Code of Massachusetts Regulations › 105 CMR - DEPARTMENT OF PUBLIC HEALTH › Title 105 CMR 150.000 - Standards for Long-Term Care Facilities › Section 150.001 - Definitions

Current through Register 1525, July 5, 2024
Activities and Recreation Program
shall mean regularly scheduled recreational, spiritual, educational,
				entertainment, craft and work-oriented activities.
Administrator
shall mean the person
				charged with general administration of the facility.
Aversive Interventions
shall mean any
				intervention technique based upon behavior modification principles that applies
				painful, seclusive or intrusive methods, stimuli, or punishments to a resident
				in order to correct, decrease or eliminate any undesirable behaviors.
BA Social Worker
shall mean an
				individual who holds a bachelor's degree, from an undergraduate program in
				social work or who holds a bachelor's degree from an accredited college or
				university and has been employed in a social work capacity for one year in a
				community health or social service agency.
Behavior Modification Trainer
shall
				mean an individual who has a minimum of a bachelor's degree in special
				education or psychology with training and experience in behavior modification
				as it relates to the developmentally disabled person.
Carry-over Services
shall mean
				services of a Medicare/Medicaid certified Skilled Nursing Facilities/Nursing
				Facility (SNF/NF), provided throughout all hours of the resident's day, which
				complement, reinforce and are consistent with any specialized services [as
				defined by the resident's Rolland Integrated Service Plan (RISP)] the resident
				with DD/ORC is receiving or is required to receive by the State.
Certified Facility
shall mean a
				long-term care facility certified to participate in the Medicare or Medicaid
				programs.
Change of Ownership
shall mean in the
				case of a corporation the transfer of the majority of stock thereof, and in all
				other cases, transfer of the majority interest therein.
Community Support Resident
. Note: No
				resident shall be evaluated or determined to be a Community Support Resident
				without his or her consent. Any resident meeting criteria as a potential
				Community Support Resident must be asked if he or she is interested in
				receiving the mental health and support services available to a Community
				Support Resident as described in
				105 CMR 150.000 and asked
				to sign a form expressing his or her interest in receiving services and
				consenting to evaluation and designation.
(1) A Potential Community Support Resident is defined as
				follows: An individual in need of Level IV services who meets at least one of
				the following criteria (These criteria are to assist in identifying residents
				who may be in need of service and are not sufficient to determine final
				designation status):
(a) Has been referred to the facility from a Department of
				Mental Health or another psychiatric facility;
(b) Has a current diagnosis of mental illness;
(c) Receives a major antipsychotic from staff and is unable to
				self-administer; and/or (d) Currently receives mental health services.
(2) A Designated Community Support Resident is defined as a
				resident who
(a) Following identification as a potential Community Support
				Resident, expresses interest in receiving the mental health and support
				services available to a Community Support Resident as described in
				105 CMR 150.000, and
				consents in writing (if he or she is competent to give such consent), or whose
				guardian consents (if he or she is not competent) to evaluation to determine if
				he or she is eligible for the additional services described in
				105 CMR 150.000; and
(b) Is judged on mental health evaluation by a psychiatrist or
				other mental health clinician as recognized under Massachusetts law, such as a
				licensed psychologist, licensed independent clinical social worker, or
				psychiatric nurse mental health clinical specialist, to exhibit a current
				mental health problem associated with sufficient behavioral and functional
				disabilities in activities of daily living, memory, cognition, socialization
				skills,
etc
. such that the resident could benefit from the
				services as described in
				105 CMR 150.000 as
				appropriate for a Community Support Resident.
Community Support Resident Support Services
				Plan
shall mean an individualized written plan designed to
				identify and meet the support services needs of Community Support
				Residents.
Dental Hygienist
shall mean an
				individual who is currently registered with the Massachusetts Board of
				Registration in Dentistry pursuant to M.G.L. c. 112, § 51.
Dentist
shall mean an individual
				registered by the Board of Registration in Dentistry under M.G.L. c. 112,
				§ 45.
Department
shall mean the Department
				of Public Health.
Department of Public Health - Medical Review Team
				(MRT)
shall mean a Department administered multi-disciplinary,
				interagency team of professionals with clinical training and/or experience in
				the care and treatment of individuals younger than 22 years old with multiple
				handicaps. The MRT has responsibility for determining the eligibility of such
				individuals for nursing home care. The purpose of the MRT review is to ensure
				only individuals who meet appropriate criteria are certified as eligible for
				residential care at a long-term care facility.
