Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 630.000 - Home- and Community-Based Services Waiver services › Section 630.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR 630.000 have the
				meanings given in 130 CMR 630.402, unless the context clearly requires a
				different meaning.
Acquired Brain Injury (ABI)
- all
				forms of brain injury that occurs after 22 years of age including, without
				limitation, brain injuries caused by external force, but not including
				Alzheimer's disease and similar neurodegenerative diseases of which the primary
				manifestation is dementia.
Acquired Brain Injury Home- and Community-based
				Services Waivers (ABI Waivers)
- home-and community-based services
				waivers approved by the Centers for Medicare and Medicaid Services (CMS) under
				§ 1915(c) of the Social Security Act for persons with acquired brain
				injury who are transitioning from long-stay facilities in the community. The
				two separate Acquired Brain Injury Waivers, each with different covered
				services and eligibility requirements are: the Acquired Brain Injury with
				Residential Habilitation (ABI-RH) Waiver and the Acquired Brain Injury
				Non-residential Habilitation (ABI-N) Waiver.
Activities of Daily Living (ADL)
-
				certain basic tasks required for daily living, including the ability to bathe,
				dress/undress, eat, toilet, transfer in and out of bed or chair, get around
				inside the home, and manage incontinence.
Adult Companion Service
- nonmedical
				care, supervision, and socialization provided to a participant. Companions may
				assist or supervise the participant with such light household tasks as meal
				preparation, laundry, and shopping.
Assisted Living Services
- services
				consist of personal care and supportive services (for example, homemaker,
				chore, personal care services, meal preparation) that are furnished to
				participants who reside in an assisted living residence (ALR) that meets all
				applicable requirements of
				42 CFR
				441.301(c)(4) (Home and
				Community-based Settings Rule), and include 24-hour on-site response capability
				to meet scheduled or unpredictable resident needs and to provide supervision,
				safety, and security. Services may also include social and recreational
				programs, and medication assistance (consistent with ALR certification and to
				the extent permitted under State law). Nursing and skilled therapy services are
				incidental rather than integral to the provision of Assisted Living Services.
				Intermittent skilled nursing services and therapy services may be provided to
				the extent allowed by applicable regulations.
Behavioral Health Diversionary
				Services
- services that are provided, as necessary and
				appropriate, to all Participants enrolled in the MFP waivers through the
				state's MassHealth managed behavioral health plan. Under the managed behavioral
				health plan, participants have access to mental health and substance use
				disorder services that are clinically appropriate alternatives to behavioral
				health inpatient services, or support a participant returning to the community
				following a 24-hour acute placement; or provide intensive support to maintain
				functioning in the community.
Chore
- an unusual or infrequent
				household maintenance task that is needed to maintain the participant's home in
				a clean, sanitary, and safe environment.
Chore
includes heavy household chores such as washing floors, windows, and walls;
				tacking down loose rugs and tiles; and moving heavy items of furniture in order
				to provide safe access and egress.
Community-based Day Supports
- a
				service designed to enable a participant to enrich their life and enjoy a full
				range of community activities by providing opportunities for developing,
				enhancing, and maintaining competency in personal, social interactions and
				community engagement. Community-based Day Supports uses a small group model to
				provide a flexible array of individualized supports through activities
				primarily in non-center-based settings separate from the participant's private
				residence or other residential living arrangement.
Community Behavioral Health Support and
				Navigation
- a service that provides outreach and support services
				to enable participants to access and utilize clinical behavioral health
				treatment services and other supports. Community Behavioral Health Support and
				Navigation services are staffed by paraprofessionals, supported by clinical
				supervision, and are designed to be maximally flexible in supporting
				participants to implement the goals in their plan of care and attain the skills
				and resources needed to successfully maintain community tenure.
Community Family Training
- a service
				designed to provide training and instruction about the treatment regimes,
				behavior plans, and the use of specialized equipment that support a participant
				in the community. Community family training may also include training in family
				leadership, support of self-advocacy and independence for the family member.
