Noncovered Services

MassHealth does not cover any of the following as part of the PCA program or the transitional living program: (A) social services, including, but not limited to, babysitting, respite care, vocational rehabilitation, sheltered workshop, educational services, recreational services, advocacy, and liaison services with other agencies; (B) medical services available from other MassHealth providers, such as physician, pharmacy, or community health center services; (C) assistance provided in the form of cueing, prompting, supervision, guiding, or coaching; (D) time when a PCA is not providing assistance with ADLs or IADLs; (E) PCA services provided to a member while the member is a resident of a nursing facility or other inpatient facility, or a resident of a provider-operated residential facility subject to state licensure, such as a group home; (F) PCA services provided to a member during the time a member is participating in a community program funded by MassHealth including, but not limited to, day habilitation, adult day health, adult foster care, or group adult foster care; (G) services provided by family members, as defined in 130 CMR 422.402; (H) surrogates and administrative proxies, as defined in 130 CMR 422.402; (I) PCA services provided to a member without the use of EVV as required by the MassHealth agency; (J) required parental responsibilities for children younger than 18 years of age as indicated by the child’s developmental milestones, as detailed in the operating standards; and (K) personal care services provided by a PCA that exceed 60 hours per week in the aggregate.