Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Hospice Bulletin 9 August 2009 TO: Hospice Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Changes to MassHealth Policy about the Provision of MassHealth Personal Care Attendant (PCA) Services to Hospice Members Background The Centers for Medicare & Medicaid Services (CMS) recently revised the hospice rules under 42 CFR 418. As part of these revisions, hospice providers may now coordinate the provision of hospice services with Medicaid-funded personal care services. Specifically, the changes in the CMS hospice rules provide, in part, that • services under the Medicaid personal care benefit may be used by a Medicaid-eligible individual receiving hospice care to the extent that the hospice provider would routinely use the services of a hospice patient’s family in implementing the patient’s plan of care; • when an individual receiving hospice services is also receiving Medicaid personal care services, the hospice provider must coordinate its hospice aide and homemaker services with individual’s Medicaid personal care benefit to ensure that the individual receives the hospice aide and homemaker services he or she needs; and • the hospice provider must document the coordination of its services with any Medicaid personal care services provided to an individual receiving hospice care in the individual’s hospice plan of care. This bulletin informs hospice providers of the conditions under which MassHealth will pay for PCA services furnished to members who have elected the hospice benefit, and delineates hospice providers responsibilities when coordinating hospice services with any PCA services. Overview of the MassHealth PCA Program Eligible MassHealth members may receive personal care services through the MassHealth Personal Care Attendant (PCA) program. MassHealth regulations governing the PCA program can be found at 130 CMR 422.000. The MassHealth PCA program is a consumer-directed program in which the member (the consumer) is the employer of the PCA and is fully (continued on next page) Overview of the MassHealth PCA Program (cont.) responsible for recruiting, hiring, firing, training, scheduling, and supervising the PCA. The member is also responsible for submitting completed PCA Activity Forms (timesheets) for payment. If the member is unable to manage PCA services independently, the member may appoint a surrogate to assist the member in the management of PCA services. To qualify for PCA services, and pursuant to 130 CMR 422.403, a member must: • have a chronic disability that impairs the member’s ability to perform activities of daily living and instrumental activities of daily living without physical assistance; • require physical assistance with two or more activities of daily living; • have a physician order for PCA services; and • obtain prior authorization (PA) from MassHealth. MassHealth contracts with 29 personal care management (PCM) agencies who evaluate a member’s need and eligibility for MassHealth PCA services, submit prior-authorization requests to MassHealth, and provide functional skills training to members to instruct them (and their surrogate, if needed) on their roles and responsibilities as a PCA consumer. Changes to MassHealth Policy on the Provision of PCA Services to MassHealth Members Who Have Elected hospice MassHealth’s policy about the provision of PCA services to members who have elected hospice has been to allow members who were authorized for PCA services to continue to receive PCA services at the amount authorized before their election of hospice. However, because is an all-inclusive benefit, MassHealth has considered it the Hospice hospice provider’s responsibility to provide any needed new or additional personal care services once the member has elected hospice. Effective immediately, and in accordance with the above-referenced changes to the CMS hospice rules, MassHealth will authorize medically necessary PCA services for MassHealth members who have elected hospice, to the extent that the hospice provider would routinely use the services of a hospice patient’s family in implementing a hospice patient’s plan of care. The hospice provider is responsible for coordinating hospice services with any PCA services that a member is authorized to receive, and must document its coordination of hospice services with PCA services in the member’s hospice plan of care to ensure there is no duplication of services. (continued on next page) Changes to MassHealth Policy on the Provision of PCA Services to MassHealth Members Who Have Elected hospice (cont.) To ensure that PCA services are provided in accordance with the above mentioned revised CMS hospice rules, MassHealth has instructed PCM agencies to obtain a copy of the member’s hospice plan of care from the hospice provider and submit it along with other required documentation when requesting prior authorization for PCA services for members who have elected hospice. Hospice Provider Responsibilities Given the life-limiting conditions of members who have elected hospice, MassHealth and PCM agencies are committed to expediting PCA prior- authorization requests for members in hospice. Accordingly, MassHealth is requesting that hospice providers assist members and PCM agencies in expediting the prior-authorization