Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

iv

Provider Manual Series (130 CMR 422.000)

Transmittal Letter Date

Personal Care Attendant Services Manual

PCA-27 07/03/26

4. Program Regulations

130 CMR 422.000: Personal Care Attendant Services

422.401: Introduction .............................................................................................................. 4-1 422.402: Definitions ............................................................................................................... 4-1 422.403: Eligible Members ..................................................................................................... 4-6 422.404: Provider Eligibility .................................................................................................. 4-6 422.405: Personal Care Management Agency and Fiscal Intermediary Functions…………. 4-7 (130 CMR 422.406 through 422.409 Reserved) 422.410: Activities of Daily Living and Instrumental Activities of Daily Living .................. 4-9 422.411: Covered Services ..................................................................................................... 4-10 422.412: Noncovered Services ............................................................................................... 4-10 422.413: Payment for PCA Services ....................................................................................... 4-11 422.414: Complex Care Authorization ................................................................................... 4-12 (130 CMR 422.415 Reserved) 422.416: PCA Program: Prior Authorization for PCA Services ............................................ 4-13 422.417: PCA Program: Notice of Approval, Denial, or Modification of Prior Authorization

Request .................................................................................................................... 4-15

422.418: PCA Program: Special Payments ............................................................................ 4-16 422.419: PCA Program: Scope of PCA Services and Personal Care Management

Agency and Fiscal Intermediary Functions ............................................................. 4-19

422.420: PCA Program: Member Responsibilities ................................................................ 4-21 422.421: PCA Program: Personal Care Management Agency Intake and Orientation

and Functional Skills Training ................................................................................ 4-24

422.422: PCA Program: Personal Care Management Agency Operating Procedures ........... 4-26 422.423: PCA Program: Service Agreement ......................................................................... 4-30 (130 CMR 422.424 through 422.430 Reserved) 422.431: Transitional Living Program: Prior Authorization .................................................. 4-32 422.432: Transitional Living Program: Notice of Approval or Denial for Transitional

Living Services ........................................................................................................ 4-32

422.433: Transitional Living Program: Scope of Services .................................................... 4-32 422.434: Transitional Living Program: Administrative Day Rate ......................................... 4-32 422.435: Transitional Living Program: Leaves of Absence .................................................. 4-33 422.436: Transitional Living Program: Staffing Requirements ............................................. 4-33 422.437: Transitional Living Program: Functional Skills Training ....................................... 4-33 422.438: Transitional Living Program: Operating Procedures .............................................. 4-34 422.439: Transitional Living Program: Service Agreement .................................................. 4-35 422.440: Transitional Living Program: Physical Site ............................................................ 4-36 422.441: Transitional Living Program: Emergency Procedures ............................................ 4-36 (130 CMR 422.442 through 422.445 Reserved) 422.446: Recordkeeping Requirements .................................................................................. 4-38 422.447: Billing Responsibility .............................................................................................. 4-38 422.448: Rates of Payment ..................................................................................................... 4-38

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-1

Provider Manual Series (130 CMR 422.000)

Transmittal Letter Date

Personal Care Attendant Services Manual

PCA-27 07/03/26