Stavros has put together a list of common questions people ask about the PCA Program that will help you become familiar with the rules and requirements of the PCA Program. Please take time to review the questions and answers, and contact your Stavros Skills Trainer should you have any questions about this information. Your skills trainer will be reviewing much of this information with you during your PCA Orientation process.
What is the MassHealth PCA program?
The MassHealth PCA program is a “consumer-directed” program funded by MassHealth (Medicaid) that helps people with permanent or chronic disabilities maintain their independence, remain in their communities, and manage their own personal care by providing funds to hire personal care attendants (PCAs). The PCA consumer (the person receiving PCA services) is the employer of the PCA, and is fully responsible for recruiting, hiring, scheduling, training, and, if necessary, terminating PCAs.
What are the eligibility criteria for the PCA program?
To be eligible to receive PCA services, you must:
- Have MassHealth Standard or CommonHealth coverage
- Have a disability that is permanent or chronic that prevents you from performing your Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs) without physical assistance.
- Require physical assistance with two or more of the following Activities of Dayling Living (ADLs):
- mobility, including transfers
- range of motion exercises
Have a prescription from your physician or nurse practitioner for PCA services. Your Primary doctor and/or Nurse practitioner must be enrolled on the Masshealth network
Obtain prior authorization for PCA services from MassHealth
Stavros can provide you with more information about the eligibility criteria, and will assist with submitting your application for PCA services to MassHealth should you meet this criteria.
What are Instrumental Activities of Daily Living (IADLs)?
Individuals who meet the criteria to receive PCA services can also receive physical assistance with IADLs, if authorized by MassHealth. IADLs include household management tasks, such as laundry, shopping, and housekeeping; meal preparation and clean-up; transportation to medical providers; care and maintenance of adaptive devices, such as wheelchairs; assistance with completing PCA paperwork; and other special needs as determined instrumental to the health care of the individual.
I only need help with IADLs, not ADLs, Can I still get PCA services?
No. As described above, you must have a chronic disability that requires you to have physical assistance to complete Activities of Daily Living. If you need physical assistance with two or more ADLs, then you can qualify to receive assistance with IADLs. Please note that if you qualify for PCA services and live with family members, MassHealth expects family members, not PCAs, to provide assistance with most of your IADLs, such as routine housekeeping, shopping, and meal preparation.
Who decides if I am eligible for PCA Services and how many hours per week or per night of PCA services I will receive?
A Registered Nurse (RN) from Stavros PCM Agency will visit you in your home to conduct an Evaluation of your need for PCA services. If this is your first PCA Evaluation, an Occupational Therapist will also conduct a functional assessment. 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. 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. You, and your Surrogate if appropriate, will also be asked to sign the PCA Evaluation. Stavros will then request prior 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, 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). Stavros will need to re-evaluate you before the end date of your prior authorization 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.
What does “consumer-directed” mean?
For purposes of the PCA program, “consumer-directed” means that you, the PCA Consumer, are the employer of your PCAs and are fully responsible for managing your PCA program, including recruiting, hiring, scheduling and supervising your PCAs, as well as ensuring all required PCA paperwork is completed accurately and submitted to the PCM Agency or Fiscal Intermediary in the timeframes requested, including PCA Activity Forms (timesheets).
What if I am not capable of managing my PCA program on my own?
Stavros is required by MassHealth to conduct a face-face Consumer Assessment of your ability to manage your PCA services independently. If the Assessment determines that you need help to manage some or all your PCA services, you will be asked to identify someone to be your Surrogate. Your Surrogate cannot also be your PCA. Generally a Surrogate is a family member or friend. Your Skills Trainer can brainstorm ideas with you to find a Surrogate. If you are unable to identify a Surrogate, you will not be able to participate in the PCA program, and your Skills Trainer will provide you with a list of other resources that may be able to help you.
What does a Surrogate do?
Your responsibilities and those of your Surrogate (if you need one) are described in your PCA Service Agreement. The Service Agreement is a document required by MassHealth that describes the responsibilities of all parties involved in assisting you to manage your PCA program, including you, your Surrogate, Stavros , and Stavros Fiscal Intermediary. Stavros will work with you and your Surrogate, if any, to develop this document, which you and your Surrogate, if any, must sign.
Who can I hire as my PCA?
MassHealth is fairly flexible on who you can hire to be a PCA. However, some rules do apply.
- Be legally authorized to work in the Unites States
- Have a current and valid PCA provider number (issued by the Fiscal Intermediary)
- Be employed by the Consumer and have completed all necessary paperwork required by the FI
- Be able to understand and carry out directions given by the Consumer or the Surrogate
- Be willing to receive training and supervision in all PCA services provided by the Consumer or Surrogate, including the PCA New Hire Orientation;
- Be named on the Office of Inspector General (OIG) List of Excluded Individuals or Entities (LEIE) or any other list that excludes individuals from being paid by Medicare or Medicaid
- Be a family member as defined by MassHealth regulations (i.e. a spouse; parent or adoptive parent of a Consumer who is a minor child; or any legally responsible relative)
- Be the employer’s (Consumer’s) Surrogate
- Be the employer’s (Consumer’s) foster parent
- Be receiving payment from any other person or entity during the hours worked for the Consumer.
- Be paid if the Consumer is in a nursing facility or other inpatient facility; if the Consumer is also receiving AFC or GAFC services; or during the time a Consumer is attending a MassHealth day program such as Adult Day Health or Day Habilitation.
Your Skills Trainer can talk with you about things to consider when recruiting and hiring PCAs.
Does Stavros have, or can they recommend, PCAs to work for me?
No. Stavros does not hire PCAs and is not permitted to recommend PCAs.
