reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.431 - Requirements for Admission

Current through Register 1525, July 5, 2024
(A) Members seeking
			 psychiatric day treatment program services must be evaluated by a
			 multidisciplinary team composed of the treatment team and a psychiatrist (if
			 the psychiatrist is not a member of the treatment team) following the admission
			 procedures set forth in
			 130 CMR
			 417.432. The multidisciplinary team may admit
			 the member to the program only if it determines that the applicant has a mental
			 illness and functional impairment appropriate to psychiatric day treatment.
			 Documentary evidence must support these findings.
(B) Applicants are considered appropriate for
			 psychiatric day treatment program services if substantial functional
			 limitations exist in at least two of the following areas:
(1) emotional stability;
(2) vocational/educational
			 productivity;
(3) social relations;
			 and
(4) self-care.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.432 - Admission Procedures

Current through Register 1525, July 5, 2024
(A) A qualified
			 professional employed by the psychiatric day treatment program must conduct a
			 comprehensive evaluation, including an admission interview, to evaluate the
			 member's potential to benefit from the services of the program.
(B) This comprehensive evaluation must be
			 reviewed by the multidisciplinary team described in
			 130 CMR
			 417.431(A), including an
			 examination of the member's medical status.
(C) If the member is referred to the program
			 by a mental health clinic, hospital, physician, or by a psychotherapist, the
			 program must document their attempts to obtain reports of previous histories
			 and evaluations from the referring institution or individual. If this
			 preliminary evaluation indicates that admission is not appropriate, the program
			 must notify the referring agency or individual of this and terminate the
			 admission procedures. If the preliminary evaluation indicates that the member
			 may benefit from psychiatric day treatment program services, the comprehensive
			 evaluation set forth in
			 130 CMR 417.432(A) and
			 (B) should then be completed.
(D) If the comprehensive evaluation does not
			 sufficiently demonstrate that the member needs or has a level of recovery
			 appropriate for psychiatric day treatment program services, the member may be
			 admitted to the program for a short term evaluation period to determine the
			 ability of the program to meet the member's needs. The MassHealth agency pays
			 the program for services provided during such an evaluation period only under
			 the following conditions:
(1) the member's
			 record must contain specific documentation as to the need and time frame of the
			 evaluation period;
(2) the
			 evaluation period must not exceed two weeks; and
(3) the multidisciplinary team must review
			 and update the preadmission evaluation at the end of the evaluation
			 period.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.433 - Treatment Planning

Current through Register 1525, July 5, 2024
(A) The
			 multidisciplinary team described in
			 130 CMR 417.431(A)
			  must prescribe a plan of therapeutic
			 activities and treatment designed to improve or maintain the participant's
			 ability to function independently. This plan must be developed with and agreed
			 to verbally or in writing by the participant. The multidisciplinary team must
			 develop the plan after the member has completed ten visits to the program or by
			 the end of the first month of attendance, whichever occurs first.
(B) The treatment plan must be goal oriented
			 and time-limited with a focus on the principles of rehabilitation and recovery,
			 and time frames must be established for the attainment of short-and long-term
			 behavioral goals.
(C) All elements
			 of the treatment plan must be documented in the medical record, as set forth in
			 130 CMR
			 417.437.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.435 - Case Management

Current through Register 1525, July 5, 2024
(A) A member of the
			 program's professional or paraprofessional staff must be assigned to each
			 member as case coordinator to assume primary responsibility for that member's
			 case. The case coordinator supervises the implementation of the treatment plan,
			 maintains the member's records, initiates periodic review of the treatment plan
			 for necessary modifications or adjustments, coordinates the various services
			 provided by the program itself and by other agencies, coordinates referrals to
			 other state agencies as needed, meets regularly with relatives and significant
			 friends of the member, and monitors the member's progress in accomplishing the
			 treatment goals.
(B) The case
			 coordinator must review the member's treatment goals and treatment response
			 weekly and, during staff meetings, inform the staff of any significant changes
			 in the member's medical, mental, or emotional status. The entire staff must
			 review the member's overall progress every 90 calendar days and, with the
			 participation of the member, alter or revise the treatment plan as
			 necessary.
(C) If the member fails
			 to keep appointments or to adequately participate in the treatment plan, the
			 case coordinator must make every effort to encourage the member to do so, and
			 these follow-up efforts must be documented in the member's record.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.436 - Discharge from Program

