Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 420.00 - Rates for Adult Long-term Residential Services › Section 420.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR 420.00, unless the
				context requires otherwise, terms have the meanings in 101 CMR 420.02.
Add-on Rate
. A rate that is intended
				to provide an additional, necessary service not included in the current
				programmatic model, which will be instituted at the discretion of the
				purchasing governmental unit.
ALTR Services
. Residential
				site-specific programs that provide adult clients a place of overnight housing
				for an extended period of time in a residential facility with necessary daily
				living, physical, social, and clinical and/or medical support, and that are not
				subject to licensure under M.G.L. c. 111, § 71.
Basic
. The category of ALTR service
				models for clients who need daily intervention, supervision, and skills
				training in activities of daily living, managing within a home environment, and
				community integration. Individuals may require some physical assistance or
				accommodation due to cognitive and/or intellectual disability, including a
				mild-to-moderate developmental delay.
Client
. An individual receiving ALTR
				services purchased by a governmental unit.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) is used when required.
Direct Care (DC) Staff Intensity
				Level
. The number of full-time equivalent (FTE) positions for
				direct care staff included in each program model. The DC staff intensity level
				reflects the sum of the FTEs for direct care workers, including overnight
				staffs.
Emergency Stabilization Residence
.
				This service provides temporary, flexible, and individualized services to
				adults in a facility or home-like environment. The program is designed for
				adults who are not able to be stabilized in their current family home or
				residential program due to behavioral, mental health, or other care issues. The
				program is available 24 hours a day/seven days a week. Provider billing for
				Emergency Stabilization Residence services utilizing rates under
				101 CMR 420.00 is pursuant
				to contract with the purchasing governmental unit and for dates of service on
				or after July 1, 2016.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Full-time Equivalent (FTE)
. Staff
				position equivalent to a full-time employee.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Intermediate
. The category of ALTR
				service models designed to meet the needs of clients with support need beyond
				the basic level. These program models include specialized staffing, training or
				additional skills for staff, and/or additional operational support when
				compared to basic. The selection of intermediate tier programs is based on
				client need for behavioral supports, enhanced supervision, or interventions
				designed to address multiple disabilities.
Medical/Clinical
. The category of ALTR
				service models that delivers additional supports, when compared to the
				intermediate models, through the utilization of direct nursing services and
				highly experienced or credentialed direct care staff. At the discretion of the
				purchasing governmental unit, medical/clinical level 1 may alternatively
				reflect programs where specialized behavioral/ clinical staff constitute a
				significant portion of the total staffing pattern. The intermediate models are
				used as the foundation for all medical models. For each intermediate model,
				there are three associated medical models, each reflecting the additional
				direct nursing resources available for the site.
Model
							 Type
Model Nursing
							 %
Eligible Nursing
							 %
Medical/Clinical Level 1
25
20-29
Medical Level 2
35
30-39
Medical Level 3
45
40+
New Program/Replacement Rate
. Rate for
				a new program site or replacement of an existing site.
Program
Per Diem
.
				Program service unit based on a 24-hour period of care.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been or may be adopted by a purchasing governmental
				unit.
Reporting Year
. The provider's fiscal
				year for which costs incurred are reported to the Operational Services Division
				on the UFR.
Service Model Rate
. A rate that
				includes the programmatic resources to provide the client focused direct care
				and support services, including consultants, materials and supplies, and
				administrative services attributed to the service portion of the program. It
				does not include the resources for provision of the physical space associated
				with the program and included in the site rate.
Site Rate
. A rate established by the
				purchasing governmental unit for the provision of the physical site housing the
				ALTR program which may include, but is not limited to, lease or rental
				payments, depreciation, interest associated with long-term debt, insurance on
				buildings, maintenance, electricity, heat, water, and meals. Lease payments to
				related parties must not exceed the cost of what the provider would pay if the
				provider directly owned the property.
Site Unit Cost
. The result of dividing
				the total annualized cost of a program's physical site for the period from July
				1, 2011 through June 30, 2012, by the product of the capacity times 365. The
				purchasing governmental unit will determine the total annualized cost of a
				program's physical site based on applicable line items in the UFR as determined
				by the purchasing governmental unit, and may approve adjustments to the site
				unit cost for unanticipated circumstances as determined by the purchasing
				governmental unit.