What is the Consumer Service Agreement

The MassHealth Personal Care Attendant Program requires the Personal Care Management (PCM) agency to develop a PCA Service Agreement with the consumer and the surrogate (if any). The PCA Service Agreement is an important part of the consumer’s plan of care while participating in the PCA program and will be developed based on the consumer’s individual needs.

The PCA Service Agreement describes the roles and responsibilities of the PCA consumer (and those of the surrogate, if any), including the consumer’s role as an employer of PCAs. The PCA Service Agreement also describes the roles and responsibilities of the PCA, PCM agency, and fiscal intermediary (FI).

This agreement will be reviewed and modified as appropriate:

• at the time of the consumer’s reevaluation for PCA services;
• quarterly (every three months) when the consumer is in the first prior-authorization year;
• quarterly when it is the first year that the consumer has a new surrogate;
• when the consumer is not managing PCA services effectively, then quarterly thereafter;
• when the consumer, EOHHS, or the FI requests a review; or
• when there is a significant change in the consumer’s circumstances that affects the consumer’s PCA services

The purpose of the consumer service agrement is to ensure that Consumers and Surrogates understand their roles and responsibilities in managing the PCA program, as well as those of the PCA, the FI, and Stavros PCM Agency; to develop a PCA emergency back-up plan; to identify the type and frequency of skills training the Consumer and Surrogate (if any) will need to successfully manage the PCA program; and to review and modify the Service Agreement in accordance with MassHealth requirements.