Current through Register 1525, July 5, 2024
A member must be discharged from a psychiatric day treatment
				program when a periodic review shows that the member has met all therapeutic
				goals or has ceased to substantially benefit from the program. If this
				discharge occurs because the member requires a lesser level of services than
				those of psychiatric day treatment, the program must prepare the member for the
				transition to a less intensive program or environment, such a clubhouse, a
				mental health clinic, or a social services agency.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.438 - Written Policies and Procedures

Current through Register 1525, July 5, 2024
A psychiatric day treatment program must have and observe
				written policies and procedures that include:
(A) a statement of program philosophy and
			 objectives;
(B) admission
			 procedures, including criteria and procedures for multidisciplinary review of
			 each individual referral;
(C)
			 treatment procedures, including development of the treatment plan, case
			 assignment, periodic review, and follow-up on drop-outs;
(D) discharge criteria and
			 procedures;
(E) medication
			 policy;
(F) referral policy,
			 including procedures for ensuring uninterrupted and coordinated patient care
			 upon transfer;
(G) procedures for
			 clinical emergencies that occur both during and outside the program's operating
			 hours;
(H) recordkeeping
			 policy;
(I) personnel and
			 management policies, including policies for hiring, discharging, and
			 supervision protocol for all staff;
(J) a policy for proper food preparation,
			 cleanliness, and storage, including designation of a staff person to take
			 responsibility for supervision of the member's food preparation at each
			 meal;
(K) explicit fee policies for
			 billing third-party payers and patients, along with procedures for cancellation
			 and fee reductions;
(L) procedures
			 for fire and other nonclinical emergencies; and
(M) staff training and evaluation.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual › Section 417.439 - Administration

Current through Register 1525, July 5, 2024
(A)
Organization
.
			 The program must establish an organizational chart showing major operating
			 programs of the facility, with staff divisions, administrative personnel in
			 charge of each program, and their lines of authority, responsibility, and
			 communication.
(B)
Staff Meetings
. The program must document that staff
			 meetings are held at least once a month to review the program and to recommend
			 appropriate changes, if any.
(C)
Staff Development and Supervision
. Each staff member
			 must receive supervision appropriate to the person's skills and level of
			 professional development. Supervision must be documented and must occur within
			 the context of a formalized relationship that provides frequent and regularly
			 scheduled individual or group personal contact with the supervisor.
(D) All documents described in
			 130 CMR 417.439(A) through
			 (C) will be accessible and available upon
			 request.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.401 - Introduction

Current through Register 1525, July 5, 2024
130 CMR
				418.000 establishes requirements for participation of
				substance use disorder treatment programs in MassHealth and governs public and
				private programs. All substance use disorder treatment programs participating
				in MassHealth must comply with MassHealth regulations, including but not
				limited to,
				130 CMR
				418.000, and
				130 CMR
				450.000:
Administrative and Billing
				Regulations.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.403 - Eligible Members

Current through Register 1525, July 5, 2024
(A)
(1)
MassHealth
			 Members
. The MassHealth agency pays for substance use disorder
			 treatment services only when provided to eligible MassHealth members, subject
			 to the restrictions and limitations described in MassHealth regulations.
			 Covered services for each MassHealth coverage type are set forth in
			 130
			 CMR 450.105:
Coverage
			 Types.
(2)
Members of Emergency Aid to the Elderly, Disabled and Children
			 Program
. Covered services for recipients of the Emergency Aid to
			 the Elderly, Disabled and Children Program, are set forth in
			 130
			 CMR 450.106:
Emergency Aid to the
			 Elderly, Disabled and Children Program.
(3)
Special Services for Pregnant
			 Members
.
(a)
Eligibility Period
. A substance use disorder treatment
			 plan for a pregnant member may provide for no more than 10 consecutive months
			 of service from the initiation of treatment. Services may be initiated as soon
			 as the pregnancy is clinically verified or at any month during the
			 pregnancy.
(b) Eligibility for
			 special services for pregnant members continues until the last day of the
			 calendar month in which the 12-month postpartum period ends. Other substance
			 use disorder treatment services described in
			 130 CMR
			 418.000 may be available to pregnant members during or
			 after this eligibility period.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.404 - Provider Eligibility

Current through Register 1525, July 5, 2024
(A)
In
			 State
. Each program is eligible to participate only if the program
			 is:
(1) for provider types eligible for such
			 enrollment, enrolled as a Medicare provider;
(2) licensed or approved by the Massachusetts
			 Department of Public Health to provide the appropriate substance use disorder
			 treatment service pursuant to
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs
and as defined in
			 130
			 CMR 418.404(A);
(3) enrolled and actively participating with
			 the MassHealth agency as a billing provider, as evidenced by the issuance of a
			 Provider Identification and Service Location (PIDSL) number for the provision
			 of substance use disorder treatment services at that location.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.405 - Provider Enrollment Process

