Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 422.000 - Personal Care Attendant Services › Section 422.420 - PCA Program: Member Responsibilities

Current through Register 1525, July 5, 2024
(A)
			 As a condition of receiving MassHealth PCA services, the member must:
(1) complete and sign the standard consumer
			 agreement supplied by the fiscal intermediary;
(2) complete and sign all employment forms
			 required by the fiscal intermediary; and
(3) complete and sign activity forms and
			 submit them to the fiscal intermediary in the form and format as required by
			 the MassHealth agency, including through the use of EVV, and in accordance with
			 the instructions provided and time frame specified by the fiscal intermediary
			 or the MassHealth agency;
(4)
			 ensure that information submitted on the activity forms for each pay period
			 correctly identifies who provided the PCA services, and the correct hours and
			 dates that the PCA services were provided; and
(5) employ and schedule for PCA services in
			 the following manner:
(a) employ PCAs for no
			 more than the number of PCA hours authorized by the MassHealth agency in
			 accordance with
			 130
			 CMR 422.416(E), and only to
			 provide physical assistance with ADLs and IADLs as described in the personal
			 care attendant evaluation submitted by the PCM agency and authorized by the
			 MassHealth agency;
(b) not schedule
			 an individual PCA to work in excess of the weekly hour limit, unless authorized
			 to schedule a PCA to work additional overtime hours pursuant to
			 130
			 CMR 422.418(A);
			 and
(c) schedule PCAs and
			 coordinate with PCAs to use EVV as required by the MassHealth agency and
			 pursuant to
			 130
			 CMR 422.419(C)(5).
(6) hire, terminate, schedule, and
			 train PCAs;
(7) employ PCAs who
			 meet the requirements of
			 130
			 CMR 422.404(A)(1);
(8) inform PCAs of PCA program requirements,
			 including the requirement to use EVV as required by the MassHealth agency and
			 pursuant to
			 130
			 CMR 422.419(C)(5), and the
			 requirement to have PCA payments direct deposited into the PCA's bank
			 account;
(9) cooperate with the
			 MassHealth agency and the PCM agency during assessments, evaluations, and
			 reevaluations;
(10) notify the
			 fiscal intermediary of the date of hire and the date of termination of the
			 member's personal care attendants and of a personal care attendant's change of
			 address;
(11) notify the MassHealth
			 agency and the fiscal intermediary of the member's change of address and
			 telephone number, if any;
(12)
			 notify the PCM agency when there is a change in the member's medical condition
			 or living situation that may require an adjustment in the number of PCA hours
			 per week authorized by the MassHealth agency;
(13) contact the PCM agency to request
			 authorization to schedule an individual PCA to work in excess of the weekly
			 hour limit according to conditions described in
			 130
			 CMR
			 422.418(A)(2)(c);
(14) contact the PCM agency to request
			 payment for juror service for a PCA in accordance with
			 130
			 CMR 422.418(B);
(15) contact the PCM agency to request
			 authorization to schedule an individual PCA to work in excess of the weekly
			 hour limit according to conditions described in
			 130
			 CMR 422.418(A)(2)(a) and
			 (b);
(16) work with the PCM agency to establish
			 and maintain a current list of available PCAs, who can be contacted when an
			 unforeseen event occurs that prevents the member's regularly scheduled PCA from
			 providing PCA services;
(17) work
			 with the fiscal intermediary and the PCM agency to resolve any issues or
			 complaints;
(18) review and sign
			 the evaluation or reevaluation prepared by the PCM agency in accordance with
			 130
			 CMR 422.422(C) and
			 (D);
(19) comply with all applicable state and
			 federal labor laws including, but not limited to, federal and state child labor
			 laws;
(20) comply with all
			 applicable MassHealth regulations;
(21) participate in functional skills
			 training as required by the MassHealth agency including, but not limited to,
			 participating in in-person comprehensive functional skills training on at least
			 a quarterly basis during the first year of approved PCA services and at least
			 annually thereafter, and other functional skills training as applicable in
			 accordance with
			 130
			 CMR 422.421(B);
(22) if assessed by the PCM Agency to require
			 a surrogate or administrative proxy in accordance with 130 CMR
			 422.422(A)(1)(b), locate and appoint a surrogate or administrative proxy to
			 assist the member in performing the PCA management tasks or related
			 administrative functions that the member is unable or unwilling to perform as
			 described in the service agreement in accordance with 130 CMR 422.423(A)(1) and
			 (2). In appointing a surrogate or administrative proxy, the member must select
			 a surrogate or administrative proxy who is not the member's PCA or an employee
			 or contractor of the member's PCM agency or fiscal intermediary, and who must
			 live in proximity to the member and be readily available to perform the tasks
			 described in the service agreement. A member may not appoint both a surrogate
			 and an administrative proxy; and
(23) cooperate with the MassHealth agency,
			 the PCM agency, and the Fiscal Intermediary for the implementation and use of
			 EVV.