Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.02 - General Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				361.00, terms have the meanings set forth in
				101
				CMR 361.02, unless the context requires
				otherwise.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Complex Care Assistant
. A person who
				is employed or contracted by a CSN agency and meets the qualifications of a
				complex care assistant to perform certain health-related services as described
				in 130 CMR
				438.415(C):
Recordkeeping
.
Continuous Skilled Nursing (CSN)
				Agency
. A public or private organization that meets the
				requirements of
				130 CMR
				438.000:
Continuous Skilled Nursing
				Agency
and provides CSN agency services to complex care members within
				the member's home.
Continuous Skilled Nursing (CSN) Agency
				Services
. CSN services and complex care assistant services as
				described in
				130
				CMR 438.402:
Definitions
and
				delivered to MassHealth-eligible members. For details on requirements,
see
130 CMR
				438.000:
Continuous Skilled Nursing
				Agency
.
Continuous Skilled Nursing (CSN)
				Services
. Skilled nursing care provided by a licensed nurse to
				complex care members who require more than two continuous hours of nursing
				services per day and as defined in
				130 CMR
				438.000:
Continuous Skilled Nursing
				Agency
.
Eligible Provider
. An individual
				practitioner or an organization that meets such conditions of participation as
				have been or may be adopted by a governmental unit purchasing CSN or CSN agency
				services.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth of
				Massachusetts and any department, agency, board, commission, division, or
				political subdivision of the Commonwealth.
Home Health Agency
. An organization
				that meets the requirements of
				130 CMR
				403.000:
Home Health Agency
to
				provide home health services, including continuous skilled nursing.
Individual Practitioner
. An RN or
				licensed practical nurse (LPN), who directly provides authorized continuous
				skilled nursing services and who bills independently for professional services
				rendered as defined in
				130
				CMR 414.402:
Independent
				Nurse
.
Provider Agency
. A partnership,
				corporation, or other entity, other than an individual, that provides
				authorized CSN agency services, as defined in
				101
				CMR 361.02:
Continuous Skilled
				Nursing (CSN) Agency Services
, by an RN, LPN, or complex care
				assistant (as applicable) who is its employee.
Publicly Aided Individual
. A person
				who receives health care and services for which a governmental unit is in whole
				or part liable under a statutory program.
Reasonable Costs
. Those reasonable and
				necessary costs incurred by an eligible provider of CSN, subject to the
				requirements and limitations of
				101 CMR
				361.00. In determining the reasonableness of costs,
				EOHHS may consider the particular services offered, the introduction of
				efficiency measures, the requirements for staffing, and the costs of providing
				comparable service.
Security/Escorts
. The provision of
				security services to direct care personnel in the performance of a reimbursable
				home health visit.
Sixty-day Supervisory Visit (60-day Supervisory
				Visit)
. The 60-day supervisory visit conducted by an RN and
				described in
				130
				CMR 438.415(C)(5)(c), made
				to the member's home in order to observe and assess the complex care assistant
				while they are performing care. A reassessment of the member's needs may be
				done at this time.
Weekday
. The hours from 7:00 A.M. to
				3:00 P.M., Monday through Friday.
Weekend and Nights
.
(a)
Weekend
. The
			 hours from 3:00 P.M., Friday, to 7:00 A.M., Monday.
(b)
Nights
. The
			 hours from 3:00 P.M. to 7:00 A.M., Monday through Friday.
(c)
Holidays
. All
			 official Commonwealth of Massachusetts holidays. For purposes of
			 101 CMR
			 361.00, holidays that occur on a weekend are observed
			 on that day and not the preceding Friday or following Monday.
New Year's Day
Martin Luther King Jr. Day
Presidents' Day
Patriots' Day
Memorial Day
Juneteenth Independence Day
Independence Day
Labor Day
Indigenous Peoples' Day
Veterans Day
Thanksgiving Day
Christmas Day