Current through Register 1525, July 5, 2024
(A) A separate,
			 complete application for enrollment as a MassHealth substance use disorder
			 treatment provider must be submitted for each site. The applicant must submit
			 the appropriate provider enrollment application to the MassHealth agency. The
			 MassHealth agency may request additional information or perform a site
			 inspection to evaluate the applicant's compliance with the regulations in
			 130 CMR
			 418.000.
(1) Based on
			 the information in the enrollment application, information known to the
			 MassHealth agency about the applicant, and on the findings from any site
			 inspection deemed necessary, the MassHealth agency will determine whether the
			 applicant is eligible for enrollment.
(2) The MassHealth agency will notify the
			 applicant of the determination in writing within 60 days of the MassHealth
			 agency's receipt of a completed application. An application will not be
			 considered complete until the applicant has responded to all MassHealth
			 requests for additional information, and MassHealth has completed any required
			 site inspection.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.406 - Required Notifications and Reports

Current through Register 1525, July 5, 2024
(A)
Annual Report
. Each substance use disorder treatment
			 program must submit a completed annual report, on forms furnished by the
			 MassHealth agency, and file them with the MassHealth agency by September
			 30th of each year. The report must include at
			 minimum:
(1) a statement that the program has
			 reviewed and updated, as necessary, its written policies and procedures during
			 the reporting period. Each program must provide a copy of the program's written
			 policies and procedures as requested by the MassHealth agency;
(2) a list of all administrative and clinical
			 and medical management staff that includes the following information: staff
			 name, license number, type of license, and board certification, if applicable,
			 and a list of the clinical supervisor for any clinical staff who are unlicensed
			 or not independently licensed;
(3)
			 a statement describing the current language capacities, capacity to provide
			 services to specialized populations, and utilization of evidenced-based
			 modalities of the program;
(4)
			 written attestation that the program complies with
			 130 CMR
			 418.000; and
(5) any other information that the MassHealth
			 agency may request.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.407 - Revocation of Enrollment

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency has the right to review a substance use disorder treatment program's
			 continued compliance with the conditions for enrollment referred to in
			 130
			 CMR 418.405 and the reporting requirements in
			 130
			 CMR 418.406, upon reasonable notice and at
			 any reasonable time during the program's hours of operation. The MassHealth
			 agency has the right to revoke the enrollment, subject to any applicable
			 provisions of
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations,
if such review reveals that the program has failed to or
			 ceased to meet such conditions.
(B)
			 If the MassHealth agency determines that there exists good cause for the
			 imposition of a lesser sanction than revocation of enrollment, it may withhold
			 payment, temporarily suspend the program from participation in MassHealth, or
			 impose some other lesser sanction as the MassHealth agency sees fit, pursuant
			 to the processes in
			 130 CMR
			 450.000, as applicable.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.408 - Site Inspection

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency may, at any time, conduct announced or unannounced site inspections of
			 any program to determine compliance with applicable regulations. Such site
			 inspections need not pertain to any actual or suspected deficiency in
			 compliance with the regulations.
(B) After any site inspection where
			 deficiencies are observed, the MassHealth agency will prepare a written site
			 inspection report. The site inspection report will include the deficiencies
			 found, and the period within which the deficiency must be corrected. The
			 program shall submit a corrective action plan, within the timeframe set forth
			 by the MassHealth agency, for each of the deficiencies cited in the report,
			 including the specific corrective steps to be taken, a timetable for these
			 steps, and the date by which full compliance will be achieved. The MassHealth
			 agency will review the corrective action plan and will accept the corrective
			 action plan only if it conforms to these requirements.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.409 - Scope of Services

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency pays only for services furnished by substance use disorder treatment
			 programs, in accordance with
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs,
as follows:
(1)
Opioid Treatment Programs
. The MassHealth agency will
			 pay for opioid treatment programs services rendered by medical, counseling,
			 peer, and paraprofessional staff under the direction of the Medical Director
			 and delivered in conformance with the following:
(a) the administration and dispensing of
			 FDA-approved medications for the treatment of opioid use disorders for the
			 purposes of medically supervised withdrawal or maintenance treatment;
(b) multidimensional biopsychosocial
			 evaluation and treatment planning;
(c) individual and group counseling by a
			 clinician;
(d) psychoeducation on
			 the disease of addiction;
(e)
			 discharge planning and coordination of services;
(f) for pregnant members, coordination with
			 OB/GYN, pediatrics, and any other appropriate medical, social services
			 providers, and state agencies; and
(g) facilitate access to recovery support
			 navigator services and peer recovery coach services either directly or through
			 referral.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.410 - Supervision and Other Staff Requirements

