Can You Have Two PCAs in Massachusetts?

Yes. MassHealth lets you employ more than one PCA and divide your approved hours between them, and if your authorization is large you will have to. No single PCA may work more than 60 hours in a week, and anything above 50 hours in a week needs prior authorization before the shift is worked.

Can I employ more than one PCA?

You can, and most members with a sizeable authorization do. In the PCA program you are the employer. Under 130 CMR 422.420 it is the member, not an agency, who hires, terminates, schedules and trains PCAs, and nothing in that role limits you to one person. Two attendants on a schedule is a normal arrangement, not an exception you have to argue for.

What does take paperwork is each hire and each departure. You have to notify the fiscal intermediary of every PCA's hire date and termination date, and of a PCA's change of address, and each PCA has to meet the program's eligibility requirements before they work a shift.

How many hours can one PCA work in a week?

The limits, under 130 CMR 422.412(K), run like this:

• Up to 50 hours a week with no prior authorization needed
• Between 50 and 60 hours a week only with an approved prior authorization
• More than 60 hours in a week is not allowed at all

So an authorization much above 50 hours a week is the practical reason to bring on a second PCA. Splitting the week between two people keeps you inside the limit without anyone needing an approval at all. The current rules are on the MassHealth PCA overtime policy page.

If you are still waiting to find out how many hours you will get, how MassHealth decides PCA hours explains the time for task method behind the number.

What if my PCA also works for someone else?

The hours add together. The weekly limit follows the PCA across every consumer they work for, not just your household, so a PCA who works 30 hours for you and 25 hours for another member is over 50 hours and needs an authorization. A PCA in that position needs one for each consumer, which means the other member has to file too.

Ask any PCA you are about to hire how many hours a week they already work elsewhere. It is an awkward question and it will save you a suspension later.

How do I split the hours between two PCAs?

However the care actually needs to happen, as long as the total stays inside what MassHealth approved and no one person goes over the weekly limit. Common splits are weekdays with one PCA and weekends with the other, mornings with one and evenings with the other, or a main PCA with a second person covering two fixed days.

Three things to get right from the first week. Put the schedule in writing so both PCAs know whose shift is whose. Make sure each one understands the electronic visit verification requirement and uses it, because that is how their time is recorded and paid. And train each of them yourself on how you want the tasks done, since the plan is yours and they are not interchangeable staff sent by an agency.

More on the employer side of this in the PCA program and what being the employer means.

What happens if a PCA goes over the limit without approval?

It is a program violation, and it counts against both of you. Scheduling a PCA into overtime without an approved authorization breaks the program rules, and after a third violation both the member and the PCA can be suspended or terminated from the program. This is the part families underestimate, usually in a week when someone called out and the remaining PCA quietly covered the gap.

If a gap is coming, file for the authorization before the week starts rather than explaining it afterwards.

How do I request an exception?

You submit a prior authorization request and MassHealth reviews it. Approvals are time limited, typically for a stretch of one to 12 weeks, and the request has to say how long you need and why, with documentation to match the reason. What each reason calls for:

• A PCA working for several consumers at 50 to 60 hours in total needs no supporting documentation
• Time to hire a replacement calls for job ads, termination forms, or proof that a PCA left suddenly
• Travel calls for the travel dates
• A PCA's short term leave calls for a statement from that PCA and the leave dates
• Care after a hospital stay, or hospice, calls for clinical records

There is also a continuity of care route for members with an ongoing intensive need for help with daily tasks, or on hospice, which can be approved for the full length of the authorization rather than a few weeks. It needs records to support it.

Should I hire a second PCA just for backup?

A second attendant already on the schedule is what turns a call out into an inconvenience instead of a day without care.

The program expects something close to it. Under 130 CMR 422.420 the member and the PCM agency together have to establish and keep a current list of available PCAs, for use when an unforeseen event stops the regularly scheduled PCA from working. That list is the backup plan, and it is a requirement rather than a suggestion.

A second PCA who already works a few hours a week knows the house, the routine and the transfers, which a name on a list does not. That is the strongest argument for splitting hours even when your authorization is small enough for one person. See what to do when your PCA calls out for the shorter term fixes.

Where does a PCM agency come in?

Care Remedy is a Personal Care Management agency, so this is the part we do. We handle the intake and orientation, the evaluation, the functional skills training and the paperwork that goes to MassHealth, including the authorization requests described above, and we keep the available PCA list current with you.

What we do not do is employ your PCAs. You hire them, you schedule them, you train them and you can let them go. A PCM agency that tells you otherwise is describing a different program.

Who do I call?

For PCA and PCM questions or referrals, email pcm@careremedy.com or call 781 957 8076. We work with members across eastern and central Massachusetts from offices in Woburn, Brockton and Springfield.

Program rules and hour limits change. Confirm the current limits and what your own authorization allows with MassHealth or with your PCM agency before you change a schedule, and speak to your own doctor about anything clinical.