PCA Eligibility

You must:
1. Currently receive MassHealth benefits (Standard or Commonhealth).
2. Have a referral for PCA services from your physician. (If necessary, we will help expedite this form.)
3. Live in a home environment.
4. Have a chronic or permanent disability that impairs your functional ability.
5. Require physical assistance with at least two Activities of Daily Living (ADLs), which include mobility and transfers; medications; bathing/grooming; dressing; range-of-motion exercises; eating; and toileting.

• A Physician’s Summary will be requested to ensure that this program is needed and agreed to by your physician. A Functional Skills Trainer (FST) will then visit you to determine eligibility and outline the program. The FST will provide training in all program areas.

• After the initial visit, an evaluation will be conducted by a Registered Nurse and an Occupational Therapist. Your physician will also be expected to sign off on the evaluation/care plan conducted by the RN and OT.

• Prior Authorization will be requested from MassHealth. Once approved for the program, your information will be sent to the Fiscal Intermediary (FI). The FI will then begin to generate a personnel file for you. They will write the checks that you will use to pay your PCA workers.

• The FST will notify you when you have been approved by DMA. IMPORTANT—This can take up to three months to receive. The FST will again visit you to offer further training on the PCA program, as well as provide a program manual. This manual will include all the paperwork you will need to manage your PCA workers and other resources that might be helpful. Quarterly visits will be scheduled by the FST during the first year, and then as needed or as requested.

Contact Tri-Valley for further information.