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

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 advanced Alzheimer's disease or 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 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.