MassHealth PCA Overtime Policy Effective January 1, 2026

MassHealth PCA Overtime Policy Effective January 1, 2026

Introduction

Personal care attendants (PCAs) can work up to 50 hours a week without an overtime prior authorization (PA). However, a PA is required if a PCA is going to work between 51 and 66 hours in a single week. Because hours worked are aggregated, PCAs working for more than one consumer need a PA to work overtime for each of their consumers.

PCAs can’t work more than 66 hours in a single week in the aggregate, as specified by 130 CMR 422.412 (K). Hours worked are aggregated, which means that if a PCA works for more than one consumer, those hours are added together.

Process

Consumers must request a PA to schedule a PCA to work more than 50 hours and up to 66 hours in a single week in accordance with program regulations at 130 CMR 422.418(A) and 130 CMR 422.412(K). MassHealth will review the request and, if approved, will provide a time-limited authorization. MassHealth will use program regulations and health and safety guidelines to make approval determinations. 

Scheduling a PCA to work overtime without a PA is a violation of the PCA program regulations. The consumer and the PCA may be suspended or terminated from the PCA program after the third violation.

Requests for temporary overtime authorizations must always state that the request for overtime is time limited and include the length of time for which the overtime authorization is being requested (up to 12 weeks).

Requests for all overtime authorizations must

• include the specific reason(s) for such request; and
• include required documentation to support the reasons for the overtime request.

MassHealth will approve overtime PAs under the following circumstances.

1. Temporary Authorization and Required Supporting Documentation

Temporary authorizations are time limited. This means that the authorization can be requested for a period of one to 12 weeks. Temporary authorizations are approved when at least one of the following conditions is present.

Reason for the Overtime Request	Required Supporting Documentation
The consumer needs time to hire an additional PCA, and at least one of the following applies. The consumer placed multiple ads/used multiple resources to find a  PCA, but received no responses. (One resource may be registering on the PCA directory website and using that website to try to recruit PCAs.) The consumer interviewed multiple PCAs, but no PCA would accept the position. The consumer hired a PCA, but the PCA didn’t remain employed because the PCA couldn’t attain the basic knowledge to carry out PCA-assigned tasks safely. The PCA left employment suddenly.	At least one of the following: Printed ads offering PCA jobs or posted on any web or social media resource, including the PCA Directory PCA termination forms with a specific reason When available, proof that the PCA left employment suddenly (resignation letters or other documentation)
The consumer has planned travel within the United States, including its territories, and it would not be possible to bring multiple PCAs to provide the consumer’s PCA services.	Travel dates relevant to the request
One or more of the consumer’s PCAs need to take a short-term leave for any reason, including the following. The PCA is in school or temporarily unavailable due to school (winter, summer breaks). The PCA is taking medical or family leave (sick, paternity, or maternity leave). The PCA is going on vacation.	Statement from the PCA explaining the reason for the temporary leave and the dates when the leave will take place Travel dates relevant to the request
The consumer has a temporary need to schedule their PCA to work additional approved PA hours, including post-acute hospitalization or post-skilled nursing facility. OR The consumer is receiving hospice care.	Post-hospitalization and discharge summaries, provider’s notes, electronic medical records, doctors' letters, plan of care, or any other clinical supporting documentation relevant to the request

2. Continuity-of Care-Authorization and Required Supporting Documentation

Continuity-of care-authorization requests may be approved for the length of the PA for PCA services. To be eligible for approval, at least one of the following conditions must be present.

Reason for Request	Required Supporting Documentation
The consumer needs time to hire additional PCAs because there are one or more circumstances that make it difficult to hire additional PCAs.	Proof associated with the specific circumstance(s) that make it difficult for the consumer to hire additional PCAs, including the following: Supporting documentation that the consumer is actively recruiting PCAs, such as job postings, responses, etc. PCA terminations with a specific termination reason
The consumer has an ongoing medical need requiring intensive ADL care. Because of this, they need to schedule the PCA to work additional approved hours, and must also document their effort to  try to hire an additional PCA. The following procedures and equipment are considered when determining the need for intensive ADL care (Time for Task Tool). Tracheostomy care Ventilator use Ostomy care Catheter care Transfer and mobility needs with a mechanical lift Urological equipment and drainage systems The consumer provides evidence that they have other medical needs that require a specialized level of care. These needs include the following. Behavioral health impairments that result in difficulty engaging with new people, which impacts daily function. (Examples include social anxiety disorder, post-traumatic stress disorder, autism spectrum, schizo-affective disorder, etc.) Deficits in communication, including a formal diagnosis of aphasia, or communicating only via American Sign Language (ASL)	Proof of intensive ADL needs associated with a formal diagnosis (electronic medical records, doctors' letters) Supporting documentation that the consumer is actively recruiting PCAs, such as job postings, responses, etc.
The consumer is receiving hospice care.	Electronic medical records, doctors' letters, or plan of care.

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Date published:	December 31, 2025