Request Emergency Overtime

A consumer may request authorization to schedule a PCA to work in excess of 10 hours of overtime in a single week under certain circumstances. When authorizing a consumer to schedule a PCA to work overtime in excess of 10 hours, MassHealth will review the consumer’s request and, if approved, will provide either a temporary authorization of up to 12 weeks or a continuity of care authorization for the duration of the consumer’s prior authorization period. MassHealth will use health and safety guidelines in making approval determinations.

Described below are the circumstances under which MassHealth will approve overtime in excess of 10 hours in a single week.

TEMPORARY APPROVAL


A consumer may request a Temporary approval to schedule a PCA to work overtime when:

  • The consumer has a temporary need to schedule one PCA to work overtime hours, including:
  • The consumer has planned travel, and it would not be feasible to bring multiple PCAs to provide the consumer’s PCAs services.
  • The consumer’s PCAs is temporary unavailable (e.g. vacation, winter break, family leave).
  • The consumer has a temporary need to schedule their PCA to work additional approved PA hours. (e.g. post-acute hospitalization)
  • The consumer’s PCA works greater than 66 hours per week and the Consumer needs time to hire additional PCAs.

Requests for a temporary approval must include the specific reason(s) for such request.

CONTINUITY OF CARE APPROVAL

A consumer may request a continuity of care approval to schedule a PCA to work overtime when:

  • The consumer has complex medical needs that require the specialized skills of the experienced PCA.
  • The consumer has communication barriers that require the specialized skills of the experienced PCA.
  • The consumer has specialized medical conditions that necessitate fewer PCAs. Examples might include circumstances in which additional PCAs in the consumer’s home would compromise the consumer’s health due to a highly compromised immune system, or a circumstance in which a consumer has significant cognitive impairments or behaviors that impact safety, and that the hiring additional PCAs would cause disruption in security, health and/or safety to the consumer.
  • The consumer receives Hospice care.
  • The consumer’s PCA has worked with the consumer for 5 or more years.

Continuity of care approvals are for the duration of the consumer’s Prior Authorization.Continuity of care Approvals must be resubmitted for subsequent Prior Authorization periods. Requests for continuity of care Approvals must include the specific reason(s) for such request. If a PCA works greater than 66 hours per week, the consumer must apply for a Temporary Authorization. Please see MH Overtime Request form