Current through Register 1525, July 5, 2024
(A)
Staff Supervision Requirements
(1)
Unlicensed or Not
			 Independently Licensed Staff
. All professionals who are
			 unlicensed, who are in a profession without licensure, or who are not
			 independently licensed or certified as a peer supervisor must receive direct
			 and continuous supervision. Direct and continuous supervision may be provided
			 using telehealth technology.
(2)
Independently Licensed and Certified Peer Supervisor
			 Staff
. All independently licensed professionals and certified peer
			 supervisors must receive supervision in accordance with the relevant licensing
			 requirements and program policy. Supervision may be provided using telehealth
			 technology.
(3) The supervising
			 clinician is primarily responsible for the care of the member. For any care
			 delivered by a professional under supervision, there must be documentation in
			 the clinical chart that the chart was reviewed by the supervising
			 clinician.
(4) All supervision must
			 be documented in files accessible for review by the MassHealth agency.
			 Supervision notes must, at a minimum, contain information regarding frequency
			 of supervision, format of supervision, supervisor's signature and credentials,
			 and general content of supervision session.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.411 - Recordkeeping Requirements

Current through Register 1525, July 5, 2024
(A) Each program
			 provider must maintain member records in accordance with
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
and
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs.
Member records must be complete, accurate, and
			 properly organized. The member's record must include a complete record of all
			 services provided to members directly, referrals made, if the appointment was
			 kept, and a progress note for each counseling session, including the treatment
			 modality and duration and the therapist's discipline and degree, written and
			 signed by the primary therapist.
(B)
Program Records
.
			 The substance use disorder treatment program must retain documentation
			 reflecting compliance with the requirements of
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs.
(C)
Availability of Records
. All records shall be made
			 available to the MassHealth agency, upon request.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.412 - Service Limitations

Current through Register 1525, July 5, 2024
(A) In addition to
			 the requirements set forth in
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs
, programs must adhere to the following service
			 limitations:
(1)
Opioid Treatment
			 Services
.
(a) Payment for oral
			 opioid agonist and partial agonist medication is limited to one dose per member
			 per day. Payment for providing a take home supply is limited to the amounts and
			 frequency set forth in
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs
.
(b)
			 Payment for opioid partial agonist medication, whether a single-agent or in
			 combination with naloxone, is limited to one dose per member per day. Payment
			 for a take-home supply is limited to the amounts and frequency set forth in
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs
.
(c)
			 Payment for administering injectable opioid antagonist medication is limited to
			 one dose per member per month.
(d)
			 Payment for administering injectable opioid partial agonist medication is
			 limited to one dose per member per month.
(e) Payment for drug screens for members
			 receiving opioid agonist, partial agonist, and antagonist medication is limited
			 to the amounts and frequency set forth in
			 105 CMR
			 164.000:
Licensure of Substance Use Disorder
			 Treatment Programs.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.413 - In-state Providers: Maximum Allowable Fees

Current through Register 1525, July 5, 2024
The Massachusetts Executive Office of Health and Human Services
				determines the maximum allowable fees for substance use disorder treatment
				services. Payment is always subject to the conditions, exclusions, and
				limitations set forth in
				130 CMR
				418.000.
Reimbursement for a service shall be the lower of the
				following:
(A) the maximum allowable
			 fee listed in the applicable fee schedule pursuant to
			 101 CMR
			 346.00:
Rates for Certain Substance-Related
			 and Addictive Disorders Programs,
and 101 CMR 444:
Rates for
			 Certain Substance Use Disorder Services;
or
(B) the program's usual and customary
			 fee.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.414 - Out-of-state Providers: Maximum Allowable Fees

Current through Register 1525, July 5, 2024
Payment to a substance use disorder treatment program located
				out of state shall be in accordance with the applicable rate schedule of its
				state's Medicaid Program or its equivalent and is always subject to the
				applicable conditions, exclusions, and limitations set forth in
				130 CMR
				418.000.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.401 - Introduction

