Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 408.000 - Adult Foster Care Services
Section 408.506 - GAFC Clinical Eligibility Criteria
Universal Citation: 130 MA Code of Regs 130.408
Current through Register 1531, September 27, 2024
A member must meet the following clinical eligibility criteria for receipt of GAFC:
(A) GAFC has been ordered by the member's PCP; and
(B) The member has a medical or mental condition that requires daily assistance with at least one of the ADLs described at 130 CMR 408.506(C). Such assistance must be either:
(1) hands-on
(physical) assistance, or
(2)
cueing and supervision throughout the entire ADL.
(C) The following activities constitute ADLs applicable to GAFC eligibility:
(1)
bathing: a full-body bath or shower or a sponge
(partial) bath which must include washing and drying of face, chest, axillae
(underarms), arms, hands, abdomen, back and peri-area that may include personal
hygiene such as combing or brushing of hair, oral care (including denture care
and brushing of teeth), shaving, and, when applicable, applying
make-up;
(2)
dressing: upper and lower body, including street
clothes and undergarments, but not solely help with shoes, socks, buttons,
snaps, or zippers;
(3)
toileting: member is incontinent (bladder or bowel) or
requires assistance or routine catheter or colostomy care;
(4)
transferring:
member must be assisted or lifted to another position;
(5)
mobility
(ambulation): member must be physically steadied, assisted, or
guided during ambulation indoors and outdoors, or is unable to self-propel a
wheelchair appropriately without the assistance of another person;
and
(6)
eating: if the member requires constant supervision
and cueing during the entire meal, or physical assistance with consuming a
portion or all of the meal.
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