Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 414.000 - Independent Nurse › Section 414.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130
				CMR 414.000 have the meanings given in 130 CMR 414.402
				unless the context clearly requires a different meaning. The reimbursability of
				services defined in 130 CMR 414.402 is not determined by these definitions, but
				by the application of regulations elsewhere in
				130
				CMR 414.000 and
				450.000:
Administrative and Billing Regulations.
Calendar Week
- seven consecutive days
				beginning Sunday at midnight and ending Saturday at 11:59 P.M.
Care Management
- a function performed
				by the MassHealth agency or its designee that assesses and reassesses the
				medical needs of complex-care members and authorizes or coordinates community
				long-term-care (CLTC) services that are medically necessary for such members to
				remain safely in the community.
Certification Period
- a period of no
				more than 60 days for which the member's physician has certified that the plan
				of care is medically appropriate and necessary.
Clinical Manager
- a registered nurse
				employed by the MassHealth agency or its designee, who performs the in-person
				assessment of a member for MassHealth coverage of continuous skilled nursing
				(CSN) services and, if it is determined that CSN services are medically
				necessary, coordinates authorization of medically necessary community
				long-term-care (CLTC) services for the member.
Community Long-term-care (CLTC)
				Services
- certain MassHealth-covered services intended to enable
				a member to remain in the community. Such services include, but are not limited
				to, home health, durable medical equipment, oxygen and respiratory equipment,
				personal-care attendant, and other health-related services as determined by the
				MassHealth agency or its designee.
Complex-care Member
- a MassHealth
				member whose medical needs, as determined by the MassHealth agency or its
				designee, are such that he or she requires a nurse visit of more than two
				continuous hours of nursing services to remain in the community.
Continuous Skilled Nursing (CSN)
				Services
- a nurse visit of more than two continuous hours of
				nursing services.
Co-vending
- an arrangement through
				which a member's CSN services are provided by one or more home health agencies
				or independent nurses, with each provider possessing its own MassHealth prior
				authorization to provide nursing services to the member.
Home Health Agency
- a public or
				private organization that provides nursing and other therapeutic services to
				individuals whose place of residence conforms to the requirements of
				42 CFR
				440.70(c). Home health
				agency providers are governed by MassHealth regulations at
				130 CMR
				403.000:
Home Health Agency
				Services.
Household
- a place of residence where
				two or more people are living that is a group home, a residential care home, or
				other group living situation; at the same street address if it is a single
				family house that is not divided into apartments or units; or at the same
				apartment number or unit number if members live in a building that is divided
				into apartments or units.
Independent Nurse
- a licensed nurse
				who independently enrolls as a provider in MassHealth to provide CSN services.
				Independent nurse providers are governed by
				130
				CMR 414.000.
Medical History
- a component of the
				member's medical record that provides a summary of all health-related
				information about the member. A history includes, but is not limited to,
				medical and nursing-care histories as well as summaries of physician physical
				examination and nursing-assessment results.
Medical Record
- documentation,
				maintained by the independent nurse, that includes medical history, nursing
				progress notes, the member's plan of care, and other information related to the
				member.
Medical Records Release Form
- a
				signed authorization from the member or the member's parent or legal guardian
				if the member is a minor that allows the designated releasee to access the
				member's confidential health information from other health-care
				providers.
Nurse
- a person licensed as a
				registered nurse or a licensed practical nurse by a state's board of
				registration in nursing.
Nursing Progress Notes
- a component
				of the medical record that indicates the outcome of nursing
				interventions.
Nursing Services
- the assessment,
				planning, intervention, and evaluation of goal-oriented nursing care that
				requires specialized knowledge and skills acquired under the established
				curriculum of a school of nursing approved by a board of registration in
				nursing. Such services include only those services that require the skills of a
				nurse.
Primary Caregiver
- the individual,
				other than the nurse, who is primarily responsible for providing ongoing care
				to the member.