MassHealth continues to engage with PCA consumers and other stakeholders on how to manage PCA overtime in a way that preserves these valuable services, ensures access, and is financially responsible.
This update to PCA overtime management reflects feedback MassHealth has received. This information supersedes and replaces information in letters, guidance and FAQs on PCA overtime management issued prior to this date.
- Between now and January 1, 2017, any MassHealth member whose current PCA(s) work more than 40 hours (PCA overtime) will be allowed to continue use of PCA overtime. This means:
- Any PCA working hours for which consumers have received prior authorization by MassHealth will be paid for those hours, including overtime pay for more than 40 hours per week.
- Between now and October 22, 2016, every PCA consumer using overtime must submit the PCA Overtime Request Form. If you have already submitted a form, you do not need to do anything else at this time.
- If your PCA(s) works more than 40 hours per week, and you have not yet submitted a form, please do so by October 22, 2016. This is important in order for MassHealth to get good information about your particular situation. MassHealth will send letters to all members who submit a PCA Overtime Request form confirming approval through at least December 31, 2016. The letter will provide a specific expiration date.
- From October 22, 2016 to January 1, 2017 MassHealth will collaborate with PCM agencies and others to outreach to consumers who are using PCA overtime in order to provide assistance with finding additional PCAs, and to identify any unique challenges PCA consumers have in finding additional PCAs.
- Also, between October 22, 2016 and January 1, 2017, MassHealth will review all of the information it gathers from overtime request forms, consumer input, PCMs and PCAs (SEIU 1199) to inform the final Continuity of Care process for PCA overtime.
- When finalized, the Continuity of Care process will allow for short-term approvals, while additional PCAs are recruited and trained.
- The final process will also define additional situations in which MassHealth will grant a long-term approval. Long-term Continuity of Care approvals will be for the same length of time as the consumer’s prior authorization period.
- MassHealth will post changes and updates to the Continuity of Care process on our website. PCMs, Fiscal Intermediaries (FIs) and MassHealth Customer Service will support communications.
- MassHealth is also working with others to increase the number of available PCAs. We are partnering with the PCA union (SEIU 1199) and the PCA Workforce Council to expand PCA recruitment and training, and looking for better ways to support matching consumers with PCAs.
- In mid-November 2016, MassHealth will provide updates to the Continuity of Care process and post a simplified PCA Overtime Request Form. All updates will be available on the MassHealth website and will be communicated to consumers through PCMs and MassHealth Customer Service. PCAs will receive information about enforcement through joint efforts by MassHealth, FIs, the PCA Workforce Council and SEIU 1199.
- Beginning January 2017, MassHealth will fully implement the PCA overtime management rules with updated Continuity of Care processes and additional consumer support for finding PCAs in place. PCA consumers who have not adjusted PCA schedules to eliminate overtime, must submit a new PCA Overtime Request Form before expiration of their approval.
Please visit the MassHealth website at www.mass.gov/masshealth for official communication regarding PCA overtime management.