process by • providing the PCM agency with the member’s hospice plan of care upon request; • having the hospice medical director or nurse practitioner sign off on the PCA Evaluation, if requested by the PCM agency; • having the hospice occupational therapist assist with completion and sign-off of the PCA Evaluation, if the PCM agency occupational therapist is unavailable; • providing other documentation to the PCM agency or MassHealth as needed and upon request; and • responding to hospice members’ inquiries about PCA services and providing a list of MassHealth PCM agency providers to the member upon request. MassHealth PCA services can only be used to the extent that the hospice provider would routinely use the services of a member’s family in implementing the plan of care. In addition, PCA services must be coordinated with any in-home support services that the member is receiving or is eligible to receive from a home and community based services network, such as elder services. Accordingly, documentation provided to the PCM agency by the hospice provider should address such services that the member is receiving or is authorized to receive. If the member or the member’s family and the hospice determine that a referral for PCA services is warranted, the hospice provider may refer the member to a PCM agency of the member’s choice, and provide the PCM with a copy of the hospice member’s care plan. A list of MassHealth PCM agencies is attached. MassHealth has published a PCA Consumer handbook, which provides more detailed information about the PCA program, and is available on the MassHealth Web site at www.mass.gov/masshealth. In the Publications (continued on next page) Hospice Provider panel on the right side of the homepage, click on Applications and Responsibilities Member Forms. The handbook can also be obtained by contacting (cont.) MassHealth Customer Service at 1-800-841-2900. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. . Personal Care Management (PCM) Agencies and Selected Fiscal Intermediaries PCM Agency Selected Fiscal Intermediary Ad Lib, Inc. Stavros 215 North Street Pittsfield, MA 01201 413-442-7047 BayPath Elder Services Cerebral Palsy of Massachusetts 354 Waverley Street Framingham, MA 01702 508-872-1866 Boston Center for Independent Living (BCIL) Cerebral Palsy of Massachusetts 60 Temple Place, 5th Floor Boston, MA 02111 617-338-6665 Bristol Elder Services Cerebral Palsy of Massachusetts 182 North Main Street Fall River, MA 02720 508-675-2101 Center for Living and Working Stavros 484 Main Street Worcester, MA 01608 508-798-0350 Coastline Elderly Services Cerebral Palsy of Massachusetts 1646 Purchase Street New Bedford, MA 02740 508-999-6400 Elder Services of Berkshire County Cerebral Palsy of Massachusetts 66 Wendell Avenue Pittsfield, MA 01201 413-236-1718 Elder Services of the Merrimack Valley North Shore ARC 360 Merrimack Street Lawrence, MA 01843 978-683-7747 Elder Services of Worcester Area, Inc. CPMA 411 Chandler Street Worcester, MA 01602 508-756-1545 PCM Agency Selected Fiscal Intermediary Family Service Association of Greater Fall River Cerebral Palsy of Massachusetts 151 Rock Street Fall River, MA 02720 508-678-7542 Franklin County Home Health Care Corporation (FCHCC) Cerebral Palsy of Massachusetts 330 Montague City Road Turners Falls, MA 01376 413-773-5555 Greater Lynn Senior Services (GLSS) North Shore ARC 8 Silsbee Street Lynn, MA 01901 781-599-0110 Greater Springfield Senior Services North Shore ARC 66 Industry Avenue Springfield, MA 01104 413-781-8800 Independence Associates, Inc. Stavros 141 Main Street, 1st Floor Brockton, MA 02301 508-583-2166 Montachusett Home Care Corp. Cerebral Palsy of Massachusetts 680 Mechanic Street Leominster, MA 01453 978-537-7411 Northeast Independent Living Center, Inc. Stavros 20 Ballard Road Lawrence, MA 01843 978-687-4288 North Shore ARC North Shore ARC 6 Southside Road Danvers, MA 01923 978-762-0301 Old Colony Elderly Services Cerebral Palsy of Massachusetts 144 Main Street, P.O. Box 4469 Brockton, MA 02303 508-584-1561 Options PCA Agency Cerebral Palsy of Massachusetts Cerebral Palsy of Massachusetts 30 Taunton Green, Unit 8 Taunton, MA 02780 508-880-7577 PCM Agency Selected Fiscal Intermediary PRIDE North Shore ARC 3 Maple Street Taunton, MA 02780 508-823-7134 Somerville Cambridge Elder Services North Shore ARC 61 Medford Street Somerville, MA 02143 617-628-2601 South Shore ARC Cerebral Palsy of Massachusetts 371 River Street North Weymouth, MA 02191 781-335-3023 Southwest Boston Senior Services, Inc. (Ethos) Cerebral Palsy of Massachusetts 555 Amory Street Boston, MA 02130 617-522-6700 Springwell, Inc. Cerebral Palsy of Massachusetts 125 Walnut Street Watertown, MA 02472 617-926-4100 Stavros Center for Independent Living Stavros 210 Old Farm Road Amherst, MA 01002 413-256-0473 Toward Independent Living and Learning (TILL) Cerebral Palsy of Massachusetts 20 Eastbrook Road, Suite 201 Dedham, MA 02026 781-302-4600 Tri-Valley Elder Services Cerebral Palsy of Massachusetts 251 Main Street Webster, MA 01570 508-949-6640 United Cerebral Palsy Association of Metro Boston Cerebral Palsy of Massachusetts 71 Arsenal Street Watertown, MA 02172 617-926-5480 WestMass Elder Care, Inc. Cerebral Palsy of Massachusetts 4 Valley Mill Road Holyoke, MA 01040 413-538-9020