PCA Overtime Policy Information

 

Introduction to the Overtime Policy

First, it is important for you to understand that the total amount of PCA hours that you are authorized to receive WILL NOT CHANGE.

The change is that you as the consumer/employer will need approval from MassHealth before scheduling your PCA to work overtime, and your Skills Trainer can assist you in requesting this approval.

If your PCA works more than 40 hours a week for you, or for both you and another MassHealth member, you will either need overtime approval from MassHealth or you will need to adjust your PCA(s) schedule(s) or, hire an additional PCA (or PCAs).

MassHealth will issue Overtime Approval in one of the following cases:

  1.  You are authorized to schedule between 40 and 60 hours per week of PCA Service and you live with your PCA who provides all your care.
  2.  You will need to apply for overtime approval once a year at the same time you receive prior authorization for services.
  3. You need additional time to hire another PCA to ensure continuity of care, so that your care is not interrupted while you look for and hire additional PCAs.
  4. You will need to apply for a Continuity of Care exception, which is a short-term approval for an eight (8) week period.
  5. Subsequently, all approved Continuity of Care exceptions will be authorized for 12 weeks.
  6. If you need more time, you can re-submit for another Continuity of Care, which you must submit to your PCM at least 15 days prior to the end of your existing Continuity of Care overtime approval.

As your PCM Agency, we will:

  • Explain the new regulations to you and help you understand if the regulations affect you
  • Assist you in filling out the overtime request form, should you need it
  • Submit the completed overtime authorization form to MassHealth for review
  • Notify you of MassHealth’s decision of your overtime request
  • Provide Skills Training to you to help you understand the new regulations
  • Provide Skills Training to you to help you recruit and hire additional PCAs
  • Notify you when your overtime authorization is going to expire

 

OVERTIME REQUEST FORM AND PROCESS

You have the following options for obtaining the Overtime Request Form and Instructions:

  1. The form is available online on the MassHealth website:
    http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/pca-oaf.pdf
  2. The form is available in person at PCM Agencies or we can mail or email the form to you, or we can schedule a time for your FST to come to you
  3. The form can is also available on your Fiscal Intermediaries website.

Filling out the overtime request form:

  • You can fill out the form yourself; instructions are included on the form
  • If the instructions do not answer your question(s) or if you require assistance completing the form, contact your Skills trainer here at your PCM Agency
  • Your Skills Trainer can meet with you to assist you in completing the form
  • Your Skills Trainer can assist you in filling out the form over the phone, but you will still need to sign it in order to submit it to MassHealth

Once the overtime request form is completed:

  • Mail the form and related documents (if any) to your PCM agency
  • Or, Fax the form and related documents (if any) to your PCM agency
  • Or, Bring the form and related documents (if any) to your PCM agency
  • Or, you can schedule a time for your PCM agency to come to you to pick up the form and related documents (if any)
  • Or you can scan and email the completed form and related documents (if any) to your PCM agency

Your PCM Agency will:

  • Review and submit the completed form to MassHealth within 1 business day of receiving your completed form.
  • MassHealth will receive your form and make a determination on your request within 2 business days of receiving your completed form.
  • Your PCM agency will contact you via phone within 1 business day of MassHealth’s decision. MassHealth will also mail a letter informing you of MassHealth’s decision to your home.

Approvals:

  • If you received a one to one living situation overtime authorization, you must:
  • Request approval to schedule overtime on an annual basis at the same time you receive prior authorization for services
  • Notify your Fiscal Intermediary if you hire additional PCAs, or your living situation changes.
  • If you receive a short term Continuity of Care authorization, you must:
  • Recruit and hire additional PCAs during the period of the Continuity of Care authorization
  • If you have either kind of approval to schedule your PCA to work overtime, you must ensure that you do not schedule your PCA for more than the number of MassHealth authorized PCA hours.
  • For example, if your PCA authorization is for 35 day and evening hours and 15 night hours, you must make certain your PCA does not work more than 50 hours per week.

Denials:

  • If you are denied for your PCA to work overtime you must:
  • Recruit and hire additional PCAs. Organize your schedule so that no one PCA is working more than 40 hours a week for you.
  • Should you wish to appeal, work with your PCM Agency to understand your appeal rights, which are heard by the Board of Hearings.
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