Code of Massachusetts Regulations › 651 CMR - EXECUTIVE OFFICE OF ELDER AFFAIRS › Title 651 CMR 3.00 - Home Care Program Regulations › Section 3.02 - Definitions

Current through Register 1525, July 5, 2024
When used in
				651
				CMR 3.00, unless the context otherwise requires, the
				following terms shall have the following meanings:
Abuse
. Consistent with
				651 CMR 5.00:
Elder
				Abuse Reporting and Protective Services Program
, an act or omission,
				including emotional abuse, financial exploitation, neglect, physical abuse,
				sexual abuse, and/or self-neglect.
Activities of Daily Living (ADLs)
.
				Tasks, including the ability to bathe, dress/undress, eat, toilet, transfer in
				and out of bed or chair, move while in bed, and ambulate inside the home, and
				management of incontinence which are used to measure the Functional Impairment
				Level (FIL) of an Applicant or Consumer.
Applicant
. An individual who has
				applied for Home Care Program services.
ASAPs
. Aging Services Access Points as
				authorized in M.G.L. c. 19A, § 4B and defined in
				651 CMR 14.01:
Purpose and Scope
.
Assisted Living Residence
. An entity
				certified by Elder Affairs under
				651 CMR 12.00:
Certification Procedures and Standards for Assisted Living
				Residences
which provides room, board, and personal care services to
				residents.
Caregiver
. A person, regardless of
				place of residence, who is 18 years of age or older and provides assistance
				with Activities of Daily Living and/or Instrumental Activities of Daily Living,
				supervision, or social and emotional support as required by a Consumer on a
				daily basis without pay.
Comprehensive Service Plan
. A person
				centered plan of care that delineates all services and funding sources to be
				provided to a Consumer that is developed by an ASAP using EOEA guidelines in
				conjunction with the Consumer and/or the Consumer's Designated
				Representative.
Congregate Housing
. A joint program
				between Elder Affairs and the Department of Housing and Community Development
				that offers a shared living environment and integrates housing and support
				services.
Consumer
. An adult who is enrolled in
				a Home Care program.
Consumer Record
. An aggregate file of
				all documentation associated with a Consumer maintained by an ASAP in
				compliance with Documentation Standards. Documents requiring signature or that
				are otherwise unable to be recorded electronically shall be stored in a hard
				copy file for each Consumer.
Copayment
. A monthly dollar amount
				billed to a Consumer for Home Care Program Services based on the Consumer's
				income.
Designated Representative
. A person
				who is either:
(a) affirmatively identified and designated by the Consumer to
				share personal health information and provide assistance in making decisions
				related to the provision of Home Care Services, provided that the Consumer is
				competent; or
(b) a person serving as a durable power of attorney or as a
				guardian appointed by a court on behalf of a Consumer, regardless of the
				Consumer's competency.
Division of Medical Assistance (DMA)
.
				A government agency within the Executive Office of Health and Human Services
				that is responsible for the administration of the Title XIX (Medicaid) Program
				known as MassHealth.
Documentation Standards
. Standards
				issued by Elder Affairs regarding the procedures for gathering and maintaining
				Consumer information.
Elder Affairs
. The Executive Office of
				Elder Affairs.
Family
. An Applicant or Consumer and
				his or her spouse.
Frail Elder Home and Community Based
				Waiver
. A waiver of federal requirements granted to the
				Commonwealth, by the U.S. Department of Health and Human Services under
				42 U.S.C. §
									1396n(d), that allows DMA to
				pay for home and community-based services for MassHealth members who meet
				MassHealth criteria for Nursing Facility services but continue to reside in the
				community and agree to receive a waiver service.
Functional Impairment Level (FIL)
. The
				degree of functional impairment experienced by an Applicant or Consumer as
				evidenced by an inability to complete Activities of Daily Living and
				Instrumental Activities of Daily Living.
Home Care Program Services
. Services
				provided to a Consumer, including but not limited to the following:
(a)
Adult Day Health (ADH)
. Health
				care and supervision, restorative services, and socialization for elders who
				require skilled nursing or therapy, or assistance with Activities of Daily
				Living, nutrition, and personal care;
(b)
Alzheimer's Day Program
.
				Specialized day program services provided to address the needs of people with
				Alzheimer's Disease or related disorders;
(c)
Alzheimer's/Dementia Coaching
.
