Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 310.00 - Rates for Adult Day Health Services › Section 310.02 - General Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				310.00, terms have the meanings set forth in
				101
				CMR 310.02.
Adult
. Any person 18 years of age or
				older.
Adult Day Health Services
. Programs
				approved by the MassHealth agency under
				130 CMR
				404.000:
Adult Day Health Services
and that provide for adult recipients an alternative to 24-hour long-term
				institutional care through an organized program of health care and supervision,
				restorative services and socialization.
Admission Services
. Services provided
				to ensure safe and appropriate care planning for adult day health members
				enrolling in adult day health services for the first time. This is a one-time
				only claim per MassHealth member ID.
Basic Level of Care
. The level of care
				for publicly aided clients receiving adult day health services as defined in
				130
				CMR 404.402:
Basic Payment
				Level
.
Center
. The Center for Health
				Information and Analysis (CHIA) established under M.G.L. c. 12C.
Complex Level of Care
. The level of
				care for publicly aided clients receiving adult day health services as defined
				in 130 CMR 404.402:
Complex Payment Level
.
Day Setting
. Any single physical
				facility that is open at least Monday through Friday for eight hours per day
				that has been reviewed and approved by the MassHealth agency and other proper
				authorities for the operation of adult day health services program.
Eligible Provider
. Any person,
				partnership, corporation, or other entity that is authorized in the
				Commonwealth of Massachusetts to engage in the business of furnishing adult day
				health services to the public and who also meets such conditions of
				participation as may be adopted by a governmental unit.
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.
Non-wheelchair Transportation
.
				Transportation services provided by a motor vehicle for members who are
				ambulatory and can be transported on a van while seated in a bench or single
				seat passenger chair.
Partial
Per Diem
.
				Adult day health services provided for a period equal to or less than three
				hours per day.
Per Diem
. Adult day
				health services provided for a period greater than three hours per day.
				MassHealth will not pay for services that exceed six hours per day.
Publicly Aided Individual
. A person
				whose medical and other services a governmental unit is in whole or 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.
Restorative Services
. Indirect
				services including, but not limited to, case conferences or those of an
				in-service educational therapist, speech pathologist, or other qualified
				restorative therapist.
Transportation
. Method by which a
				member is brought from their home to the adult day health provider or from the
				adult day health 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.