PCA Overtime FAQs

For a printable version of the FAQs:     PCA Overtime FAQs – revised 11-22-16

For a printable version of  PCA Overtime Request Form – revised 12-8-16

November 22, 2016 Update
On September 1, 2016, MassHealth put in place new rules to manage PCA overtime. MassHealth has been working with PCA consumers and other stakeholders since then about managing PCA overtime. Based on the feedback we received, MassHealth has made important changes to the PCA Overtime Management rules including increasing the number of hours a PCA can work before an overtime approval is required to 50 hours per week as well as updating the overtime approval criteria.

These FAQs replace all other information previously shared.

What is the new PCA Overtime Management?

The number of hours one PCA can work providing MassHealth PCA services is limited to 50 hours each week unless you are approved to schedule that one PCA to work more than 50 hours each week. The 50 hour limit applies if the PCA works for you, or for you and other members.

Will the new PCA overtime rules reduce the number of PCA hours I can get?

No. The new PCA overtime rules do not change or reduce the total number of PCA hours you can get.

MassHealth will determine the total number of PCA hours you can receive. The prior approval process has not changed. This policy has no impact on your approved hours of PCA services.

What do I have to do now?

If you have PCA that works more than 50 hours per week and you haven’t submitted an overtime request form, please contact your PCM agency to do so. If you don’t know who to call, please call MassHealth Customer Service Center at 1-800-841-2900
(TTY: 1-800-497-4648). They can help you find your PCM agency.

What if I already submitted a form requesting for my PCA to work overtime?

If you already sent in a request to schedule a PCA to work overtime, you will receive a letter from MassHealth with an overtime approval expiration (end) date. You should work with your PCM agency during your approval period to adjust your PCA(s) schedules.

PCA-FAQ (Rev. 11/16) 1

What if I already received an approval for my PCA to work overtime?

If you already received an approval for your PCA to work more than 40 hours per week your approval remains in effect until the expiration date.

What happens after December 2016?

Starting January 2017, MassHealth will fully implement the PCA overtime management rules. We will use the updated criteria to provide Temporary and Continuity of Care approvals. We will offer more tools to support you to find available PCAs.

You may need to adjust your PCA(s) schedules to ensure your PCA is not working more than 50 hours a week by the expiration (end) date on your approval letter. If you do not, you will need to send your PCM agency another form to request approval to schedule one PCA more than 50 hours in one week. You will need to send in the form 15 days before the expiration (end date) of each PCA overtime approval you receive from MassHealth.

What hours does MassHealth count under the PCA Overtime Management?

All hours on a PCA’s activity sheet (timesheet) are counted. If a PCA works for more than one member in a week, hours on each activity sheet (timesheet) are counted.

How do I know if the new PCA Overtime Management affects me?

The new rules affect you if you have a PCA(s) who works more than 50 hours a week providing MassHealth PCA services for you, or for you and other MassHealth members.

If you aren’t sure if the new rules affect you, contact your PCM agency. If you don’t know who to call, please call MassHealth Customer Service Center at 1-800-841-2900
(TTY: 1-800-497-4648). They can help you find your PCM agency.

What is my Personal Care Management (PCM) Agency?

Your PCM is the agency that evaluated you to determine your eligibility for the PCA program. They may have provided you with skills training to hire and work with your PCA. They also conduct annual PCA reviews.

When you contact your PCM, tell them you are calling to speak to your skills trainer about the PCA overtime rules.

What if I don’t know who my PCM is or how to contact them?

Call MassHealth Customer Service at 1-800-841-2900. Select option #1 for MassHealth members, and then select option #2 for PCA related questions. This option will be just for calls about PCA Overtime Management. A Customer Service Representative will look up your PCM and provide you with the name and phone number. The Representative will also call your PCM for you while you are on phone to make sure you get connected.

What if I am in One Care or SCO?

The new PCA overtime rule applies to all MassHealth members, including members in One Care and SCO. Contact your PCM or your One Care or SCO Care Coordinator if you have questions.

How do I find out if my PCA works more than 50 hours?

You will need to talk to your PCA to make sure you both know and understand the new rules.

Even if your PCA does not work more than 50 hours per week for you, you should ask your PCA to make sure s/he lets you know if they work more than 50 hours in any week as a MassHealth PCA. You do not need information about who else your PCA works for. You just need to know if your PCA’s total hours for you and any other MassHealth members adds up to more than 50 hours in a week. If you do not know if your PCA works more than 50 hours per week, contact your PCM agency. If you need help talking to your PCA about this, ask your PCM to help you.

If my PCA works more than 50 hours a week for more than one member, who needs to apply for approval of overtime?

If your PCA works more than 50 hours a week for more than one member, you
(the consumer) must submit a form requesting your PCA be approved to work more than 50 hours in one week. You need to submit the form even if you get less than 50 hours of PCA services a week from that PCA.

What if I need my PCA to work more than 50 hours a week because of an emergency and no other PCA can provide my care?

The new rules do not affect emergency overtime. Contact your PCM agency if you need your PCA to work overtime due to an emergency.

What if I need help applying for PCA overtime?

You can call your PCM agency. They will talk you through the process or also set up a time to meet with you. They can help you fill out the request form.

Or you can call MassHealth Customer Service at 1-800-841-2900 and select option #2. That option will be just for calls about PCA Overtime Management. A Customer Service Representative will look up your PCM and provide you with the name and phone number. The Representative will also call your PCM for you while you are on phone to make sure you get connected.

Where can I get the form to request overtime for my PCA?

• Online at www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/ masshealth-provider-forms.html. You will need to print the form out to complete it. You will need to contact your PCM agency so they can submit it to MassHealth.

• In-person at your PCM Agency. The PCM agency can also mail or e-mail the form to you.

• By telephone by calling MassHealth’s Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648).

Can I get a copy of the form in large print and braille?

Yes. Call MassHealth’s Disability Accommodation Ombudsman at 1-617-847-3468 (TTY: 1-617-847-3788). You can also e-mail MassHealthHelp@ehs.state.ma.us.

How do I fill out the overtime request form?

You can fill out the form yourself. Instructions are included on the form. Send the form to your PCM agency after you fill it out.

Contact your PCM agency if you need help. You can meet with your PCM Skills Trainer in-person, or they can help you over the phone.

Your PCM agency will send the filled-out form to MassHealth for you.

How long will it take to get an answer about my request to schedule my PCA more than 50 hours per week? 

Your PCM will check your form and send it to MassHealth within 1 business day of getting the filled-out form.

MassHealth will make a decision within 2 business days of getting your filled-out form. Your PCM agency will call you within 1 business day of MassHealth’s decision. MassHealth will also mail you a letter that explains the decision.