Developmental Disabilities/Other Related Conditions
				(DD/ORC)
shall mean a severe, chronic disability that meets all of
				the following conditions:
(1) Cerebral palsy or epilepsy; or
(2) Any other condition, other than mental illness, requiring
				treatment or services similar to those required for these persons:
(a) It is manifested before the person reaches 22 years
				old;
(b) It is likely to continue indefinitely;
(c) It results in substantial functional limitations in three
				or more of the following areas of major life activity:
1. Self-care;
2. Understanding and use of language;
3. Learning;
4. Mobility;
5. Self-direction; and
6. Capacity for independent living.
Dietary Services
shall mean the
				planning, preparation and serving of routine and therapeutic diets.
Dietitian
shall mean an individual
				licensed as a dietitian by the Board of Registration of Dietitians and
				Nutritionists.
Direct Care Worker
means a staff
				member whose work involves extensive resident contact or administrative
				decisions regarding care.
Direct Care Worker
shall not
				be limited to those workers employed by the nursing home, and shall include
				contracted workers who provide direct care to residents.
Direct
				Care Worker
shall include, but not be limited to: the medical
				director, registered nurses, licensed practical nurses, nurse practitioners,
				physician assistants, certified nurse aides, activities personnel, feeding
				assistants, social workers, dietary aides, and all occupational, physical, and
				speech therapy staff. Office-based practitioners whose primary practice site is
				not in the long-term care facility are exempt from the definition of
Direct Care Workers
. Examples of exempt practitioners
				include, but are not limited to: podiatrists, dentists or primary care
				providers that are part of on-call medical coverage arrangements.
Emergency
shall mean a situation or
				condition presenting imminent danger of death or serious physical harm to
				residents, or others.
Food Service Supervisor
shall mean an
				individual who is a high school graduate or the equivalent, has completed at
				least one course in food service supervision and has had at least one year of
				supervisory experience in the planning, preparation and service of food in a
				health facility or group feeding situation.
Guardian
shall mean a person appointed
				by the court to make medical decisions on behalf of an adult who has a
				clinically diagnosed medical condition and is unable to make or communicate
				effective decisions about their everyday self-care, health and safety.
Hours of Care per Resident per Day
				(PPD)
shall mean the total number of hours worked by registered
				nurses, licensed practical nurses, and nursing assistants, including certified
				nurse aides, and nurse aides in training with direct resident care
				responsibilities for each 24-hour period, divided by the total census of the
				facility for each day.
Identifiable Unit
shall mean a section
				of a facility such as a wing, floor or ward and shall include adjacent rooms
				where acceptable to the Department. For all new construction, additions,
				conversions or alterations, an identifiable unit shall mean not more than 41
				beds for units providing Level I or II care, and not more than 60 beds for
				units providing Level III or IV care.
Levels of Long-term Care Facilities or
				Units
.
(1)
Nursing Care Unit
shall mean a
				unit licensed to provide Intensive Nursing and Rehabilitative Care, Skilled
				Nursing Care, Skilled Nursing Care for Children, or Supportive Nursing
				Care.
(2)
Intensive Nursing and Rehabilitative Care
				Facility (Level I)
shall mean a facility or units thereof
				providing continuous skilled nursing care and an organized program of
				rehabilitation services in addition to the minimum, basic care and services
				required in
				105 CMR 150.000. Level I
				facilities shall comply with the Conditions of Participation for Extended Care
				Facilities under Title XVIII of the Social Security Act of 1965 ( P.L. 89-97 )
				and shall provide care for residents as prescribed therein.
(3)
Skilled Nursing Care Facilities (Level
				II)
shall mean a facility or units thereof that provide continuous
				skilled nursing care and meaningful availability of rehabilitation services and
				other therapeutic services in addition to the minimum, basic care and services
				required in
				105 CMR 150.000 for
				residents who show potential for improvement or restoration to a stabilized
				condition or who have a deteriorating condition requiring skilled care.
(a)
Skilled Nursing Care Facilities for Children
				(SNCFC) (Level II)
shall mean a facility or unit/s thereof
				providing skilled nursing care services and/or intensive supportive nursing
				care services together with therapeutic treatment and habilitative services to
				"multiply-handicapped" individuals birth through 22 years of age, who exhibit
				medical/nursing needs requiring intervention, observation and supervision by a
				multi-disciplinary team of professionals. Individuals requiring these services
				who are 15 through 22 years of age or who do not meet the definition of
				"multiply-handicapped" may be admitted to adult (Level II or Level III) units
				with prior approval from the Department's Medical Review Team (MRT) and the
				Department's licensing agency. A SNCFC is not an appropriate facility or unit
				for individuals requiring long-term custodial care.
