Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 408.000 - Adult Foster Care Services › Section 408.502 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130
				CMR 408.503 through
				408.527 have the meanings
				given in130 CMR 408.502, 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 130 CMR 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.
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 GAFC 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 GAFC
				plan of care.
Electronic Visit Verification (EVV)
-
				the method or system designated or approved by EOHHS to electronically verify
				service delivery in the form and format as required by EOHHS.
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.
Group Adult Foster Care (GAFC)
- a
				service ordered by a PCP delivered to a member in a member's home by a MDT and
				a qualified GAFC direct care aide, that includes assistance with ADLs and
				IADLs, nursing oversight and care management, as described under
				130
				CMR 408.505.
GAFC Direct Care Aide
- a person who
				is employed or contracted by a GAFC provider and meets the qualifications and
				responsibilities provided in
				130
				CMR 408.524(C).
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)
- a 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 member's residence, or any other medical need determined
				by the 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.
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.
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 GAFC.
Provider
- an organization that meets
				the requirements of
				130
				CMR 408.504 and contracts with MassHealth as
				the provider for GAFC.
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 GAFC.
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 services does not receive services for 90 days or more,
			 or when the provider is seeking a change in service amount or payment
			 level.