Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
	MassHealth
	Personal Care Agency Bulletin 5
	July 2011




	TO:	Personal Care Agencies Participating in MassHealth

	FROM:	Terence G. Dougherty, Medicaid Director 

	RE:	Clarification of MassHealth Personal Care Regulations  



Background	The MassHealth personal care a regulations state that when a personal 
care agency is determining the number of hours of physical assistance 
that a MassHealth member (consumer) requires for instrumental activities 
of daily living (IADLs), the agency must assume that any family members 
living with the consumer will provide assistance with most of the 
consumer’s IADL needs. For example, if the consumer is living with a 
family member, it must be assumed that routine laundry, housekeeping, 
shopping, meal-preparation, and clean-up performed by the family 
member will include the related IADL needs of the consumer. (See 130 
CMR 422.410(C)(1).)


Clarification 	The personal care regulations at 130 CMR 422.402 define “family 
member” as
*	the spouse of the consumer;
*	the parent of a minor consumer, including an adoptive parent; or 
*	any legally responsible relative. 

This definition is in accordance with federal Medicaid regulations that 
define family member to include relatives who are “legally responsible” 
and that prohibit legally responsible relatives from being paid as a 
personal care attendant. (See 42 CFR 440.167.) 
	
MassHealth interprets “legally responsible relative” to include a relative 
who is a legal (court-appointed) guardian of the consumer (regardless of 
whether the relative has a duty to provide the consumer with direct 
physical care). A relative who merely has a power of attorney where the 
consumer is the principal, or who has been designated as a health care 
proxy for the consumer, is not considered to be a “legally responsible 
relative.”
	









											

Adult Consumers Living	A relative who is a legal guardian of an adult (aged 18 or older)  
with a Family Member	consumer is a legally responsible relative, and thus meets
	the regulatory definition of a “family member.” Accordingly, where an adult 
consumer is living with his or her relative who is the consumer’s legal 
guardian, that relative is a “family member” for purposes of determining 
the number of hours of physical assistance that the consumer requires for 
IADLs. In accordance with 130 CMR 422.402, the personal care agency 
must thus assume that routine laundry, housekeeping, shopping, meal 
preparation, and clean-up will be performed by that family member for the 
IADL needs of the consumer.	
	

Family Members Unable 	If a family member, as defined by 130 CMR 422.402, is unable to provide
to Provide IADL 	assistance with the consumer’s IADL needs, the personal care
Assistance	agency must provide written justification as to why the family member is 
unable to provide such assistance. A letter from the family member’s 
physician is not required.


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.
  


			MassHealth
			Personal Care Agency Bulletin 5
			July 2011
			Page 2