				The service enhances the skills of the family to assist the waiver participant
				to function in the community and at home.
Coverage Type
- a scope of services
				that are available to MassHealth members who meet specific eligibility
				criteria.
Day Services
- a structured,
				site-based, group program for participants that fosters community integration
				and offers assistance with the acquisition, retention, or improvement in
				self-help, socialization, and adaptive skills, and that takes place in a
				nonresidential setting separate from the participant's private residence or
				other residential living arrangement. Services often include assistance to
				learn ADLs and functional skills; language and communication training;
				compensatory, cognitive and other strategies; interpersonal skills;
				prevocational skills; and recreational and socialization skills.
Department of Developmental Services
				(DDS)
- the state agency within the Executive Office of Health and
				Human Services that is organized pursuant to M.G.L. c. 19B, to provide
				specialized services and supports to individuals with intellectual disabilities
				and developmental disabilities and to promote full and meaningful participation
				of the individuals as valued members of their communities.
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 the MassHealth
				agency.
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 or any
				legally responsible relative of the participant.
Fiscal Intermediary (FI)
- an entity
				under contract with EOHHS to perform employer-required tasks and related
				administrative tasks as described in
				130
				CMR 422.419(B).
Home Accessibility Adaptations
-
				physical modifications to the participant's home that are necessary to ensure
				the health, welfare, and safety of the participant or that enable the
				participant to function with greater independence in the home.
Home- and Community-based Services (HCBS)
				Waiver
- a federally approved program operated under §
				1915(c) of the Social Security Act that authorizes the U.S. Secretary of Health
				and Human Services to grant waivers of certain Medicaid statutory requirements
				so that a state may furnish home- and community-based services to certain
				Medicaid beneficiaries who need a level of care that is provided in a hospital,
				nursing facility, or Intermediate Care Facility for Individuals with
				Intellectual Disability (ICF/IID). For the purpose of
				130 CMR 630.000, Home-and
				Community-based Services Waiver refers to the two ABI waivers and the two MFP
				waivers.
Home Health Aide
- a person who
				performs certain personal care and other health-related services as described
				in
				130 CMR
				403.000:
Home Health Agency
.
Homemaker
- a person who performs
				light housekeeping duties (for example, cooking, cleaning, laundry, and
				shopping) for the purpose of maintaining a participant's household.
Independent Living Supports
- a
				service that ensures 24-hour, seven days per week access to supportive services
				for participants who have intermittent, scheduled and unscheduled needs for
				various forms of assistance, but who do not require 24-hour supervision. It
				provides participants with services and supports in a variety of activities
				such as: ADLs and instrumental activities of daily living (IADLs), support and
				companionship, emotional support and socialization. This service is provided by
				a site-based provider, and is available to participants who choose to reside in
				locations where a critical mass of individuals reside who require such support
				and where providers of such supports are available.
Individual Support and Community
				Habilitation
- regular or intermittent services designed to
				develop, maintain, and/or maximize the participant's independent functioning in
				self-care, physical and emotional growth, socialization, communication, and
				vocational skills, to achieve objectives of improved health and welfare and to
				the support the ability of the participant to establish and maintain a
				residence and live in the community.
Instrumental Activities of Daily Living
				(IADL)
- certain basic environmental tasks required for daily
				living, including the ability to prepare meals, do housework, laundry, and
				shopping, get around outside, use transportation, manage money, and use the
				telephone.
Legally Responsible Individual
- any
				person who has a duty under state law to care for another person including, but
				not limited to, a legal guardian or a spouse of a participant.
Massachusetts Rehabilitation Commission
				(MRC)
- the state agency within the Executive Office of Health and
				Human Services that is organized pursuant to M.G.L. c. 6, §§ 74
				through 84, to provide comprehensive services to individuals with disabilities,
				which maximize their quality of life and economic self-sufficiency. MRC
				accomplishes its work through multiple programs in its Community Living
				Division, the Disability Determination Service Division and the Vocational
				Rehabilitation Division.
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 for eligible
				members.
