1. (A) Personal Care Management Agencies.

   1. (1) Personal Care Management Agency Functions. Organizations that contract with the MassHealth agency to provide PCM agency functions must perform the range of functions specified in the PCM agency contract and contained within 130 CMR 422.000. Such functions include, but are not limited to, those described in 130 CMR 422.419(A).
   2. (2) Selecting a Personal Care Management Agency. The member selects the PCM agency from the PCM agencies under contract with MassHealth to perform this function. The PCM agency selected by the member will conduct the PCA evaluation and provide PCM functions to the member.

   3. (3) Reassignment to a Personal Care Management Agency. The MassHealth agency may reassign a member to another PCM agency selected by the MassHealth agency, if, in the sole determination of the MassHealth agency, the PCM agency selected by the member

      1. (a) becomes unavailable for any reason;
      2. (b) is unable or unwilling to provide PCM functions pursuant to the requirements set forth in 130 CMR 422.000; or
      3. (c) is not in compliance with its obligations as set forth in its contract with the MassHealth agency.
   4. (4) An organization may apply to the MassHealth agency to become a PCM agency only during the time that the MassHealth agency opens a request for responses for PCM functions.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-8

Provider Manual Series (130 CMR 422.000)

Transmittal Letter Date

Personal Care Attendant Services Manual

PCA-27 07/03/26

1. (B) Fiscal Intermediary.

   1. (1) Fiscal Intermediary Functions. The organization that contracts with the MassHealth agency to provide fiscal intermediary functions must provide such functions in accordance with the fiscal intermediary contract and with 130 CMR 422.000. Fiscal intermediary functions must include, but are not limited to, those described in 130 CMR 422.419(B).
   2. (2) PCM Agencies and the Fiscal Intermediary. PCM agencies that do not exclusively provide transitional living services under 130 CMR 422.431 through 422.441 must work with the fiscal intermediary selected by the MassHealth agency for all eligible MassHealth members that the PCM agency serves.

   3. (3) Reassignment to a Fiscal Intermediary. The MassHealth agency may reassign PCM agencies to a fiscal intermediary selected by the MassHealth agency, if, in the sole determination of the MassHealth agency, the fiscal intermediary selected by such PCM agency

      1. (a) becomes unavailable for any reason;
      2. (b) is unable or unwilling to provide fiscal intermediary functions pursuant to the requirements set forth in 130 CMR 422.000 and 130 CMR 450.000: Administrative and Billing Regulations; or
      3. (c) is not in compliance with its obligations as set forth in its contract with EOHHS.
   4. (4) An organization may apply to the MassHealth agency to become a fiscal intermediary only during the time that the MassHealth agency opens a request for responses for fiscal intermediary functions.

(130 CMR 422.406 through 422.409 Reserved)

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-9

Provider Manual Series (130 CMR 422.000)

Transmittal Letter Date

Personal Care Attendant Services Manual

PCA-27 07/03/26