Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Home Health Agency Bulletin 34
March 1999

TO:      Home Health Agencies Participating in MassHealth

FROM:      Bruce M. Bullen, Commissioner

RE:      TEMPORARY EMERGENCY PERSONAL CARE ATTENDANT (PCA) SERVICES PLAN

Introduction                      MassHealth has implemented the Temporary Emergency PCA Services Plan (the emergency plan), which authorizes MassHealth members who are eligible for PCA services but not home health services to access the services of a home health aide on a temporary basis.  The purpose of the emergency plan is to address certain temporary access issues.  The emergency plan will be in effect from March 15, 1999, through June 30,
1999.  MassHealth encourages all MassHealth home health agencies
(HHAs) to participate.

Overview of PCA                MassHealth pays for PCA services provided to MassHealth members
Services                            who can be appropriately cared for in the home.  A physician must prescribe the PCA services, and the member’s condition must be permanent or chronic in nature.  The member must require physical assistance in activities of daily living or in a combination of activities of daily living and instrumental activities of daily living (such as shopping, laundry, and housekeeping).  Such assistance is provided by a PCA who is hired, trained, and supervised by the member.

Eligibility for the                To qualify for a home health aide under the emergency plan, a member
Emergency Plan                must:

·     have lost the servcies of one or more PCAs on or after January 1,
1999, and have not been able to find a replacement PCA;

·     have a current prior authorization for PCA services; and

·     be actively seeking a replacement PCA.

MassHealth
Home Health Bulletin 34
March 1999
Page 2

Self-Referral Process         Personal care agencies will inform MassHealth members who are eligible for the emergency plan of their responsibility to self-refer to one of the home health agencies on MassHealth’s list of home-health-agency providers.

Assessment Process         The HHA will assess the needs of a MassHealth member who self-refers for home health services as follows.

·     If the member qualifies for home health services, the HHA will provide services in accordance with regulations at 130 CMR 403.000.

·     If the member does not qualify for home health services, the HHA is authorized to provide a home health aide to the member as a temporary emergency PCA service until June 30, 1999, or the date the member’s replacement PCA services begin, whichever is sooner.

Authorized Home Health     The HHA may provide a home health aide for a MassHealth member who
Aide Hours                        is eligible for the emergency plan up to the number of weekly hours authorized in the member’s prior authorization for personal care services. Note:  A copy of the member’s PCA prior-authorization form is available from the member (see Documentation Required by the HHA below).

Rates of Payment               Payment to the HHA for necessary nursing care visits and home health aide visits provided to MassHealth members eligible for the emergency plan will be in accordance with 130 CMR 403.429.  Payment is subject to current MassHealth eligibility.

Service Codes                   For members who qualify for home health services, the HHA must bill using the appropriate service code from Subchapter 6 of the Home Health Agency Manual.

For members who do not qualify for home health services, but are eligible for the emergency plan, MassHealth has developed the following unique service codes to be used by HHAs:

X0021:  Nursing care visit for temporary emergency PCA services
X0022:  Home health aide visit for temporary emergency PCA
services

Do not list the prior-authorization number on the claim form for home- health-agency services billed under the emergency plan.

MassHealth
Home Health Bulletin 34
March 1999
Page 3

Documentation Required    The HHA must obtain the following documentation from each MassHealth
by the HHA                        member eligible for the emergency plan:

·     a copy of the member’s PCA evaluation that includes signed physician’s orders.  Note:  MassHealth will consider this evaluation sufficient for billing purposes for services provided under the emergency plan; and

·     a copy of the member’s prior-authorization form for personal care attendant services.

Documentation Required    Each week, the HHA must fax to Lois Aldrich of the MassHealth PCA
by MassHealth                   Program (fax number:  (617) 210-5511) a list that contains the following:

·     name and MassHealth recipient identification (RID) number for each MassHealth member who will receive a home health aide under the emergency plan;

·     the HHA’s name, provider number, fax number, telephone number, and contact person; and

·     the number of weekly hours the home health aide will provide and the anticipated start date.

Questions                         If you have any questions about the information in this bulletin, please contact the Unisys Provider Services Department at 1-800-325-5231 or
(617) 628-4141.