Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 422.000 - Personal Care Attendant Services
Section 422.412 - Non-covered Services
Current through Register 1531, September 27, 2024
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) 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;
(E) 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;
(F) services provided by family members, as defined in 130 CMR 422.402;
(G) surrogates, as defined in 130 CMR 422.402; or
(H) PCA services provided to a member without the use of EVV as required by the MassHealth agency.
