Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 422.000 - Personal Care Attendant Services › Section 422.419 - PCA Program: Scope of PCA Services and Personal Care Management and Fiscal Intermediary Functions

Current through Register 1525, July 5, 2024
(A)
The
			 PCM Agency
. The PCM agency must provide personal care management
			 functions in accordance with
			 130 CMR
			 422.000 and its contract with EOHHS including, but not
			 limited to:
(1) maintaining a communication
			 system that is accessible to members on a 24-hour basis;
(2) responding to member inquiries about the
			 MassHealth agency's prior-authorization decisions within the timeframes
			 specified in the contract and in
			 130 CMR
			 422.000;
(3) maintaining records in accordance with
			 130
			 CMR 422.446 and the PCM agency
			 contract;
(4) conducting a formal,
			 written assessment of the member's ability to manage the PCA program
			 independently and, if applicable, conducting a formal, written assessment of
			 the ability of the surrogate or administrative proxy to manage the PCA program
			 on behalf of the member in accordance with
			 130
			 CMR 422.422(A)  and the PCM
			 agency contract, and in the form and format required by the MassHealth
			 agency;
(5) performing evaluations
			 and reevaluations of members who are eligible for PCA services in accordance
			 with 130 CMR 422.422(C) and
			 (D) and the PCM agency contract;
(6) submitting to the MassHealth agency all
			 requests for prior authorization for PCA services in accordance with the
			 procedures and timelines identified in the PCM agency contract,
			 130
			 CMR 422.416(A) through (C),
			 and 130 CMR 422.418;
(7) developing in conjunction with the member
			 and the member's surrogate, if any, a formal, written service agreement for the
			 member in accordance with
			 130
			 CMR 422.423 and the PCM agency contract, and
			 in the form and format required by the MassHealth agency;
(8) providing intake and orientation to
			 determine a member's initial eligibility for PCA services, and to instruct the
			 member in the rules, policies, and regulations of the PCA program and the
			 skills and functions necessary to manage the PCA program in accordance with
			 130
			 CMR 422.421(A)  and the PCM
			 agency contract;
(9) providing
			 functional skills training to instruct the member and the surrogate or
			 administrative proxy, if applicable, as necessary, in the basic requisites
			 appropriate management of the PCA program in accordance with
			 130
			 CMR 422.421(B)  and the PCM
			 agency contract;
(10) maintaining
			 policies and procedures for the receipt and timely resolution of member
			 complaints in accordance with the PCM agency contract;
(11) providing written information to members
			 in a language and format that is understandable to them;
(12) providing PCM functions that are
			 culturally sensitive;
(13) seeking
			 out and including member input and feedback into the PCM functions provided by
			 the PCM agency;
(14) educating
			 members and surrogates and administrative proxies about the tools available to
			 promote PCA services that are safe, such as the availability of Criminal
			 Offender Record Investigation (CORI), Disabled Persons Protection Commission
			 (DPPC), the sex offender registry, and the Elder Services hotline;
(15) working with the member 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 services;
(16) developing
			 creative methods to assist members in the recruitment of PCAs; and
(17) establishing a cooperative working
			 relationship with the fiscal intermediary by:
(a) working with the fiscal intermediary for
			 all members served by the PCM agency;
(b) assisting new members in enrolling with
			 the fiscal intermediary before hiring personal care attendants;
(c) educating members about the role of the
			 fiscal intermediary;
(d) working
			 with the fiscal intermediary to resolve member and PCA complaints;
(e) sharing information with the fiscal
			 intermediary, as needed, about the status of a member's prior authorization
			 decision including, but not limited to, the member's name, address, and date of
			 birth;
(f) providing the fiscal
			 intermediary with the name, address, and phone number of the member's surrogate
			 or administrative proxy, if any, and any changes in the surrogate or
			 administrative proxy information; and
(g) responding to the fiscal intermediary's
			 request for skills training for a member or surrogate who is having difficulty
			 managing the PCA program including, but not limited to, a member or surrogate
			 who repeatedly submits activity forms in excess of the PCA hours per week
			 authorized by the MassHealth agency pursuant to
			 130
			 CMR 422.416(E), the
			 scheduling and provision of PCA services resulting in overtime hours in excess
			 of those authorized by
			 130
			 CMR 422.418(A), or
			 noncompliance with the use of EVV pursuant to
			 130
			 CMR 422.420(A)(3)  and
			 422.420(A)(5)(c).
(18) reporting suspicion of fraud
			 to the MassHealth agency in the format specified by the MassHealth agency and
			 cooperating with any subsequent investigation;
(19) assist the member and the MassHealth
			 agency in coordinating for, or providing education about, the use of EVV as
			 required by the MassHealth agency; and
(20) notifying the MassHealth agency if, in
			 the opinion of the PCM agency, the member's surrogate or administrative proxy
			 is not managing PCA tasks for the member in accordance with
			 130 CMR
			 422.000.