Can My PCA Drive Me to Medical Appointments in Massachusetts?

The MassHealth PCA regulation pays for accompanying you during transportation to and from medical providers. It does not pay anyone to supply a vehicle, and it says nothing about mileage. So your PCA can go with you and be paid for that time, but whose car you ride in, and who pays for the gas, is a separate arrangement the program does not fund.

Is transportation actually a paid PCA task?

Yes. Transportation appears in the regulation at 130 CMR 422.410 as one of the instrumental activities of daily living, alongside household services, meal preparation and clean up, and special needs. The wording is specific though. It describes accompanying the member during transportation to and from medical providers. It does not say driving, and it does not use the word escort. That distinction is the whole answer to this question.

So can my PCA use their own car to take me?

The regulation does not address it, which means the program neither authorizes nor funds the vehicle. If your PCA drives you in their own car, that is a private arrangement between the two of you. Nothing in the rules provides mileage reimbursement, gas money or insurance coverage for it. Ask your PCM agency how your own case is handled before you assume anything, because the time your PCA spends on the trip and the car they do it in are two different questions.

Accompanying a member to an appointment is a paid task. Providing the car is not part of it.

What tasks can PCA hours be used for?

The regulation splits them into two groups. The activities of daily living are mobility, assistance with medications or other health related needs, bathing or grooming, dressing, passive range of motion exercises, eating and toileting. The instrumental activities are household services, meal preparation and clean up, transportation and special needs. Hours are only authorized for tasks on that list, and how many minutes each task earns is set by the time for task standard. We cover that in how MassHealth decides how many PCA hours you get.

Can my PCA be paid while I am at the appointment?

Ask your PCM agency, because the regulation does not spell this out. What it does spell out is where PCA services are excluded. Services are not covered during a nursing facility stay, and not covered during a MassHealth funded community program such as day habilitation or adult day health. Those exclusions are worth knowing before you build a week around them. Your PCM agency is the right place to settle how a specific appointment should be recorded on a timesheet, and in the PCA program you are the employer, so the timesheet is ultimately your responsibility.

What if I cannot get into a regular car?

Then the ride itself is the problem and your PCA hours will not solve it. Try the free routes first:

• Ask the medical provider to submit a PT-1 request. For MassHealth members this is the route to covered rides to covered appointments, and it exists precisely so that transport is not paid for out of your PCA hours. See free rides to medical appointments.
• Call the town Council on Aging, which often runs a van for medical trips at low or no cost.
• Ask the clinic whether it has a patient navigator or social worker who knows the local ride programs.

If those do not cover it, our wheelchair accessible transportation is $115 each way and $230 round trip within five miles, then $2 a mile beyond that. You stay in your own chair, secured with a four point tie down. For a home with steps and no ramp, stair assistance is $200 a visit with two trained staff and an electric stair chair. Call us for the chair's rated weight capacity. None of that is billed to your PCA hours, and if a free program can do the trip instead, use the free program.

Can I use a home health aide for the appointment instead?

You can, privately, at $45 an hour, one to eight hours a day, with no minimum contract, no assessment fee and no four hour minimum per visit. Families use this when the PCA is unavailable or when the appointment runs long. Our aides are trained, background checked and insured, and they are not nurses. They do not administer medication, including insulin, do not change dressings and do not make clinical judgments. They can be present while you manage your own medication and call for help if something goes wrong.

Who do I ask about my own case?

Your personal care management agency. Care Remedy is a MassHealth personal care management agency, and PCA and PCM questions go to pcm@careremedy.com. For transportation or home health aide care, call 781 957 8076 or email info@careremedyinc.com. We work from offices in Woburn, Springfield and Brockton.

This page describes the PCA regulation at 130 CMR 422.000 as published by MassHealth. Regulations are revised, and how a rule applies depends on your own authorization, so confirm anything that affects your hours with your PCM agency or MassHealth directly rather than relying on a web page. For medical questions, ask your own doctor.