are on phone to make sure you get connected.

9. What if I am in One Care or SCO?

When you contact your PCM, tell them you are calling to speak to your skills trainer about the PCA overtime rules.

The PCA overtime management rules apply to all MassHealth members, including members in One Care and SCO. Contact your PCM or your One Care or SCO Care Coordinator if you have questions.

10. How do I find out if my PCA works more than 50 hours?

You will need to talk to your PCA to make sure you both know and understand the rules.

Even if your PCA does not work more than 50 hours per week for you, you should ask your PCA to make sure s/he lets you know if they work more than 50 hours in any week as a MassHealth PCA. You do not need information about who else your PCA works for. You just need to know if your PCA’s total hours for you and any other MassHealth members adds up to more than 50 hours in a week. If you do not know if your PCA works more than 50 hours per week, contact your PCM agency.

 If you need help talking to your PCA about this, ask your PCM to help you.

11. If my PCA works more than 50 hours a week for more than one member, who needs to apply for overtime?

If your PCA works more than 50 hours a week for more than one member, you must submit the PCA Overtime Request Form. You need to submit the PCA Overtime Request Form even if you get less than 50 hours of PCA services a week from that PCA.

12. What if I need my PCA to work more than 50 hours a week because of an emergency and no other PCA can provide my care?

The rules do not affect emergency overtime. Contact your PCM agency if you need your PCA to work overtime due to an emergency.

13. What if I need help applying for PCA overtime?

You can call your PCM agency. They will talk you through the process or also set up a time to meet with you. They can help you fill out the PCA Overtime Request Form.

Or you can call MassHealth Customer Service at 1-800-841-2900. A Customer Service Representative will look up your PCM and provide you with the name and phone number. The Representative will also call your PCM for you while you are on phone to make sure you get connected.

14. Where can I get the PCA Overtime Request Form?

15. Can I get a copy of the form in large print and braille?

Yes. Call MassHealth’s Disability Accommodation Ombudsman at 1-617-847-3468 (TTY: 1-617-847-3788). You can also e-mail ADAAccommodations@state.ma.us.

16. How do I fill out the PCA Overtime Request Form?

You can fill out the form yourself. Instructions are included on the form. Send the form to your PCM agency after you fill it out.
Contact your PCM agency if you need help. You can meet with your PCM Skills Trainer in-person, or they can help you over the phone.
 

Your PCM agency will send the filled-out form to MassHealth for you.

17. How long will it take to get an answer about my PCA overtime request?

Your PCM will check your form and send it to MassHealth within 1 business day of getting the filled-out form.
MassHealth will make a decision within 2 business days of getting your filled-out form.

Your PCM agency will call you within 1 business day of MassHealth’s decision. MassHealth will also mail you a letter that explains the decision.


This information is provided by MassHealth.