PCA Complex Care

Beginning January 1, 2026, personal care attendant (PCA) providers who work for certain MassHealth members with an approved prior authorization for PCA complex care tasks will receive a $3.25 per hour pay differential.

Complex Care Add-On

PCA complex care tasks need to be approved in the member’s PCA assessment. MassHealth members should contact their primary care provider (PCP) if they need a PCA complex care task. The PCP will need to complete a PCP Summary Form to add the complex care task to their assessment. The PCP Summary Form documents that it is clinically appropriate for a PCA provider to perform those tasks under the member’s guidance.

They need to submit the form to your personal care management (PCM) agency.

Eligibility Criteria 

• Members must meet the following requirements for PCA complex care. They must have a PCA evaluation according to 130 CMR 422.422(C) and (D) and 130 CMR 422.416(A) and (B).
• MassHealth or its designee must have determined that the member requires physical assistance with digital rectal stimulation (DRS) or feedings via enteral tube (G & J). These tasks must be reflected in the member’s PCA assessment, as required under 130 CMR 422.422(C) and (D).
• They must have a PCP Summary Form. The form should show the clinical need for assistance with the complex task and that it is appropriate for a PCA provider to perform the task. PCA complex care tasks are not approved for enteral tube (G & J), for either children or adults, when there is an aspiration risk.

Requirements for Consumers

Fee-for-service members who want to enroll in the PCA program must tell their PCM agency if they need assistance with either DRS or feeding via enteral tube (G & J).  They will need a PCP Summary form in order for the tasks to be approved.

For more information, please review the PCA Administrative Bulletin 17 and get the PCA PCP Summary form.

In the summer of 2025, MassHealth sent out notices to PCAs and Consumers. Please follow the links below to access the notices.