Current through Register 1525, July 5, 2024
130 CMR 419.000 establishes the requirements for the provision
				of services by day habilitation programs under MassHealth. All day habilitation
				providers must comply with the regulations governing MassHealth including, but
				not limited to, 130 CMR 419.000 and 130 CMR 450.000:
Administrative and
				Billing Regulations
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.403 - Eligible Members

Current through Register 1525, July 5, 2024
(A)
MassHealth Members
. MassHealth members, subject to the
			 restrictions and limitations described in
			 130
			 CMR 450.105:
Coverage Types
that specifies for each MassHealth coverage type, which services are covered,
			 and which members are eligible to receive those services.
(B)
Recipients of the Emergency
			 Aid to the Elderly, Disabled and Children Program
. For information
			 on covered services for recipients of Emergency Aid to the Elderly, Disabled
			 and Children,
see
130
			 CMR 450.106:
Emergency Aid to the
			 Elderly, Disabled and Children
.
(C) For information on verifying member
			 eligibility and coverage type,
see
130
			 CMR 450.107:
Eligible Members and the
			 MassHealth Card
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.404 - Provider Eligibility

Current through Register 1525, July 5, 2024
An organization seeking to participate in MassHealth as a DH
				provider must
(A) be located in
			 Massachusetts;
(B) enter into a
			 contract with the MassHealth agency through submission of an application that
			 includes all documentation specified by the MassHealth agency or its designee
			 and be certified by the MassHealth agency or its designee in accordance with
			 the requirements set forth in 130 CMR 419.000 and 130 CMR 450.000:
Administrative and Billing Regulations
to conduct a business
			 in Massachusetts that delivers health and human services to individuals with
			 ID/DD;
(C) accept the MassHealth
			 agency payments as payment in full for DH;
(D) be in operation at least five business
			 days a week, six hours per day;
(E)
			 collaborate with DDS in accordance with EOHHS guidelines, to ensure
			 coordination of services to DDS clients;
(F) be accredited by the Commission on
			 Accreditation of Rehabilitation Facilities (CARF) or the Council on Quality and
			 Leadership;
(G) meet all provider
			 participation requirements described in 130 CMR 419.000 and 130 CMR 450.000:
Administrative and Billing Regulations
.
(H) participate in any DH provider
			 orientation required by EOHHS;
(I)
			 submit to the MassHealth agency or its designee a written description of DH
			 offered by the DH provider and its service plan; and
(J) agree to periodic inspections by the
			 MassHealth agency or its designee that assess the quality of member care and
			 ensure compliance with 130 CMR 419.000 and 130 CMR 450.000:
Administrative and Billing Regulations
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.405 - Scope of Day Habilitation

Current through Register 1525, July 5, 2024
(A) A DH provider
			 must provide the following services.
(1)
Nursing Services and Health Care Supervision
. The DH
			 provider must provide nursing coverage on site. Nursing services must be
			 provided to meet the needs of each member and must include the following:
(a) administration of medications and
			 treatments prescribed by the member's PCP during the time the member is at the
			 program;
(b) education in hygiene
			 and health concerns;
(c)
			 coordination of each member's DHSP with other health care professionals
			 including the NF where the member resides, if applicable;
(d) monitoring each member's health status
			 and documenting those findings in the member's medical record at least
			 quarterly, or more often if the member's condition requires more frequent
			 monitoring. Nursing must also document any findings every six months as part of
			 the interdisciplinary team's semi-annual review;
(e) reporting changes in the member's
			 condition to the member's PCP;
(f)
			 oversight of the implementation of the IDT recommendations, therapy treatment
			 as recommended by a licensed therapist and, as applicable, PCP order;
			 and
(g) coordinated implementation
			 of the PCP's orders with the member, authorized representative, and DH provider
			 staff.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.406 - Clinical Eligibility Criteria

Current through Register 1525, July 5, 2024
(A) All members,
			 except those who are residents of an NF, must meet the following clinical
			 eligibility criteria for receipt of DH:
(1)
			 have ID or DD as defined in
			 130
			 CMR 419.402 and as certified by a PCP;
			 and
(2) need DH to acquire,
			 improve, or retain their maximum skill level and independent
			 functioning.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.407 - Service Needs Assessment, Day Habilitation Leveling Tool, and Prior Authorization, including Individualized Staffing Supports

