Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 348.00 - Rates for Day Habilitation Services › Section 348.02 - Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
. Terms used in 101
				CMR 348.00, unless the context requires otherwise, have the meanings ascribed
				in 101 CMR 348.02.
Admission Services
. Services provided
				to ensure safe and appropriate care planning for day habilitation members
				enrolling in day habilitation services for the first time. This is a one-time
				only claim per MassHealth member ID.
Approved Rates
. The rates of payment
				that have been certified by EOHHS and filed with the Secretary of the
				Commonwealth. These rates govern payment for services under 101 CMR
				348.00.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Day Habilitation Program
. A
				structured, goal-oriented active treatment program of medically oriented,
				therapeutic, and habilitation services to raise recipients' levels of
				functioning and facilitate independent living and self-management in their
				communities.
Eligible Provider
. Any individual,
				partnership, corporation, or other entity that offers services for purchase by
				a governmental unit and that meets the conditions of purchase or licensure
				established under 130 CMR 419.000:
Day Habilitation Center
				Services
.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any department, agency, board or commission of the Commonwealth and any
				political subdivision of the Commonwealth.
Half
Per Diem
. Day
				habilitation services provided for a period equal to or less than three hours
				per day.
Individualized Support Services (ISS)
.
				One-to-one staff support services provided to members who require supplemental
				services in order to participate in DH. ISS requires prior authorization from
				MassHealth. The prior authorization process determines the total units of ISS
				that are medically necessary for the member to participate in DH.
				Individualized staffing supports must not be used to enhance general staffing
				in a DH program. One-to-one staff supports include direct care and
				nursing.
Monitor Transportation
. Transportation
				services provided when the member is accompanied by an escort to ensure safety
				due to signs and symptoms related to medical needs, including Alzheimer's
				disease and related dementias, or due to other known and verified behaviors
				related to mental health or developmental disability diagnoses.
Per Diem
. Day
				habilitation services provided for a period greater than three hours per
				day.
Publicly Aided Individual
. A person
				whose medical and other services a governmental unit is in whole or in part
				liable for under a statutory program.
Re-engagement Services
. Services
				provided to ensure successful re-engagement of members who have not received
				site-based services during the period of March 24, 2020, through June 30, 2023.
				This is a one-time only claim per MassHealth member ID on or after the
				45th day of service with sustainable re-engagement
				in site-based services.
Quarter
Per Diem
. Day
				habilitation services provided for a period equal to or less than 1½
				hours per day.
Transportation
. Method by which a
				member is brought from their home to the day habilitation provider or from the
				day habilitation provider to the member's home. Transportation service includes
				assisting the member while they enter and exit the vehicle, as appropriate. A
				member's home may include a temporary housing environment such as a shelter or
				transitional housing.
Wheelchair Transportation
.
				Transportation service provided to a member who requires a wheelchair.