				Education and support to Consumers and their families who are experiencing the
				effects of Alzheimer's Disease or a dementia-related disorder;
(d)
Chore
. Services to maintain the
				home in a clean, sanitary and safe manner, including but not limited to minor
				home repairs, general maintenance, and heavy household chores such as washing
				floors, windows, and walls, and moving heavy items of furniture to provide safe
				access and egress;
(e)
Companion
. Non-medical services
				identified in the Comprehensive Service Plan, such as socialization, meal
				preparation, laundry, shopping, escort to appointments and light housekeeping
				tasks that are incidental to the care and supervision of the Consumer;
(f)
Emergency Shelter
. Temporary
				shelter not to exceed 14 calendar days in a six month period provided to an
				elder (and his or her household) who is without a home due to eviction, fire,
				flood, other natural disaster, Abuse, neglect, substance use disorder, economic
				incapacity, or unsafe/substandard housing conditions, including lack of fuel
				and/or utilities; (g)
Environmental Accessibility
				Adaptations
. Physical adaptations to the private residence of the
				Consumer and/or adaptive equipment as required by the Consumer's Comprehensive
				Service Plan;
(h)
Grocery Shopping/Delivery
				Services
. Ordering groceries, shopping for groceries, delivering
				groceries, and assisting with storage of groceries as needed;
(i)
Home Based Wandering Response
				System
. A device that transmits signals 24 hours per day/seven
				days per week using technology such as GPS or radio frequency to provide
				location assistance in the event the Consumer wanders;
(j)
Home-delivered Meals
. Meals
				provided to Consumers to maintain optimal nutrition and health status;
(k)
Home Delivery of Pre-packaged
				Medications.
Delivery of medications, including but not limited to
				pre-filled blister packs and pre-filled syringes by a pharmacy to a Consumer's
				residence;
(l)
Home Health Services
. Services
				defined in
				130 CMR
				403.000:
Home Health Agency
which
				include Skilled Nursing; Physical, Occupational, and Speech Therapy; and Home
				Health Aide;
(m)
Homemaker Services
. Services to
				assist a client with Instrumental Activities of Daily Living provided in
				accordance with homemaker standards issued by Elder Affairs.
(n)
Laundry
. Pick up, washing, drying,
				folding, wrapping, and/or returning of laundry;
(o)
Medication Dispensing System
.
				Provision of an automated medication dispenser that allows a Consumer to
				achieve adherence to medication requirements by receiving pill form medications
				at appropriate intervals through audible and/or visual cueing;
(p)
Nutritional Assessment
. A
				comprehensive nutritional assessment conducted by a qualified
				nutritionist;
(q)
Personal Care
. Hands-on
				assistance, prompting or cueing, and supervision to assist a Consumer to
				perform Activities of Daily Living provided in accordance with the Personal
				Care Guidelines issued by Elder Affairs;
(r)
Personal Emergency Response System
				(PERS)
. Provision of an electronic device which can be used to
				alert trained third-party staff of an emergency 24 hours per day/seven days per
				week;
(s)
Respite Care Services
. The
				provision of one or more other Home Care Program Services, additionally
				including but not limited to short term placements in Adult Foster Care,
				Skilled Nursing Facilities, or Rest Homes, to temporarily relieve a Caregiver
				in emergencies, or in planned circumstances, to relieve the Caregiver of the
				daily stresses and demands of caring for a Consumer;
(t)
Supportive Day Program
. Services
				provided in a group setting, including assessments and care planning,
				health-related services, social services, therapeutic activities, and
				nutrition;
(u)
Supportive Home Care Aide Services
. Services that comply with the Supportive Home Care Aid Standards issued by
				Elder Affairs, including personal care and/or homemaking, emotional support,
				socialization, and escort services to Consumers with Alzheimer's Disease, a
				dementia-related disorder, or emotional and/or behavioral problems;
(v)
Transitional Assistance
.
				Non-recurring expenses associated with the transition of individuals who are
				moving from an institutional or other provider-operated living arrangement to a
				living arrangement in a private residence in which the person is directly
				responsible for his or her own living expenses;
(w)
Transportation
. The provision of
				transportation to enable a Consumer to gain access to community services,
				activities and resources;
(x)
Vision Rehabilitation
. A service
				intended to evaluate the needs of persons who are visually impaired and
				instruct the visually impaired in the use of compensatory skills and aids that
				will support safe, productive, and independent living; and,
(y)
Wanderer Locator Service
. Payment
				for registration in a national database established to help track and locate
				those with dementia-related disorders who are at-risk of wandering and becoming
				lost.