Current through Register 1525, July 5, 2024
(A)
			 A Service Needs Assessment (SNA) is completed by the clinical members of the
			 IDT and determines a member's functional level, needs, and strengths, and makes
			 specific recommendations to address acquisition, improvement, or maintenance of
			 each identified need area for the member. Each SNA must
(1) be completed within 45 business days of a
			 member's admission and every two years thereafter and upon a significant change
			 in the member's condition;
(2)
			 assess each of the following need areas: self-help skills, sensorimotor skills,
			 communication skills, independent living skills, affective development skills,
			 social development skills, behavioral development skills, and wellness;
			 and
(3) identify which need areas
			 will be addressed in the DHSP.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.408 - Quality Management

Current through Register 1525, July 5, 2024
DH providers must participate in any quality management and
				program integrity processes established by the MassHealth agency including
				making any necessary data available and access to visit the provider's place of
				business upon request by the MassHealth agency or its
				designee.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.409 - Conditions of Payment

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency pays for DH in accordance with the applicable payment methodology and
			 rate schedule established by EOHHS, including supplemental staffing for those
			 who reside in an NF and attend a community-based DH and for DH provided in NFs.
			 Rates of payment for DH do not cover or include any room and board.
(B) Payment for services is subject to the
			 conditions, exclusions, and limitations set forth in 130 CMR 419.000 and 130
			 CMR 450.000:
Administrative and Billing Regulations
.
(C) The MassHealth agency pays a DH provider
			 for DH only if
(1) the member receiving DH is
			 eligible under
			 130
			 CMR 419.403;
(2) the member meets the clinical eligibility
			 criteria for DH in accordance with
			 130
			 CMR 419.406;
(3) the DH provider has obtained prior
			 authorization for DH and DH ISS, if applicable, in accordance with
			 130
			 CMR 419.407;
(4) the DH provider is not billing for days
			 that are non-covered under
			 130
			 CMR 419.431; and
(5) the DH provider bills at the payment
			 level authorized by the MassHealth agency or its designee; and
(6) for members who reside in an NF, the
			 member's Level II PASRR conducted by DDS determines that the member requires
			 specialized services.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.410 - Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services

Current through Register 1525, July 5, 2024
The MassHealth agency pays for all medically necessary day
				habilitation services for EPSDT-eligible members in accordance with
				130
				CMR 450.140:
Early and Periodic
				Screening, Diagnostic and Treatment (EPSDT) Services
:
Introduction
, without regard to service limitations described
				in 130 CMR 419.000, and with prior authorization.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.411 - Transportation Services

Current through Register 1525, July 5, 2024
(A)
Transportation Service
. Transportation service
			 provides for transporting members from the member's home to the DH provider
			 (for the provision of DH services) or from the DH provider to the member's
			 home, including assisting the member while entering and exiting the vehicle, as
			 appropriate. For the purposes of
			 130
			 CMR 419.411, a home includes any residential
			 service locations, as well as private dwellings.
(B)
Provision of
			 Transportation
.
(1) DH providers
			 may provide transportation service as defined at
			 130
			 CMR 419.411(A) either
			 directly or through a subcontractor.
(2) The transportation plan must be
			 documented in the member's record.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.416 - Day Habilitation Provider Responsibilities

Current through Register 1525, July 5, 2024
In addition to meeting all of the qualifications set forth in
				130 CMR 419.000 and 130 CMR 450.000:
Administrative and Billing
				Regulations
, the DH provider must meet all of the following
				requirements.
(A)
Policies
			 and Procedures Manual
. Each DH provider must develop, maintain,
			 and periodically review and update policies and procedures governing the
			 delivery of DH. The policy and procedures manual must at minimum include
(1) governance documentation, including, but
			 not limited to
(a) a mission
			 statement;
(b) the goals and
			 objectives of the program;
(c) an
			 organizational chart describing the lines of authority and communication needed
			 to manage the DH program, including the lines of authority for delegation of
			 responsibility down to the member care level;
(d) job descriptions that include titles,
			 reporting authority, qualifications, and responsibilities;
(e) a description of the governing body;
			 and
(f) a description of the
			 fiscal/business management system that clearly specifies the use of funds
			 within budgetary constraints and fiscal restrictions and fiscal reporting by
			 month, reflecting all sources of income and program expenses.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.417 - Service Needs Assessment

