Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 408.000 - Adult Foster Care Services › Section 408.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130
				CMR 408.403 through
				408.438 have the meanings
				given in
				130
				CMR 408.402, unless the context clearly
				requires a different meaning. Payment for services defined in 130 CMR 408.000
				is not determined by these definitions, but by application of regulations
				elsewhere in 130 CMR 408.000 and 450.000:
Administrative and Billing
				Regulations
.
Activities of Daily Living (ADLs)
-
				fundamental personal-care tasks performed daily as part of an individual's
				routine of self-care. ADLs include, but are not limited to, eating, toileting,
				dressing, bathing, transferring, and mobility/ambulation.
Adult Foster Care (AFC)
- a service
				ordered by a primary care provider delivered to a member in a qualified setting
				as described in
				130
				CMR 408.435 by a multidisciplinary team (MDT)
				and qualified AFC caregiver, that includes assistance with ADLs and IADLs,
				nursing oversight, and AFC care management, as described in
				130
				CMR 408.415(C).
AFC Alternative Caregiver Days
- a
				short-term period during which a member receives AFC in a qualified setting
				from an alternative caregiver when the AFC caregiver is temporarily unavailable
				or unable to provide care.
AFC Caregiver
- a person who lives
				with the AFC member and paid by the AFC provider for the provision of direct
				care in accordance with
				130
				CMR 408.415 (A).
AFC Community Support Specialist
- a
				public health worker qualified in accordance with
				130
				CMR 408.433(D)(1) who
				applies their unique understanding of the experience, language, or culture of
				the populations they serve in order to carry out their responsibilities in
				AFC-qualified settings.
AFC Intake and Assessment Services
-
				preadmission services provided to a member seeking admission to an AFC program
				for AFC as described in
				130
				CMR 408.431(A)(2).
AFC Level I Service Payment
- a rate
				established by the MassHealth agency for members who meet the requirements of
				130
				CMR 408.419(D)(1).
AFC Level II Service Payment
- a rate
				established by the MassHealth agency for members who meet the requirements of
				130
				CMR 408.419(D)(2).
Alternative Caregiver
- a person who
				meets all of the qualifications of an AFC caregiver and provides AFC to the
				member in a qualified setting in the absence of the AFC caregiver.
Assisted Living Residence (ALR)
- any
				entity that meets the requirements for certification pursuant to M.G.L. c. 19D,
				and 651 CMR 12.00:
Certification Procedures and Standards for Assisted
				Living Residences
.
Clinical Assessment
- the screening
				process of cataloging a member's need for AFC using a tool designated by the
				MassHealth agency and that forms the basis for prior authorization.
Clinical Evaluations
- nursing, fall
				risk, nutritional, skin, and other clinical or psychosocial evaluations
				conducted by the MDT that serve as the basis for the development of the AFC
				plan of care.
Executive Office of Health and Human Services
				(EOHHS)
- the Executive Office of Health and Human Services
				established under M.G.L. c. 6A.
Family Member
- a spouse, parent of a
				minor member, including adoptive parent, or any legally responsible relative of
				the member.
Hospital
- a facility that is licensed
				or operated as a hospital by the Massachusetts Department of Public Health
				(DPH) or the Massachusetts Department of Mental Health (DMH) that provides
				diagnosis and treatment on an inpatient or outpatient basis for patients who
				have any of a variety of medical conditions.
Instrumental Activities of Daily Living
				(IADLs)
- activities related to independent living that are
				incidental to the care of the member and that include, but are not limited to,
				household-management tasks, laundry, shopping, housekeeping, meal preparation
				and cleanup, transportation (accompanying the member to medical providers and
				other appointments), care and maintenance of wheelchairs and adaptive devices,
				medication management and any paperwork required for receiving prescribed
				medications within the qualified setting, or any other medical need determined
				by the AFC provider as being instrumental to the health care and general
				well-being of the member.
Intermediate Care Facilities for Individuals with
				Intellectual Disabilities (ICF/IID)
- a facility, or distinct part
				of a facility, that provides intermediate care facility services as defined
				under 42 CFR §
									440.150, and that meets federal conditions of
				participation, and is licensed by the state primarily for the diagnosis,
				treatment, or rehabilitation for individuals with intellectual disabilities;
				and provides, in a protected residential setting, ongoing evaluation, planning,
				24-hour supervision, coordination, and integration for health or rehabilitative
				services to help individuals function at their greatest ability.
MassHealth
- the medical assistance
				and benefit programs administered by EOHHS pursuant to Title XIX of the Social
				Security Act (42 U.S.C.
				1396), Title XXI of the Social Security Act
				(42 U.S.C.
				1397), M.G.L. c. 118E, and other applicable
				laws and waivers to provide and pay for medical services to eligible
				members.
Medical Leave of Absence (MLOA)
- a
				short-term absence from an AFC-qualified setting, during which a member does
				not receive AFC services because the member is temporarily admitted to a
				hospital, nursing facility, or other medical setting.
Member
- a person determined by the
				MassHealth agency to be eligible for MassHealth.
Multidisciplinary Professional Team
				(MDT)
- a team employed or contracted by the provider, including,
				but not limited to, a program director, a registered nurse, or a licensed
				practical nurse; and a care manager; and which may also include an AFC
				community support specialist, who works in conjunction with the AFC
				caregiver.
Nonmedical Leave of Absence (NMLOA)
-
				a short-term absence from an AFC-qualified setting, during which a member does
				not receive AFC services for nonmedical reasons.
Nursing Facility
- an institution (or
				a distinct part of an institution) that is primarily engaged in providing
				skilled nursing care and related services for residents who require medical or
				nursing care, rehabilitation services for the rehabilitation of injured people,
				people with disabilities, or sick persons, or on a regular basis,
				health-related care and services to individuals who, because of their mental or
				physical condition require care and services that meet the requirements of
				Sections 1919(a), through (d) of the Social Security Act, and is licensed under
				and certified by the Massachusetts Department of Public Health.
Plan of Care
- a person-centered,
				written plan based on clinical and psychosocial evaluations, describing
				activities to meet a member's medical, physical, emotional, and social needs
				and goals for AFC.
Provider
- an organization that meets
				the requirements of
				130
				CMR 408.404 and contracts with MassHealth as
				the provider for AFC.
Primary Care Provider (PCP)
- a
				physician or a physician assistant or nurse practitioner who operates under the
				supervision of a physician.
Primary Care Provider (PCP) Summary
				Form
- the form that a PCP uses to order AFC.
Qualified Setting
- a location for the
				provision of AFC that meets all of the standards described in
				130
				CMR 408.435.
Resident Care Facility
- a facility or
				distinct units licensed as a level IV by the DPH under 105 CMR 150.000:
Licensing of Long-term Care Facilities
that are not certified
				to participate in Medicare or Medicaid and that provides a protective living
				environment and minimum basic care.
Significant Change
- a major change in
				the member's status that
(1) is
			 permanent;
(2) impacts more than
			 one area of the member's health status; and
(3) requires a multidisciplinary review or
			 revision of the care plan. A significant change is presumed when a member
			 authorized to receive AFC services does not receive AFC services for 90 days or
			 more, or when the provider is seeking a change in service amount or payment
			 level.