Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 356.00 - Rates For Money Follows The Person Demonstration Services › Section 356.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				356.00, unless the context requires otherwise, terms
				have the meanings in
				101
				CMR 356.02.
Assistive Technology
. Assistive
				technology includes:
(a) devices,
			 controls, or appliances, that enable an individual to increase their ability to
			 perform activities of daily living;
(b) devices, controls, or appliances that
			 enable an individual to perceive, control, or communicate with the community
			 environment in which they live;
(c)
			 items necessary for life support or to address physical conditions along with
			 ancillary supplies and equipment necessary to the proper functioning of such
			 items;
(d) such other durable and
			 non-durable medical equipment that is necessary to address an individual's
			 functional limitations; and
(e)
			 necessary medical supplies.
Service may also include: evaluations necessary for the
				selection, design, fitting or customization of assistive technology to meet the
				needs of the individual; customization, adaptation, fitting, set-up,
				maintenance or repairs of assistive technology; the temporary replacement of
				assistive technology; and, training or technical assistance with the use of
				assistive technology.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Community Engagement Navigation
.
				Outreach and support services to MFP Demonstration participants both as they
				prepare to transition out of facilities and after they have transitioned.
				Services may include:
(a)
			 accompaniment and transportation from facilities to community housing and
			 service options;
(b) supporting
			 service exploration and linkage; and
(c) assistance with connections to and
			 engagement with community services.
Demonstration Case Management
. A
				service that provides an individual with care coordination and assistance with
				obtaining necessary MFP Demonstration and MassHealth services, as well as other
				medical social, or educational services, regardless of the funding source, and
				that support the individual's ability to reside in a community setting.
				Demonstration Case Management includes:
(a) comprehensive assessments and periodic
			 reassessments of an individual to determine the need for any medical,
			 educational, social, or other services;
(b) development of a care plan that is based
			 on the comprehensive assessments;
(c) referral and related activities (such as
			 scheduling appointments) to help the individual obtain necessary services and
			 identified needs specified in his or her care plan;
(d) development of a back-up plan of care;
			 and
(e) monitoring and follow-up
			 activities that are necessary to ensure that the individual's care plan is
			 effectively implemented and adequately addresses the needs of the individual.
Executive Office of Health and Human Services
				(EOHHS)
. The executive agency within Massachusetts government that
				is the single state agency responsible for the administration of the MassHealth
				program (Medicaid), pursuant to M.G.L. c. 118E, Titles XIX and XXI of the
				Social Security Act, and other applicable laws and waivers thereto.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Individual Consideration (I.C)
.
				Payment rates for certain services are designated as Individual Consideration
				(I.C.). Where I.C. rates are designated, the purchasing governmental unit will
				determine the appropriate payment rate in accordance with the following
				standards and criteria:
(a) the amount
			 of time required to complete the service or item;
(b) the degree of skill required to complete
			 the service or item;
(c) the
			 severity or complexity of the service or item;
(d) the lowest price charged or accepted from
			 any payer for the same or similar service or item, including, but not limited
			 to any shelf price, sale price, advertised price, or other price reasonably
			 obtained by a competitive market for the service or item; and
(e) the established rates, policies,
			 procedures, and practices of any other purchasing governmental unit in
			 purchasing the same or similar services or items.
MassHealth
. The Medicaid program of
				the Commonwealth of Massachusetts, administered by EOHHS pursuant to M.G.L. c.
				118E, Titles XIX and XXI of the Social Security Act, and other applicable laws
				and waivers thereto.
Money Follows the Person
				Demonstration
. A MassHealth demonstration program authorized
				pursuant to a federal grant received by EOHHS that seeks to assist eligible
				MassHealth members residing in facility-based long term care settings to
				transition to a community-based setting, where they can receive home and
				community-based services.
Money Follows the Person Demonstration
				Services
. Services that are either allowable Medicaid services not
				currently included in the state's array of home and community-based services
				(HCBS) or qualified services above what would be available to non-MFP
				Demonstration Medicaid beneficiaries, and which include assistive technology,
				Community Engagement Navigation, and transitional assistance.
Money Follows the Person Demonstration Supplemental
				Services
. One-time services to support the transition of MFP
				Demonstration participants that are otherwise not allowable under the Medicaid
				program. Services address critical barriers to transition for MFP Demonstration
				participants, including the lack of affordable and accessible housing, food
				insecurity, and financial and administrative barriers to transitions.
Orientation and Mobility Services (O&M
				Services)
. Services that teach an individual with vision
				impairment or legal blindness how to move or travel safely and independently in
				his/her home and community and which include direct training, environmental
				evaluations and caregiver/direct care staff training on sensitivity to
				blindness/low vision. O&M Services are tailored to the individual's need
				and may extend beyond residential settings to other community settings as well
				as public transportation systems. There are three rates for Orientation and
				Mobility services. The three rates are based on the one-way distance traveled
				to initiate provision of the service: Level I for distances of one-30 miles;
				Level II for distances 31-60 miles and Level III for distances over 61
				miles.
Provider
. Any individual, group,
				partnership, trust, corporation or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been adopted by a purchasing governmental unit.
Reporting Year
. The Provider's fiscal
				year for which costs incurred are reported to the appropriate entity, as
				determined by EOHHS.
Transitional Assistance
. Non-recurring
				set-up expenses and short-term services necessary to facilitate an individual's
				transition from a facility-based long term care setting to the community.
				Allowable expenses are those that are necessary to enable a person to establish
				a basic household and do not constitute room and
				board.