Arithmetic, not judgment. The evaluator fills in a worksheet, task by task: minutes per episode, episodes per day, days per week. Those three numbers multiply out to minutes per week, the total is divided by 60, and the result is rounded up to the nearest 15 minutes. That is your award.

Which means a vague answer at the evaluation becomes a smaller number on the authorization. If you say bathing takes "a while," somebody has to pick a figure, and it will not be your figure.

What tasks get counted?

The activities of daily living section runs through nine categories, each scored separately for day and for night.

• Mobility, including transfers and repositioning
• Passive range of motion, upper and lower, left and right
• Bathing, including hair washing and the transfers that bathing requires
• Grooming, meaning nail care, oral care, hair and shaving
• Dressing and undressing
• Eating, including tube feeding
• Toileting, including catheter and ostomy tasks
• Assistance with medications, including prefilling, nebulizer, injections and glucometer checks
• Other healthcare needs such as suctioning, tracheostomy care, oxygen, CPAP or BiPAP, and cough assist

For each one the evaluator picks a level of assist from independent, minimum, moderate, maximum or total dependence. Independent scores no time.

Why did the household tasks get left out?

Because somebody legally responsible lives with you. Meal preparation, laundry, housekeeping, shopping and medical transportation are only scored when no legally responsible person lives in the home, or when there are special circumstances. A spouse in the house usually removes that whole section.

When it is scored, it is counted in its own way. Laundry, housekeeping and shopping go in as minutes per week directly. Meals are minutes per day times days per week, adjusted down for home delivered meals and meals eaten out. Medical transportation is annualized, meaning travel and transfer time times appointments per year, divided by 52, which makes a dialysis schedule look very different from four appointments a year.

How is night counted differently from day?

Day and evening means 6 in the morning to midnight. Night means midnight to 6 in the morning, and it is scored on a separate track with better rounding. Night time is rounded up to the nearest whole hour rather than 15 minutes, and the worksheet instructs the evaluator to enter 2 if the need comes to less than two hours.

So a genuine nighttime need is worth describing carefully. Two repositionings and a toileting trip at 3 in the morning is not a footnote, it is its own line with its own hours.

What should I do before the evaluator arrives?

Keep a log for a week. Not a summary, a log. Date, task, what time it started, what time it ended, and whether somebody had to be physically there.

• Count the whole task. A shower is not the minutes under the water. It is getting to the bathroom, undressing, the transfer in, the wash, the transfer out, drying, dressing and getting back.
• Count the bad days, not the good ones. Most people describe their best day to a stranger. The worksheet is asking what help you need, not what you managed on Tuesday.
• Count every episode. Toileting is not once a day. If it is six times, say six times, because the multiplier is doing the real work here.
• Name the equipment. Whether you need a mechanical lift, how you manage stairs, what adaptive equipment is missing. The occupational therapist report on an initial evaluation covers exactly this.

Who does the evaluation?

A nurse or an occupational therapist from your personal care management agency, in your home. On an initial evaluation there is also a separate occupational therapy functional status report covering your chronic conditions, how they affect each activity, your transfers, stair management and equipment needs.

The same visit also records whether you can manage the program yourself or need a surrogate, so that question is coming and it is worth having an answer ready.

The number came back too low. Can I challenge it?

Yes, through your PCM agency first and a MassHealth appeal if that fails. Ask for a copy of the completed worksheet before you do anything else, then look for the specific line that is wrong. An appeal that says the total is too low goes nowhere. An appeal that says toileting was recorded at two episodes a day when it is six, and here is a two week log, is a different conversation.

A reassessment is also the answer when something has genuinely changed. Hours are tied to need, so a new diagnosis, a fall, a hospital stay or a lost piece of equipment are all reasons to ask for another look rather than waiting for the annual one.

What if cueing is the real problem?

Then the hours may not come, and you should know that before the visit rather than after. The program pays for physical, hands on help. Reminding, prompting, supervising and coaching are specifically excluded, which is the most common reason a person who clearly needs help is told they do not qualify. We go through that in detail on what makes you ineligible for PCA hours.

Who can help with this?

Care Remedy is a personal care management agency serving eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. We do the intake, the evaluation, the prior authorization and the skills training, and we will tell you before the visit which of your tasks are likely to score and which are not. Call 781-957-8076 or email pcm@careremedy.com.

Task time limits are set by MassHealth regulation and the state's time for tasks guidelines, and they are updated from time to time.