Current through Register 1525, July 5, 2024
A Service Needs Assessment (SNA) determines a member's
				functional level, needs, and strengths, and makes specific recommendations to
				address acquisition, improvement, or maintenance of each identified need area
				for the member. Each SNA must
(A) be
			 completed within 45 business days of a member's admission and every two years
			 thereafter and upon a significant change in the member's condition;
(B) assess each of the following need areas:
			 self-help skills, sensorimotor skills, communication skills, independent living
			 skills, affective development skills, social development skills, behavioral
			 development skills, and wellness; and
(C) identify which need areas will be
			 addressed in the DHSP.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.419 - Day Habilitation Service Plan (DHSP)

Current through Register 1525, July 5, 2024
(A)
Interim DHSP
. Within five business days after the
			 member's admission, the DH provider's professional interdisciplinary team must
			 design an interim DHSP. The plan must outline a temporary schedule of treatment
			 and activities that will be used until the final DHSP is completed.
(B)
Final Day Habilitation
			 Service Plan
. Together with the SNA, the final DHSP must be
			 completed within 45 business days from the date of the member's admission and
			 updated every two years and upon significant change and must be developed with
			 participation of the member, the member's authorized representatives, where
			 applicable and appropriate, and must be derived from the SNA for each member.
			 The final DHSP describes each training program, measurable goals, and
			 objectives that address the need areas identified in the SNA. The DHSP must be
			 designed in a manner that integrates the various activities, tasks, and, if
			 appropriate, therapies recommended to meet the member's areas of need. The
			 final DHSP must include, but is not limited to, the following:
(1) a medical plan of care;
(2) a service plan coversheet that outlines
			 the development of the member's DHSP, based on the recommendations from the
			 SNA; and
(3) goals and objectives
			 that are written in measurable terms.
(a) Each
			 goal must
1. be written without the use of
			 ambiguous action verbs;
2. be
			 member-driven; and
3. provide clear
			 means for attaining the goal within an established time
			 frame.
(b) Objectives
			 must address specific skill acquisition and retention as it relates to a goal
			 and must
1. be written without the use of
			 ambiguous action verbs;
2. be
			 member-driven;
3. measure only one
			 behavior; and
4. identify
			 measurable outcomes performance and stability
			 criterion.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.420 - Discharge

Current through Register 1525, July 5, 2024
(A)
Discharge
			 Procedures
. The DH provider must coordinate the discharge with the
			 member, member's authorized representative, DDS, if applicable, and with the
			 staff of the DH provider or other agency to which the member is being
			 transferred, if applicable.
(B)
Discharge Plan
. A discharge plan, dated and signed by
			 the program director, must be kept in the member's record for at least six
			 years after the date of discharge and must remain accessible to representatives
			 from the MassHealth agency and other state and federal agencies that are
			 authorized by law to have such information.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.421 - Day Habilitation Staff Qualifications, Responsibilities, and Training

Current through Register 1525, July 5, 2024
(A)
General Staffing Requirements
.
(1) Prior to hiring or contracting with any
			 staff, the DH provider must
(a) check the
			 candidate's references and job history and ensure that the candidate meets all
			 of the required experience, education, and qualifications before
			 hiring;
(b) conduct a Criminal
			 Offender Records Information (CORI) check and determine whether any offender
			 records may disqualify the individual for employment;
(c) conduct a Sex Offender Registry
			 Information (SORI) check and determine whether any offender records may
			 disqualify the individual for employment;
(d) search the DPPC Abuser Registry prior to
			 hiring staff or contracting with care providers of persons with ID/DD to align
			 with Nicky's Law (M.G.L. c. 19C, § 15);
(e) check the Office of Inspector General
			 (OIG) List of Excluded Individuals and Entities (LEIE) to determine whether the
			 candidate appears on the LEIE and is thus disqualified from
			 employment;
(f) conduct a national
			 criminal background check in accordance with the administrative procedures
			 described at
			 115 CMR 12.00:
National Criminal Background Checks
;
(g) conduct license and certification checks
			 and validate that the candidate has obtained all necessary licenses and
			 certifications and that all licenses and certifications are current;
(h) ensure that each DH staff person is not
			 providing direct care to any member whom that staff person is related to or
			 legally responsible for; and
(i)
			 ensure that each DH staff person has received a tuberculosis screening within
			 the previous 12 months.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.430 - Emergency Services and Plans

