Request prior authorization for Personal Care Attendant (PCA) Services

• a MassHealth Application to Request Prior Authorization for PCA Services
• a completed and signed MassHealth PCA Evaluation form  
• a completed and signed Consumer Assessment to Manage PCA Services form

You may also need

• any documentation that supports the member's need for PCA services
• documentation that the member's physician or nurse practitioner has ordered PCA services 
• a completed and signed PCA Prior Authorization Adjustment form

Only Personal Care Management (PCM) Agencies can submit PA requests for PCA services.

For information on the documentation PCM agencies will need to include with a prior authorization request for PCA services, please refer to the Standard Documentation to Include with a Prior Authorization Request for Personal Care Attendant (PCA) Services below.