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Get Ready For Your PCA Evaluation

Get Ready for Your PCA Evaluation

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Information and Referral Department at Stavros is responsible for taking your initial call for PCA services. They are responsible to gather basic information and refer you for assignment of an Intake Specialist.

The Intake Specialist will meet with you in person to provide you with basic information about the PCA program and determine if you meet criteria for PCA Services.  If the Intake Specialist determined that you meet the criteria for PCA services, a referral for an initial PCA Evaluation and PCA Orientation will be completed.

The PCA evaluation helps Stavros determine how many hours per week and per night you require physical assistance from a PCA to complete your ADLs and IADLs. Evaluation time will be based on your need for hands-on care. You, and your Surrogate if appropriate, will also be asked to sign the PCA Evaluation

Stavros may obtain other medical documentation as needed during the evaluation process. Once completed, your Evaluation must be sent to your physician or nurse practitioner for review and signature. Stavros will then request an authorization from MassHealth by sending your completed and signed PCA Evaluation and any other supporting documentation to MassHealth.

MassHealth has 21 days to review the documentation and makes the final decision to approve, modify, or deny your request for PCA services. MassHealth will provide written notice to you, Stavros PCM agency, and Stavros fiscal intermediary (FI) of its decision.Your notice from MassHealth will include the number of PCA hours per week or per night (midnight to 6:00 AM) MassHealth has authorized, as well as the start and end dates of your prior authorization (PA).

Your PCM Agency will need to re-evaluate you before the end date of your PA and submit a new request to MassHealth to continue your PCA services. You have the right to appeal MassHealth’s decision if you disagree with MassHealth’s decision to deny or modify your request.

Meanwhile you are going to be assigned to a skill trainer who is going to give you orientation and instruction on your rights and responsibilities as a PCA consumer, the rules, regulations, and policies governing the PCA program.

The skill trainer will be responsible will be conducting a Consumer Assessment to determine the your ability to manage PCA services independently and to develop with you PCA Consumer Service Agreement where you can find the roles and responsibilities of all parties involved in your PCA services

Initial PCA Evaluation

Both consumer and surrogate (if one is necessary) need to be present at your initial evaluation. The initial PCA evaluation needs to be completed in person at consumer’s home but can be completed at an inpatient facility (nursing home, rehab), should the consumer have a discharge date.

Please have all current medication bottles available, not a list. Exception: if your medications are in a locked box or are being provided by a home care nurse, you will need to have a list available for the nurse.

PCA Reevaluation

PCA reevaluation is completed by a register nurse to ensure PCA services continue to be medically necessary, to determine the number of PCA hours for which the Consumer may be eligible, and to ensure Re-evaluations are completed in a timeframe that facilitates the submission of PA requests to MassHealth.

If you and your Surrogate are unable to be reached for your PCA Re-evaluation, you may have a lapse in your PCA services. Evaluation time will be based on your need for hands-on care.