Money Follows the Person Demonstration (MFP
				Demonstration)
- a MassHealth demonstration program authorized
				through 2016 pursuant to a federal grant received by EOHHS that seeks to assist
				eligible Members residing in institutional long term care settings to
				transition to community-based settings where they can receive home and
				community-based services.
Money Follows the Person Waivers (MFP
				Waivers)
- two Massachusetts Home and Community-based Services
				Waivers for persons participating in the MFP Demonstration and other qualified
				individuals and approved by the CMS under § 1915(c) of the Social Security
				Act. Massachusetts operates two separate MFP Waivers - the Money Follows the
				Person Residential Supports (MFP-RS) waiver and the Money Follows the Person
				Community Living (MFP-CL) waiver - each with different covered services and
				eligibility requirements.
Moving Forward Plan Waivers (MFP
				Waivers)
- two Massachusetts Home- and Community-based Services
				Waivers approved by the CMS under § 1915(c) of the Social Security Act for
				persons with disabilities who are transitioning from long-stay facilities.
				Massachusetts operates two separate MFP Waivers - the Moving Forward Plan
				Residential Supports (MFP-RS) Waiver and the Moving Forward Plan Community
				Living (MFP-CL) Waiver - each with different covered services and eligibility
				requirements. The Moving Forward Plan Waivers were formerly named the Money
				Follows the Person Waivers, and any reference to "Money Follows the Person
				Waivers" should be given the same effect as if it read "Moving Forward Plan
				Waivers," unless the context requires otherwise.
Occupational Therapist
- a person who
				is licensed by the Massachusetts Division of Registration in Allied Health
				Professions and registered by the American Occupational Therapy Association
				(AOTA) or is a graduate of a program in occupational therapy approved by the
				Committee on Allied Health Education and Accreditation of the American Medical
				Association and engaged in the supplemental clinical experience required before
				registration by AOTA.
Occupational Therapy
- therapy
				services, including diagnostic evaluation and therapeutic intervention,
				designed to improve, develop, correct, rehabilitate, maintain, or prevent the
				worsening of functions that affect the activities of daily living that have
				been lost, impaired, or reduced as a result of acute or chronic medical
				conditions, congenital anomalies, or injuries. Occupational therapy programs
				are designed to improve quality of life by recovering competence and preventing
				further injury or disability, and to improve the individual's ability to
				perform tasks required for independent functioning, so that the individual can
				engage in activities of daily living. Occupational therapy services may include
				the performance of a maintenance program beyond the scope of coverage in the
				state plan. Services may also include training and oversight for the
				participant or a family member or other person to carry out a maintenance
				program.
Orientation and Mobility
- services
				that teach a participant with vision impairment or legal blindness how to move
				or travel safely and independently in their home and community and which
				include participant training, environmental evaluations and caregiver/direct
				care staff training on sensitivity to blindness/low vision. Orientation and
				Mobility Services are tailored to the participant's need and may extend beyond
				residential settings to other community settings as well as public
				transportation systems.
Participant
- a MassHealth member
				determined by the MassHealth agency to be eligible for enrollment in one of the
				HCBS waivers, who chooses to receive HCBS waiver services, and for whom a
				service plan has been developed that includes one or more HCBS waiver
				services.
Peer Support
- ongoing services and
				supports designed to assist participants to acquire, maintain or improve the
				skills necessary to live in a community setting. This service provides supports
				necessary for the participant to develop the skills that enable them to become
				more independent, integrated into, and productive in their communities. The
				service enables the participant to retain or improve skills related to personal
				finance, health, shopping, use of community resources, community safety, and
				other adaptive skills needed to live in the community.
Personal Care
- services provided to a
				participant, which may include physical assistance, supervision or cuing of
				participants, for the purpose of assisting the participant to accomplish
				activities of daily living (ADLs) including, but not limited to, eating,
				toileting, dressing, bathing, transferring, and ambulation.
Physical Therapist
- a person licensed
				by the Massachusetts Division of Registration in Allied Health Professions to
				provide physical therapy.