Current through Register 1525, July 5, 2024
The DH provider must establish plans, policies, and procedures
				for medical and other emergencies developed with the assistance of local and
				state fire and safety experts, and posted in offices of staff and in clearly
				visible locations throughout each DH provider site. These plans and procedures
				must include, at a minimum, the following:
(A) Written emergency policies and procedures
			 that must include
(1) an emergency evacuation
			 plan that is in compliance with and coordinated with local fire department
			 requirements and that must, at a minimum, require quarterly fire and evacuation
			 drills for all staff members, and which must be documented in accordance with
			 130 CMR
			 419.416(B);
(2) a procedure to be followed if participant
			 is missing or lost;
(3) procedures
			 for handling medical emergencies at each DH provider site;
(4) persons and entities to be notified in
			 case of an emergency;
(5) locations
			 of alarm signals and fire extinguishers; and
(6) staff training in emergency procedures,
			 including, but not limited to, assignment of specific tasks and
			 responsibilities to the personnel and documentation of such
			 training.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.431 - Noncoverage

Current through Register 1525, July 5, 2024
The following are considered non-covered days and are
				ineligible for payment under 130 CMR 419.000.
(A) Any portion of a day outside the approved
			 rate structure described in 101 CMR 348.00:
Rates for Day Habilitation
			 Services
, during which the member is not receiving scheduled services
			 from the DH provider, unless the provider documents that the member was
			 receiving services from the DH provider's staff in a community
			 setting.
(B) DH provided to a
			 member when the member's needs can no longer be met by the DH as determined by
			 the PCP and the professional interdisciplinary team in consultation, or by a
			 qualified representative of the MassHealth agency, DDS, or DPH.
(C) Days or portion(s) of a day outside of
			 the rate structure in 101 CMR 348.00:
Rates for Day Habilitation
			 Services
on which the following services are provided:
(1) vocational- and prevocational-training
			 services, which include vocational-skills assessment, career counseling, job
			 training, and job placement;
(2)
			 work-related services, which provide participants with work skills and
			 supervised employment for the production of saleable goods;
(3) educational services, which involve
			 traditional classroom instruction of academic subjects, tutoring, and academic
			 counseling; and
(4) social,
			 vocational, and recreational services not administered through the DH
			 provider.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.433 - Day Habilitation for MassHealth Members with ID/DD Residing in NFs

Current through Register 1525, July 5, 2024
For purposes of providing DH to MassHealth members with ID or
				DD who are residing in NFs, DH providers must comply with all of the
				requirements outlined in
				130
				CMR 419.433 as well as coordinate and
				communicate with the member, the DDS service coordinator, if applicable, and
				the NF, actively participate in the development of the RISP, and attend the NF
				plan of care meetings to ensure that the DHSP complements and reinforces the
				service plans referenced in the member's RISP.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 419.000 - Day Habilitation Center Services › Section 419.434 - Withdrawal of a DH Provider from MassHealth

Current through Register 1525, July 5, 2024
A DH provider that intends to withdraw from MassHealth must
				satisfy all of the following obligations.
(A)
MassHealth
			 Notification
.
(1) A DH provider
			 electing to withdraw from participation in MassHealth must send written notice
			 to the MassHealth agency, or its designee, and DDS of the provider's intention
			 to withdraw from participating as a MassHealth DH provider. The DH provider
			 must send the withdrawal notice by certified or registered mail, return receipt
			 requested, to the MassHealth agency or its designee, no fewer than 90 days
			 before the effective date of withdrawal.
(2) The DH provider must forward to the
			 MassHealth agency or its designee a list of all members currently receiving DH.
			 The DH provider must notify the MassHealth agency in writing as members are
			 placed in other programs or begin to receive alternative services, including
			 the name of the new program or service and each member's start date in the new
			 program or service.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 420.000 - Dental Services › Section 420.401 - Introduction

Current through Register 1525, July 5, 2024
(A)
								130 CMR
			 420.000 contains the regulations governing dental
			 services under MassHealth. All dental providers participating in MassHealth
			 must comply with MassHealth regulations, including but not limited to
			 130 CMR
			 420.000 and
			 130 CMR 450.000:
Administrative and Billing Regulations
.
(B) As described in
			 130 CMR
			 420.000 and in
			 130 CMR 450.000:
Administrative and Billing Regulations
, covered dental
			 services are more extensive for members younger than 21 years old than for
			 members 21 years of age and older.
(C) Subchapter 6 of the
Dental
			 Manual
lists the Current Dental Terminology (CDT) codes for dentists
			 and public health dental hygienists and Current Procedural Terminology (CPT)
			 codes for specialists in oral surgery that the MassHealth agency pays for, a
			 description of those codes, and where indicated, prior-authorization
			 requirements. Oral and maxillofacial surgeons must submit all claims containing
			 CPT codes directly to MassHealth.