Home Care Service Plan
. A plan of care
				that identifies all authorized Home Care Services.
Information and Referral Services
.
				Activities related to the maintenance and dissemination of current information
				regarding the services available to elders and individuals with disabilities.
				Such activities include assessments of the type of assistance needed, referral
				to appropriate services, and follow-up to determine whether the referrals
				accomplished the desired objectives. Information and Referral services may be
				conducted by mail, by telephone, electronically, or in person.
Instrumental Activities of Daily Living
				(IADLs)
. Basic tasks, including the ability to prepare meals, do
				housework, do laundry, go shopping, manage medication, ambulate outside the
				home, use transportation, manage money, and use the telephone, which are used
				to measure the Functional Impairment Level (FIL) of an Applicant or
				Consumer.
Interdisciplinary Case Management
. A
				person-centered approach to assessment, service acquisition, reassessment, and
				monitoring of services provided to Consumers to help them live independently
				and remain in the community. The approach includes working cooperatively,
				coordinating Comprehensive Service Plans and maintaining ongoing communication
				with the elder, family members, informal and formal supports, as necessary.
				Interdisciplinary Care Management is provided by registered nurses and case
				managers working in consultation with physicians, nurses and therapists from
				home health agencies, hospice providers, nutritionists, housing managers,
				mental health professionals, and other home and health care professionals and
				complies with the Interdisciplinary Case Management Standards issued by Elder
				Affairs.
Long Term Care (LTC) Assessment
. The
				process to determine eligibility for Home Care Program Services through the use
				of the comprehensive data set (CDS) assessment tool issued by Elder Affairs and
				used by the ASAPs.
MassHealth
. The Medical assistance
				program known as MassHealth administered by the Executive Office of Health and
				Human Services pursuant to M.G.L. c. 118E and Title XIX of the Social Security
				Act.
MassHealth Member
. An individual who
				has been determined eligible to receive benefits under MassHealth.
Medicaid
. The federal designation for
				eligibility and benefits administered under MassHealth.
Medication Management
. Services
				provided to a Consumer to help ensure adherence with medication requirements,
				including cueing and providing access to medications.
Notice of Action
. A procedural
				notification created in accordance with
				801 CMR 1.00:
Standard
				Adjudicatory Rules of Practice and Procedure
and
				651 CMR 1.00:
Adjudicatory Rules of Practice and Procedures
.
Nursing Facility
. A facility that is
				licensed to provide skilled nursing care to residents in accordance with the
				requirements of
				130 CMR
				456.000:
Long Term Care
				Services
.
Peer Review
. A process by which ASAPs
				convene in groups to review Consumer Records for the purpose of providing
				feedback to one another regarding how cases were handled and ensure more
				consistent operations among providers. The Peer Review process must be
				implemented according to Peer Review Program Instructions issued by Elder
				Affairs.
Program Instruction
. A document issued
				by Elder Affairs that sets forth required procedures and protocols for the
				management of the Home Care Program.
Protective Services
. Services provided
				by an Elder Protective Services Program in accordance with M.G.L. c. 19A,
				§§ 14 through 26 and
				651 CMR 5.00:
Elder
				Abuse Reporting and Protective Services Program
, which are deemed
				necessary to prevent, eliminate or remedy the effects of Abuse to an
				elder.
Provider
. An entity which has entered
				into a contract with an ASAP to provide one or more Home Care Program
				Services.
Service Priority
. A method used to
				prioritize Applicants to the Home Care Program which is based on an assessment
				of Critical Unmet Needs and Non-critical Unmet Needs.
Suspension
. The temporary cessation of
				Home Care Program Services.
Termination
. The permanent cessation
				of Home Care Program Services or Enrollment(s).
Unmet Need(s)
. The Applicant's or
				Consumer's identified care needs which are not being met by other sources
				available to the Consumer or Applicant as determined by the Long Term Care
				Assessment. Unmet Needs consist of two sub-categories:
(1)
Non-critical Unmet Needs
. Unmet
				Needs which include one or more of the following: laundry, housework, shopping
				other than food shopping, transportation other than transportation for medical
				treatment, socialization, and telephone use; or,
(2)
Critical Unmet Needs
. A Consumer's
				Unmet Needs which include one or more of the following: any Activity of Daily
				Living (ADL), meal preparation, grocery shopping, Medication Management,
				transportation for medical treatments, Respite Care Services, and Home Health
				Services.
Voluntary Copayment
. A copayment which
				may be contributed at the option of a Consumer.