Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 408.000 - Adult Foster Care Services
Section 408.431 - Preadmission and Admission Procedures
Universal Citation: 130 MA Code of Regs 130.408
Current through Register 1531, September 27, 2024
(A) Preadmission Procedures and Activities.
(1)
Preadmission
Procedures. Before admitting a member in AFC, the AFC provider
must perform all of the activities in
130
CMR 408.431(A)(2). Intake
and assessment services are provided to members seeking admission to AFC but
who may have not yet received prior authorization by the MassHealth agency or
its designee, for AFC. The AFC provider must conduct a preadmission meeting
with the member, and if applicable or requested, the member's family, other
informal caregivers, and any other health or social service provider involved
in the member's care. The nurse must determine that the AFC provider is able to
meet all of the ADL and IADL needs of the member prior to admitting the member
to AFC, as well as use the meeting to obtain information about the member's
overall health characteristics, psychosocial condition, nutritional habits,
financial and health insurance information, housing situation, formal and
informal supports in place, and ethnic and cultural background. The AFC
provider must also use this meeting to inform the member and the member's
family about the scope of AFC to be provided and any other relevant
information;
(2)
Preadmission Activities. Prior to admitting the
member, the AFC provider must perform the following intake and assessment
services:
(a) conduct clinical evaluations of
the need for AFC;
(b) review and
approve AFC caregiver applicants;
(c) instruct members on the rules, policies,
and procedures of the AFC program;
(d) identify appropriate potential AFC
caregivers and qualified settings, including conducting on-site interviews in
the qualified setting;
(e) schedule
meetings with the member or responsible party and potential AFC
caregiver;
(f) match the member
with the most appropriate potential AFC caregiver;
(g) provide information on the member's
rights and responsibilities when receiving AFC services;
(h) provide instruction and initial training
of AFC caregivers; and
(i) schedule
the member's move-in date with the AFC caregiver in circumstances in which the
member is moving into the AFC caregiver's home.
(B) Admission Activities. Upon the AFC provider's receipt of the MassHealth agency's initial prior authorization authorizing the member to receive services and, by the end of the fifth day of service, the AFC provider must perform the following activities:
(1) Complete and submit
a written notification to the member and, if applicable, the member's legal
guardian. The notice must at a minimum specify the following:
(a) that the member has been admitted to
AFC;
(b) the member's interim AFC
plan of care, as outlined in
130
CMR 408.430(C)(1);
(c) the respective responsibilities of the
member and the member's family, the AFC provider, and the AFC
caregiver;
(d) emergency
procedures; and
(e) reasons for
discharge from the AFC provider.
(2) Create a member record. By the first day
of AFC, the AFC provider must obtain all the necessary documentation from the
member's PCP and other service providers on or before the first date of
service. The documentation must include
(a)
the PCP Summary Form and order for AFC that documents that the member has been
examined in the past 12 months and that the MassHealth member's condition
requires support with activities of daily living that is provided by the AFC
provider;
(b) the member's medical
history;
(c) results of a PCP visit
within the past three months; however if the PCP has completed a physical
examination in the past 12 months and there has been no change in the members
medical status, and the PCP has deemed a second physical is not medically
necessary, the PCP may document and sign such a statement on the PCP Summary
Form;
(d) results of a physical
examination given within the past 12 months. If the individual has been
hospitalized in the preceding three months, a complete discharge summary may be
used to fulfill the physical examination requirement;
(e) a list of current medications,
treatments, and other services provided;
(f) a statement of special dietary
requirements;
(g) a statement
indicating any contraindications or limitations to the individual's
participation;
(h) recommendations
for other services, if applicable; and
(i) a list of known allergies, if
any.
(3) Conduct on-site
visits according to the member's AFC service payment level.
(a) For members receiving AFC level I service
payment, the initial visit must be conducted on the first day of AFC and may be
conducted by the registered nurse, licensed practical nurse, or care
manager
(b) For members receiving
AFC level II service payment, the initial visit must be conducted on the first
day of AFC and must be conducted by the AFC provider's registered nurse or
licensed practical nurse. For the first month of service, weekly visits must be
made by the registered nurse or licensed practical nurse.
(4) Provide the member by day 30 a written
copy of the member's completed AFC plan of care.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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