Can a PCA Be Paid for Overnight Hours in Massachusetts?

MassHealth authorizes PCA hours as time spent physically assisting you with specific daily tasks, so a night is paid for the work that actually happens in it, not for someone sleeping in your home. If your nights involve real tasks, repositioning, toileting, transfers, those minutes belong in your evaluation and can be authorized.

Will MassHealth pay a PCA to sleep at my house?

Not as sleep. The program regulations tie a PCA's time to physical assistance with the activities of daily living and instrumental activities of daily living set out in your evaluation and approved by MassHealth, and a member may employ PCAs for no more than the number of hours authorized. Nothing in that structure pays a person to be present, on call or asleep.

What does get paid is the task. If you are turned twice in the night, need the bathroom at two in the morning, or need a transfer before dawn, that is physical assistance and it counts. So the goal is not to ask for a night shift. It is to get the night tasks counted properly in the evaluation.

How do night time tasks get into my authorized hours?

Through the evaluation and the prior authorization your PCM agency submits. The regulations require prior authorization before PCA services are paid, and the notice you receive states the number of hours MassHealth found medically necessary for each week. Hours past that total are not reimbursed by MassHealth, by the fiscal intermediary or by the PCM agency, so the authorization is the whole ballgame.

The regulations do treat night hours as their own category. The adjustment provision lets a PCM agency ask MassHealth to change the authorized number of hours of PCA services, or of night PCA services, when there is a change in your medical or functional status. If your nights have gotten worse, that is the route. An adjustment request goes in within 30 calendar days and needs a letter from your physician, nurse practitioner or physician assistant.

Write the nights down before the evaluation. Date, time, what was needed, how long it took. An evaluator counts task time, and a diary of eleven real nights does more than a general statement that nights are hard.

Night hours are approved for the hands on tasks in them, which is why the tasks have to be written down.

Can one PCA cover every night of the week?

Not if the nights are long. A PCA is capped at a set number of hours a week across every consumer they work for, including hours worked for someone other than you. MassHealth's current published guidance puts that limit at 60 hours a week. The regulation text republished on some legal websites still shows an older and lower figure, so confirm the number that applies to you with your PCM agency rather than trusting any web page, this one included.

Then do the arithmetic before you build a schedule. Seven ten hour nights is 70 hours in a single week, over the limit before a minute of daytime help. Full week overnight coverage needs at least two PCAs. Hours above the limit have to be authorized in advance, and the grounds are narrow: a temporary need, a long term need for continuity of care, or an emergency, each approved by MassHealth in writing.

What happens if my PCA goes over the limit?

Warnings first, then real consequences. Under MassHealth's published policy a warning notice goes to the PCA and to the consumer after each violation, and a third violation is referred to MassHealth for possible termination. Where that PCA works only for you, both of you can be terminated. A terminated PCA is barred for nine months, and a second termination is permanent. Violations can be removed for genuine emergencies, and after a stretch of compliance.

Regular, overtime, holiday and jury duty hours all count toward the weekly limit. Travel time, paid time off and training hours do not. If a week is going to run long, that conversation with your PCM agency happens before the week, not after the timesheet.

What if I need someone awake all night?

Then you are asking for something the PCA program is not built to pay for, and it is better to know the price than to keep requesting hours. Private pay overnight care is $540 for a twelve hour night, about $16,200 a month if it is every night. Around the clock care is $1,080 a day, about $32,800 a month. Hourly home health aide care is $45 an hour, one to eight hours a day, with no minimum contract.

Many families split it: authorized PCA hours for the tasks, and a few paid hours at the hardest part of the night or the first hour of the morning. 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, help if something goes wrong and call for help.

Can a family member take the overnight hours?

Often yes, with limits worth reading before you plan a schedule around it. Adult children, siblings and friends can be hired as PCAs in many situations. A spouse cannot. Both of those are their own subject and we have written them up separately.

What do I do if my PCA calls out at eleven at night?

Have a backup list that exists on paper before the night you need it, with names and numbers you have actually called. The overtime rules expect you to have tried your other PCAs first, so the list is not only practical, it is what an emergency request rests on.

Related reading

• How MassHealth Decides How Many PCA Hours You Get, which is where night tasks are won or lost.
• PCA Backup Plan in Massachusetts: When Your PCA Calls Out
• Can a Spouse Be a Paid PCA in Massachusetts?

Who to call

Care Remedy is a MassHealth Personal Care Management agency with offices in Woburn, Springfield and Brockton. For PCA and PCM questions, including an evaluation that missed your night hours, email pcm@careremedy.com. For home health aide care or transportation, call 781 957 8076.

This page is general information about a state program, not legal or medical advice. Your own hour total, limits and conditions come from your evaluation and from MassHealth. Confirm anything here with your PCM agency or MassHealth before you rely on it.