(b)
Respite Care in a Skilled Nursing Care Facility
				for Children (SNCFC)
shall mean temporary, short term care of a
				multiply handicapped individual birth through 22 years of age in order to
				provide relief to a family/primary care-giver.
(4)
Supportive Nursing Care Facilities (Level
				III)
shall mean a facility or units thereof providing routine
				nursing services and periodic availability of skilled nursing, rehabilitation
				and other therapeutic services, as indicated, in addition to the minimum, basic
				care and services required in
				105 CMR 150.000 for
				residents whose condition is stabilized to the point where they need only
				supportive nursing care, supervision and observation.
(5)
Resident Care Unit
shall mean a
				unit licensed to provide Resident Care or Community Support.
(6)
Resident Care Facilities (Level IV) or Rest
				Home
shall mean a facility or units thereof that provides or
				arranges to provide in addition to the minimum basic care and services required
				in
				105 CMR 150.000, a
				supervised supportive and protective living environment and support services
				incident to old age for residents having difficulty in caring for themselves
				and who are ambulatory and do not require Level II or III nursing care or other
				medically related services on a routine basis.
(7)
Community Support Facilities (CSF)
shall mean a Resident Care Facility in which the Department determines 50% or
				more of the facility's residents are Community Support Residents. The Community
				Support Facility is the only Level IV facility allowed to routinely admit
				Community Support Residents and will be expected to maintain 50% or more of
				these residents. The central purpose of a CSF shall be to provide its current
				Community Support Residents, and new Community Support Resident admissions,
				with the mental health and support services outlined in 105 CMR 150.001. These
				services will be provided in order to assure resident security and the
				provision of appropriate care, as well as to maximize resident independence,
				prevent reinstitutionalization, and wherever possible provide rehabilitation
				and integration into the community.
License
shall mean the license issued
				by the Department for a two-year period to a facility found on inspection to be
				in full compliance with
				105 CMR 150.000, a
				provisional license, or, upon a change of ownership, an application for a
				license for a period of three months when filed with the Department within 24
				hours of such change of ownership.
Licensed Practical Nurse
shall mean a
				nurse who is currently licensed by the Board of Registration in Nursing to
				practice as a licensed practical nurse in Massachusetts.
Long-term Care Facility (LTCF)
shall
				mean any institution whether conducted for charity or profit that is
				advertised, announced or maintained for the express or implied purpose of
				providing four or more individuals admitted thereto with long-term resident,
				nursing, convalescent or rehabilitative care; supervision and care incident to
				old age for ambulatory persons; or retirement home care for elderly persons.
				Long-term care facility shall include convalescent or nursing homes, rest
				homes, infirmaries maintained in towns and charitable homes for the aged.
Facility
as used in
				105 CMR 150.000, shall mean
				a long-term care facility or unit thereof and units within acute hospitals
				converted under provisions of St. 1988 c. 23, § 32.
Medical Care
shall mean services
				provided by a physician or other primary care provider including physical
				examination and diagnosis; orders for treatments, medications, diets, and
				associated services; emergency care; periodic supervision and review; and
				determination of appropriateness of care and placement.
Medical Director
shall mean a
				physician who advises on the conduct of medical and medically related services
				in a facility. In a SNCFC, the Medical Director shall be a pediatrician.
Multiply-handicapped Individuals
shall
				mean individuals certified by the MRT for nursing home care who are between
				birth and 22 years of age, presenting with significant developmental
				disabilities, skilled nursing care needs and who may also require intensive
				therapeutic treatment and habilitative interventions.
Multiple Level Facility
shall mean a
				facility providing two, three or four levels of care in one or more
				identifiable units for each level of care.
MSW Social Worker
shall mean an
				individual who has received at least a master's degree from a graduate school
				of social work accredited by the Council on Social Work Education.
Nurse Aide
shall mean an individual
				who has successfully completed a nurses' aide training course.
Nursing Care
shall mean services
				provided by licensed nursing personnel (registered nurses and licensed
				practical nurses) or by nurse aides, under the direction of a registered nurse
				or a licensed practical nurse.
Nurse Practitioner
shall mean a nurse
				who is authorized to practice advanced practice registered nursing as a nurse
				practitioner by the Board of Registration in Nursing.
Occupational Therapist
shall mean an
				individual licensed as an occupational therapist by the Board of Registration
				of Allied Health Professionals.
Occupational Therapist Assistant
shall
				mean an individual licensed as an occupational therapy assistant by the Board
				of Registration of Allied Health Professionals.
