Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services
Section 361.02 - General Definitions

Current through Register 1518, March 29, 2024

As used in 101 CMR 361.00, terms have the meanings set forth in 101 CMR 361.02, unless the context requires otherwise.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Complex Care Assistant. A person who is employed or contracted by a CSN agency and meets the qualifications of a complex care assistant to perform certain health-related services as described in 130 CMR 438.415(C): Recordkeeping.

Continuous Skilled Nursing (CSN) Agency. A public or private organization that meets the requirements of 130 CMR 438.000: Continuous Skilled Nursing Agency and provides CSN agency services to complex care members within the member's home.

Continuous Skilled Nursing (CSN) Agency Services. CSN services and complex care assistant services as described in 130 CMR 438.402: Definitions and delivered to MassHealth-eligible members. For details on requirements, see 130 CMR 438.000: Continuous Skilled Nursing Agency.

Continuous Skilled Nursing (CSN) Services. Skilled nursing care provided by a licensed nurse to complex care members who require more than two continuous hours of nursing services per day and as defined in 130 CMR 438.000: Continuous Skilled Nursing Agency.

Eligible Provider. An individual practitioner or an organization that meets such conditions of participation as have been or may be adopted by a governmental unit purchasing CSN or CSN agency services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts and any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Home Health Agency. An organization that meets the requirements of 130 CMR 403.000: Home Health Agency to provide home health services, including continuous skilled nursing.

Individual Practitioner. An RN or licensed practical nurse (LPN), who directly provides authorized continuous skilled nursing services and who bills independently for professional services rendered as defined in 130 CMR 414.402: Independent Nurse.

Provider Agency. A partnership, corporation, or other entity, other than an individual, that provides authorized CSN agency services, as defined in 101 CMR 361.02: Continuous Skilled Nursing (CSN) Agency Services, by an RN, LPN, or complex care assistant (as applicable) who is its employee.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or part liable under a statutory program.

Reasonable Costs. Those reasonable and necessary costs incurred by an eligible provider of CSN, subject to the requirements and limitations of 101 CMR 361.00. In determining the reasonableness of costs, EOHHS may consider the particular services offered, the introduction of efficiency measures, the requirements for staffing, and the costs of providing comparable service.

Security/Escorts. The provision of security services to direct care personnel in the performance of a reimbursable home health visit.

Sixty-day Supervisory Visit (60-day Supervisory Visit). The 60-day supervisory visit conducted by an RN and described in 130 CMR 438.415(C)(5)(c), made to the member's home in order to observe and assess the complex care assistant while they are performing care. A reassessment of the member's needs may be done at this time.

Weekday. The hours from 7:00 A.M. to 3:00 P.M., Monday through Friday.

Weekend and Nights.