Physical Therapy
- therapy services,
				including diagnostic evaluation and therapeutic intervention, designed to
				improve, develop, correct, rehabilitate, maintain, or prevent the worsening of
				physical functions that have been lost, impaired, or reduced as a result of
				acute or chronic medical conditions, congenital anomalies, or injuries.
				Physical therapy emphasizes a form of rehabilitation focused on treatment of
				dysfunctions involving neuromuscular, musculoskeletal,
				cardiovascular/pulmonary, or integumentary systems through the use of
				therapeutic interventions to optimize functioning levels. Physical therapy
				services may include the performance of a maintenance program beyond the scope
				of coverage in the state plan. Services may also include training and oversight
				for the participant or a family member or other person to carry out a
				maintenance program.
Prevocational Services
- a service
				that consists of a range of learning and experiential type activities that
				prepare a participant for paid or unpaid employment in an integrated, community
				setting. Services are not job-task oriented but instead, aimed at a generalized
				result (
e.g
., attention span, motor skills). The service may
				include teaching such concepts as attendance, task completion, problem solving
				and safety as well as social skills training, improving attention span, and
				developing or improving motor skills. Basic skill-building activities are
				expected to specifically involve strategies to enhance a participant's
				employability in integrated, community settings.
Provider Agreement
- the contract
				between the MassHealth agency and a person or organization under which the
				provider agrees to furnish services to MassHealth members in compliance with
				state and federal Title XIX requirements. Federal regulations concerning
				provider agreements are located in
				42 CFR §
									431.107.
Residential Family Training
- a
				service designed to provide training and instruction about treatment regimes,
				behavior plans, and the use of specialized equipment that support a participant
				in the community. Residential family training may also include training in
				family leadership, support of self-advocacy, and independence for the family
				member. The service enhances the skill of the family to assist the waiver
				participant to function in the community and at home when the waiver
				participant visits the family home.
Residential Habilitation
- ongoing
				services and supports provided to a participant in a provider-operated
				residential setting that are designed to assist participants in acquiring,
				maintaining, or improving the skills necessary to live in a community setting.
				Residential habilitation provides participants with daily staff intervention
				including care, supervision, and skills training in activities of daily living,
				home management, and community integration in a qualified residential setting
				with 24-hour staffing. This service may include the provision of medical and
				health-care services that are integral to meeting the daily needs of
				participants.
Respite Services
- services provided
				to individuals unable to care for themselves; furnished on a short-term basis
				because of the absence or need for relief of unpaid caregivers.
Room and Board
- the term
room
means shelter-type expenses, including all
				property-related costs, such as rental or purchase of real estate, maintenance,
				utilities, and related administrative services. The term
board
means up to three meals a day or any other full
				nutritional regimen.
Self-directed Services
- a model of
				service delivery in which a waiver participant has decision making authority
				over certain aspects of the delivery of their care.
Service Plan
- a written document that
				specifies the waiver and other services (regardless of funding source) along
				with any informal supports that are furnished to meet the participant's needs
				and goals, as assessed and identified through a person-centered planning
				process, and to assist a participant in remaining in the community.
Service Plan
is also known as the individual service
				plan and can include the waiver plan of care.
Shared Home Supports
- an individually
				tailored supportive service that assists with the acquisition, retention, or
				improvement in skills related to living in the community. A participant is
				matched with a shared home supports caregiver. Shared home supports are
				overseen by a residential support agency. Shared home supports do not include
				24-hour care. Shared home supports include such supports as: adaptive skill
				development, assistance with ADLs and IADLs, adult educational supports, social
				and leisure skill development, and supervision.
Shared Living - 24 Hour Supports
- a
				residential service that matches a participant with a shared living caregiver.
				Shared living - 24 hour supports are overseen by a residential support agency.