Permanency Planning
shall mean
				supporting and maintaining family ties for multiply -handicapped individuals
				and their biological families; and working toward achieving permanent family
				ties for multiply-handicapped individuals who have no ties with their
				biological families.
Pharmacist
shall mean a pharmacist who
				is currently licensed by the Board of Registration in Pharmacy.
Physician
shall mean a doctor of
				medicine or doctor of osteopathy who is registered by the Board of Registration
				in Medicine to practice medicine in Massachusetts.
Pediatrician
shall mean a physician
				who is board-certified by the American Board of Pediatrics.
Physician Assistant
shall mean a
				person who is licensed by the Board of Registration of Physician
				Assistants.
Physical Therapist
shall mean an
				individual who is currently licensed as a physical therapist by the Board of
				Registration of Allied Health Professionals.
Physical Therapist Assistant
shall
				mean an individual licensed as a physical therapist assistant by the Board of
				Registration of Allied Health Professionals.
Primary Care Provider
shall mean the
				physician, physician assistant or nurse practitioner responsible for the
				resident's continuing medical care and periodic reevaluation.
Provisional License
shall mean a
				license issued for not more than 180 days to a facility found on inspection to
				be in substantial compliance and has demonstrated improvement and evidences
				potential for achieving full compliance within said period.
Psychiatric Nurse
shall mean a
				registered nurse who is authorized to practice advanced practice registered
				nursing as a psychiatric clinical nurse specialist by the Board of Registration
				in Nursing.
Registered Nurse
shall mean a nurse
				who is currently licensed by the Board of Registration in Nursing to practice
				as a registered nurse in Massachusetts.
Rehabilitation Services
shall mean
				services provided by physical therapists, occupational therapists, and speech,
				hearing and language therapists for the purpose of maximum reduction of
				physical or mental disability and restoration of the resident to maximum
				functional level. Only Medicare certified facilities may provided outpatient
				rehabilitation services. In addition, facilities must obtain written approval
				from the Department before outpatient rehabilitation services may be
				provided.
Rehabilitation Services Unit
shall
				mean a room or rooms specifically equipped for physical therapy, occupational
				therapy or speech, hearing and language therapy, and staffed by therapists in
				these specialties.
Resident
shall mean any individual
				receiving care in a facility or the resident's health care proxy, if the
				resident has an activated health care proxy.
Responsible Person
shall mean an
				individual 21 years of age or older, who has received a high school diploma, is
				of good moral character and with ability to make mature and accurate judgments.
				The responsible person shall also have the ability to communicate orally and in
				writing in English and the primary language used by residents of a
				facility.
Single Level Facility
shall mean a
				facility providing only one level of care in one or more identifiable
				units.
Social Services
shall mean those
				services provided to meet the medically-related emotional and social needs of
				the resident at the time of admission, during treatment and care in the
				facility and at the time of discharge.
Social Worker
means an individual who
				is currently licensed to practice social work in Massachusetts pursuant to
				M.G.L. c. 112, § 131 under the licensure categories of Licensed
				Independent Practitioner of Clinical Social Work (LICSW), or Licensed Certified
				Social Worker (LCSW) or Licensed Social Worker (LSW).
Specialized Services
shall mean the
				services specified by the State which, combined with services provided by the
				Nursing Facility or other service providers, results in treatment which meets
				the requirements of 42 CFR 483, §
								483.440(a)(1).
Speech Pathologist or Audiologist
(speech, hearing and language therapist) shall mean an individual who is
				licensed by the Board of Registration for Speech-language Pathology and
				Audiology.
Support Services
shall mean those
				services provided for the benefit of Community Support Residents in order to
				enhance psychosocial and physical functioning, and shall include arranging and
				coordinating appointments for health and mental health visits, educational and
				vocational services, as well as recreational services. Support Services also
				include the provision of counseling, and coordination with the Mental Health
				Treatment Plan.
Support Services Coordinator
shall
				mean an individual who has received a BA or BS degree in a human services field
				of study such as Psychology, Nursing or Social Work and is employed by a
				Resident Care Facility or a Community Support Facility to provide and
				coordinate care to Community Support Residents. The Coordinator is responsible
				for arranging and coordinating Support Services. Support Services is a term
				applied to a variety of services including health and mental health visits,
				educational and vocational services, as well as recreational services, which
				are intended to enhance the psychosocial and physical functioning of Community
				Support Residents.
Utilization Review Committee
shall
				mean a multi-disciplinary committee consisting of at least two physicians, a
				registered nurse and, where feasible, other appropriate health professionals
				with responsibility to review the resident care provided in a facility or group
				of related facilities. No committee member shall have a proprietary interest in
				the facility.