It is extremely important to make sure that the PCA(s) that you have hired are never working more hours than you have approved each week by your insurance.
What will happen if I submit a timesheet and my PCA worked more hours than what I currently have approved?
You will not have those hours at the end of the authorization period, meaning you will be short those hours and once you are out of hours, the new hours will not begin until the new authorization year begins.
Will my PCA get paid for the hours they work if they work for more hours than I am approved?
Most of the time the PCA will be paid, however it is not always guaranteed. There are many consequences to overusing, which include running out of hours before the end of the authorization, meaning your PCA cannot work or get paid until the new prior authorization begins, and having MassHealth cap your hours if you repeatedly overuse. Once MassHealth caps your hours then the PCA will not get paid for the hours they submit that are more than the hours you are approved for.
How will I know if I overused?
You will receive a letter in the mail from your Fiscal Intermediary Department and will also get a call from your skills trainer in order to discuss how many hours you overused by and what hours you should be using going forward. However, since the PCM program is a consumer driven program, it is also important that you are keeping track of the amount of hours you have approved and the amount of hours you have used. Many consumers in the program find it helpful to have a schedule outlined each week for their PCA’s, in order to ensure they are scheduled the correct amount of hours. Please consider this if you are receiving multiple overuse notices.