What type of work can my PCA do for me?
PCAs can be paid to provide you with physical assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) as described in your PCA Evaluation and as authorized by MassHealth. Stavros will provide you with a copy of your completed PCA Evaluation and work with you to determine what tasks your PCA can, and cannot, assist you with. These tasks will be identified in your Service Agreement.
PCAs CANNOT be paid to work for you if:
- You are in a hospital or nursing facility
- You are attending a MassHealth-funded adult day health or day habilitation program
- You are receiving MassHealth adult foster care (AFC) or Group Adult Foster Care (GAFC) services.
PCAs CANNOT be paid to provide you with help in the form of cueing, prompting, supervision, guiding, or coaching.
Who pays my PCA?
Stavros Fiscal Intermediary is responsible for receiving and processing your PCA Activity Forms (Timesheets), and for issuing PCA payment. Effective January 1, 2017, all PCAs are paid through direct deposit and the FI will issue payment electronically to the PCA’s bank or debit account. Consumers will receive the payroll register for “regular time” worked by the PCA. Payment for overtime, earned sick time, and travel time is made directly to the PCA, and not reflected in the payroll registers the Consumer receives.
Who decides how much my PCA gets paid?
The amount PCAs are paid is determined by a collective bargaining (union) agreement (CBA). In the collective bargaining negotiations, PCAs are represented by the Union (1199SEIU) and Consumers are represented by the PCA Quality Home Care Workforce Council (the Council). Your Skills Trainer or FI can tell you what the current PCA wage is.
Can my PCAs get paid overtime?
Yes, but only under certain conditions. Your Skills Trainer will provide you with more information on overtime during your Orientation process.
Does my PCA receive any other paid benefits?
Yes. PCAs are eligible for earned sick time. Your Skills Trainer will provide you with further information on earned sick time, how it is accrued, how many hours can be earned, and how to complete the “earned sick time” timesheets.
What does Stavros Personal Care Management (PCM) Agency do?
Stavros contracts with MassHealth to provide Personal Care Management (PCM) services to Consumers to help them apply for and manage their PCA services. As your PCM Agency, Stavros will:
- Provide you with skills training to instruct you in the rules and regulations of the PCA program and your responsibilities as a PCA Consumer;
- Assess your ability to manage the PCA Program independently;
- Evaluate your eligibility and need for PCA services and submit your prior-authorization requests for PCA services to MassHealth;
- Provide you with ongoing skills training to help you manage the PCA Program successfully; and
- Work with you to develop a written Service Agreement that describes your role and responsibilities, as well as those of your Surrogate (if any), your PCA, your PCM Agency, and your Fiscal Intermediary. The Service Agreement includes developing an emergency back-up plan and identifying people you can call if your regularly scheduled PCA is unable or unavailable to work for you.
What does Stavros Fiscal Intermediary (FI) do?
Stavros Fiscal Intermediary (FI) contracts with MassHealth to help you with many of the required tasks of employing a PCA. With the assistance of the FI, you will be able to pay your PCAs with MassHealth funds, and fulfill your state and federal employer obligations. As your Fiscal Intermediary, Stavros FI will:
- Obtain your Employer Identification Number (EIN) from the government;
- Assign an identification number to your PCA;
- Receive and process your PCA Activity Forms (also called time sheets);
- Pay your PCA via direct deposit to the PCA’s bank or debit account;
- Send you payroll registers for “regular time” worked by your PCA;
- File and pay your share of state and federal taxes, including unemployment;
- Deduct and pay PCA union dues, if your PCA joined the Union;
- Buy workers’ compensation insurance for your PCA; and
- Withhold PCA taxes and issue a W-2 to your PCA.
What if I disagree or have a complaint about PCM services provided by Stavros?
You have the right to file a complaint or grievance with Stavros if you disagree with decisions made by Stavros or if you have a complaint regarding services provided by Stavros. Your Skills Trainer will provide you with a copy of Stavros’ Complaint and Grievance Procedures, which describes the process for filing a complaint or grievance with Stavros.
Who do I call if I have questions about the PCA program?
Call the1-800-804-1899 number at Stavros if:
- You have questions about your PCA evaluation or reevaluation;
- You have questions about your prior authorization;
- Your medical condition changes and you feel you need more or fewer PCA hours;
- You want to request prior authorization for your PCA to be paid overtime;
- Your PCA has jury duty when scheduled to work for you;
- You are having trouble managing the PCA Program;
- You don’t understand your responsibilities;
- You have questions about certain PCA Program rules or regulations;
- Your Surrogate information has changed;
- You have moved or have a new telephone number;
- You disagree with your PCA Evaluation, Service Agreement, or Consumer Assessment;
- You need a Skills Trainer to visit you; or
- You have questions about how to recruit, hire, or schedule PCAs.
Call the Stavros Fiscal Intermediary number1-800-442-1185 if:
- You need more Activity Forms (timesheets) or other PCA paperwork. (Most FI forms are available on the Stavros FI website at http://www.stavrosfi.org/
- You would like to complete Activity Forms (timesheets) electronically;
- You have hired or fired a PCA, or your PCA has quit;
- You have questions about overtime or earned sick time;
- You have questions about the PCA New Hire Orientation Program;
- You have moved or have a new phone number, or your PCA has moved or has a new phone number;
- You believe your PCA was not paid correctly;
- You need to correct an activity form you submitted;
- You have other related payroll questions.
Who can I call with other questions related to the management of my PCA program, such as questions about labor laws?
Please refer to list of Helpful Telephone Numbers in this webside. We provide you with contact information and links that may be of interest to you as a participant in the PCA program and employer of PCAs.