Provider Eligibility

(A) Provider Qualifications. (1) Personal Care Attendants. To provide personal care attendant (PCA) services described in 130 CMR 422.411(A) and the service agreement established pursuant to 130 CMR 422.423, the PCA must (a) be legally authorized to work in the United States; (b) not be on the List of Excluded Individuals and Entities as provided by the Office of Inspector General of the U.S. Department of Health and Human Services, or other applicable lists excluding individuals or entities from participating in MassHealth under state or federal law; (c) have a current and valid PCA provider number; (d) be employed by a member to provide PCA services. To be eligible to be employed by a member to provide PCA services, a PCA must 1. not be a family member, as defined in 130 CMR 422.402; 2. not be the member’s surrogate or administrative proxy; 3. not be the member’s foster parent; 4. be at least 16 years of age; 5. be physically able to perform the tasks they are being hired to perform by the member or the member’s surrogate; 6. be able to understand and carry out directions given by the member or the member’s surrogate; 7. be willing to receive training and supervision in all PCA services provided by the member or the member’s surrogate; 8. not be receiving compensation from any other person or entity for that activity time; and 9. enter into a PCA provider agreement to perform PCA services. (2) Providers of Transitional Living Services. To provide transitional living services described in 130 CMR 422.431 through 422.441, the organization must (a) submit a proposal for review by the MassHealth agency in accordance with MassHealth’s proposal requirements; (b) obtain written authorization from the MassHealth agency to become a MassHealth provider of transitional living services; (c) demonstrate the appropriate licensure or program accreditation by a recognized body for the provider’s type of program; and (d) obtain a MassHealth provider number. (B) Scope of Services. (1) Personal Care Attendants. Individuals who provide PCA services must provide services in accordance with 130 CMR 422.000 and the scope of services described under 130 CMR 422.419(C) and the service agreement established pursuant to 130 CMR 422.423. (2) Transitional Living Services. Organizations that provide transitional living services must provide services in accordance with 130 CMR 422.431 through 422.441, and in accordance with the MassHealth agency’s proposal requirements for transitional living services.