				Shared living is an individually tailored 24-hour, seven days per week,
				supportive service available to a participant who needs daily structure and
				supervision. Shared living includes supportive services that assist with the
				acquisition, retention, or improvement of skills related to living in the
				community. This includes such supports as: adaptive skill development,
				assistance with ADLs and IADLs, adult educational supports, social and leisure
				skill development, protective oversight and supervision.
Short-term Alternative Shared Home Support
				Days
- a short-term placement during which a member receives
				shared home supports from an alternative caregiver when the shared home
				supports caregiver is temporarily unavailable or unable to provide care.
Short-term Alternative Shared Living - 24 Hour
				Support Days
- a short-term placement during which a member
				receives shared living - 24 hour supports from an alternative caregiver when
				the shared living - 24 hour supports caregiver is temporarily unavailable or
				unable to provide care.
Skilled Nursing Services
- the
				assessment, planning, provision, 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. Skilled nursing services are provided by a person licensed as a
				registered nurse or a licensed practical nurse by a state's board of
				registration in nursing.
Specialized Medical Equipment and
				Supplies
- devices, controls, or appliances to increase abilities
				in activities of daily living, or to control or communicate with the
				environment.
Speech/Language Therapist
- a person
				who is licensed by the Massachusetts Division of Registration in
				Speech-language Pathology and Audiology and has either a Certificate of
				Clinical Competence from the American Speech-Language-Hearing Association
				(ASHA) or a statement from ASHA of certification equivalency.
Speech/Language Therapy
- therapy
				services, including diagnostic evaluation and therapeutic intervention, that
				are designed to improve, develop, correct, rehabilitate, maintain, or prevent
				the worsening of speech/language communication and swallowing disorders that
				have been lost, impaired, or reduced as a result of acute or chronic medical
				conditions, congenital anomalies or injuries. Speech therapy services may
				include the performance of a maintenance program beyond the scope of coverage
				in the state plan. Services may include training and oversight for the
				participant or a family member or other person to carry out a maintenance
				program.
Supported Employment
- regularly
				scheduled services that enable participants, through training and support, to
				work in integrated work settings in which individuals are working toward
				compensated work, consistent with the strengths, resources, priorities,
				concerns, abilities, capabilities, interests, and informed choice of the
				individuals.
Supportive Home Care Aide
- services
				provided to participants with Alzheimer's/dementia or behavioral health needs
				to assist with ADLs and IADLs. These services include personal care, shopping,
				menu planning, meal preparation including special diets, laundry, light
				housekeeping, escort, and socialization /emotional support.
Transitional Assistance
- nonrecurring
				residential set-up expenses for participants who are transitioning from a
				nursing facility or hospital to a community living arrangement where the
				participant is directly responsible for their own set-up expenses. Allowable
				expenses are those that are necessary to enable a person to establish a basic
				household and do not constitute Room and Board.
Transportation Service
- conveyance of
				participants by vehicle, from their residence to and from the site of HCBS
				waiver services and other community services, activities, and resources,
				including physical assistance to participants while entering and exiting the
				vehicle.
Tuberculosis Screening
-
				administration of the Massachusetts Tuberculosis Risk Assessment published by
				the Massachusetts Department of Public Health or a similar tool by a medical
				provider to identify asymptomatic individuals for testing for latent
				tuberculosis infection.
Vehicle Modification
- necessary
				adaptations or alterations to an automobile or van that is the participant's
				primary means of transportation and that is not owned or leased by an entity
				providing services to the participant. Vehicle modifications are necessary when
				they are required to accommodate special needs of the participant. Examples of
				vehicle modifications include: van lift, tie downs, ramp, specialized seating
				equipment and seating/safety restraint.
Visit
- a face-to-face personal
				contact with the participant for the purpose of providing an HCBS waiver
				service.
Waiver Provider
- a qualified
				individual or organization that meets the requirements of
				130 CMR 630.000, provides
				waiver services to participants, and has signed a provider agreement with the
				MassHealth agency.
Waiver Services
- home- and
				community-based services that are covered in accordance with the requirements
				of
				130 CMR 630.000 for
				participants enrolled under an ABI waiver or MFP waiver.