Personal Care

(A) Conditions of Payment. (1) Personal care services are covered when the participant requires a range of assistance with ADLs related to independent living and when the personal care service enables the participant to function with greater independence within the participant’s home and community. Personal care services under an HCBS waiver may include supervision and cuing of participants. Personal care services may also include assistance with IADLs. Personal care services provided under an HCBS waiver may not duplicate personal care services provided under the state plan. (2) MassHealth authorizes the following types of payments to Direct Care Workers providing self-directed waiver personal care services to MFP-CL waiver participants: (a) holiday rate determined in accordance with 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program and 101 CMR 359.00: Rates for Home and Community-Based Services Waivers for activity time performed at the times and on the holidays authorized pursuant to 101 CMR 309.00 and 130 CMR 422.000: Personal Care Attendant Services. (b) completed new hire orientation payment in accordance with 101 CMR 309.00 and 101 CMR 359.00 and pursuant to a collective bargaining agreement effective in accordance with M.G.L. c. 118E, § 73, and c. 150E. (B) Nonpayable Services. Homemaker, home health aide, personal care, adult companion, individual support and community habilitation, and supportive home care aide services, in combination are limited to no more than 84 hours per week. The MassHealth agency or its designee may grant exceptions to the limit on a 90-day basis in order to maintain a participant’s tenure in the community, to provide respite to a caregiver who lives with the participant, to facilitate transitions to a community setting, to ensure that a participant at risk for medical facility admission is able to remain in the community, or to otherwise stabilize a participant’s medical condition. Exceptions may also be granted for participants awaiting transition to a residential waiver. Exceptions to the 84 hour per week limit must be included in the participant’s waiver plan of care.