Code of Massachusetts Regulations
651 CMR - EXECUTIVE OFFICE OF ELDER AFFAIRS
Title 651 CMR 14.00 - Aging Service Access Points
Section 14.01 - Purpose and Scope

(1) The legislative and administrative authorizations for 651 CMR 14.00 are as follows:

(2) The Definitions set forth in 651 CMR 14.00 and as used in 651 CMR 3.00 shall have the stated meaning, unless the context requires otherwise.

Adult Day Health (ADH) - Services provided by an Adult Day Health program approved for operation by the Division of Medical Assistance and operating in accordance with 130 CMR 404.000 or successor regulation. ADH services provide health care, supervision, restorative services, and socialization.

Adult Foster Care Services (AFC) - Care provided through an Adult Foster Care Program (which meets the requirements set forth by the Division of Medical Assistance) to provide personal care in a family-like setting to Clients in the residence of the caretaker.

Aging Services Access Points (ASAPs) - One or more non-profit agencies, one or more home care providers as defined in M.G.L.. c. 19A, § 4, clause (c), a combination of said home care corporations acting jointly, or a state agency which is/are designated by and under contract with Elder Affairs to carry out an interagency service agreement between Elder Affairs and the Division of Medical Assistance (DMA) for the management of clinical screening, service authorization activities and case management for Medicaid community based long term care to eligible elderly persons. ASAPs contract with Elder Affairs to: purchase Community-Based Long Term Care Services for certain Clients, provide Protective Services, (and in some cases provide nutrition services), provide Information and Referral Services, provide Case Management Services, coordinate and authorize the delivery of Home Care Program Services, and provide clinical screening for: Nursing Facility, and Community-Based Long Term Care Services. Each agency is organized to plan, develop, and implement the coordination and delivery of Community-Based Long Term Care Services.

Applicant - A person who seeks services or screening for Medicaid reimbursed or Elder Affairs reimbursed services from the ASAP.

ASAP Services - Those functions that are performed by the ASAP according to the terms of an ASAP Contract. The functions include Screenings, Interdisciplinary Case Management, Protective Services, Information and Referral, and in cases where the ASAP elects to perform rather than subcontract the function, Nutrition Services.

Certified Home Health Agency - An agency certified by the Department of Public Health that has met the Medicaid and Medicare Conditions of Participation.

Client - A person who is receiving Community Based Long Term Care Services.

Client Record -One record maintained by the ASAP for a Client which contains all required documentation in compliance with Elder Affairs' Documentation Standards.

Clinical Eligibility Determination - A decision regarding medical eligibility rendered by a registered nurse based on medical information.

Community-Based Long Term Care Services - Such services shall include but not be limited to, Home Care Program Services; Adult Day Health (ADH); Adult Foster Care (AFC); Group Adult Foster Care (GAFC)/Assisted Living (AL); Program for All-inclusive Care for the Elderly (PACE) 1115 Demonstration Waiver services and Pre-PACE for purposes of Nursing Facility level of care determinations; Personal Emergency Response System (PERS); 2176 Home and Community-Based Waiver services (for the frail elderly); and Home Health Services.

Congregate Housing - A joint program between Elder Affairs and the Department of Housing and Community Development that offers a shared living environment and integrates housing and supportive services.

Congregate Meals - A nutrition program for elders where meals are provided at a congregate meal site such as a church, senior center, or other community center.

Contract - The agreement executed pursuant to the ASAP Request for Responses (RFR) between the ASAP Contractor and Elder Affairs, and any amendments thereto.

Coordination of Care Manual - A manual that sets forth procedures for Clinical Eligibility Determinations.

Division of Medical Assistance (DMA) - The Division of Medical Assistance of the Massachusetts Executive Office of Health and Human Services is a governmental agency responsible for the administration of the Title XIX (Medicaid) Program.

Documentation Standards - Standards issued by Elder Affairs regarding the documentation procedures for gathering and maintaining client information.

Elder -A person age 60 or older.

Elder Affairs - The Executive Office of Elder Affairs of the Commonwealth of Massachusetts.

Enhanced Community Options Program (ECOP) - A program administered by ASAPs for frail elders who are clinically eligible for Nursing Facility services under MassHealth and meet criteria set forth by Elder Affairs. ECOP provides a broad range of community services for these elders to remain in the community that includes services available under the Home Care Program.

Group Adult Foster Care Services - Care provided through an Adult Foster Care Program which meets the requirements set forth by the Division of Medical Assistance, to provide personal care in an Elder's residence.

Home and Community-Based Waiver (Waiver) - A waiver of federal regulations granted to the Commonwealth, by the U.S. Department of Health and Human Services under 42 U.S.C.#1396n(d), which allows DMA to pay for home and community-based services for MassHealth Members who meet MassHealth criteria for Nursing Facility services but reside in the community.

Home Care Management Information System (HOMIS) - The management information system established by Elder Affairs and used by ASAPs to maintain client demographic and assessment data, service authorization and utilization data, and to manage ASAP expenditures.

Home Care Program Services - Home Care Program Services include: Homemaker, Personal Care, Laundry, Home-delivered Meals, Interdisciplinary Case Management, Chore, Home Health, Transportation, Social Day Care Services, Adult Day Health, Dementia Day Care, Adaptive Housing, Personal Emergency Response, Grocery Shopping/Delivery, Companion, Emergency Shelter, Respite Care and other Home Care Program Services as set for thin 651 CMR 3.01. Service definitions and services standards are established by Elder Affairs and in 651 CMR 3.00, et seq.

Hospice means a public agency or private organization or a subdivision of either that is providing care to terminally ill individuals and meets Medicare conditions of participation specified in 42 CFR 418.50 through 418.98 for hospices. Core services include nursing, physician, medical social work, and counseling. Supplemental services include: short term inpatient care; medical appliances and supplies; home health aide and homemaker services; physical therapy, occupational therapy, and speech language pathology services.

Information and Referral Services - Activities related to the maintenance of current information with respect to services and benefits available to Elders, assessments of the type of assistance needed by an elder requesting information, referral to appropriate services, and follow-up to determine if needed services were received. Information and Referral services may be conducted by mail, telephone, electronically, or in person.

Interagency Service Agreement - The agreement between Elder Affairs and the Division of Medical Assistance which establishes ASAP performance requirements in conducting screening activities and managing Medicaid funded community based programs and services.

Interdisciplinary Case Management - A client centered approach to assessment, service acquisition, reassessment, and monitoring of services provided to assist elders to live independently in the community. It includes working cooperatively, coordinating service plans and maintaining ongoing communication with the elder, family members, informal supports and formal supports as necessary. It is provided by registered nurses and case managers working in consultation with physicians, nurses and therapists from home health agencies, hospice providers, nutritionists, housing managers, mental health professionals, and other home and health care professionals. These services comply with the Interdisciplinary Case Management Standards issued by Elder Affairs.

LTC Assessment - The Long Term Care Assessment procedure specified by Elder Affairs to determine eligibility for Home Care Program Services, Community-Based Long Term Care Services and Nursing Facility Services.

LTC Assessment Too l - Instrument designated by Elder Affairs used in the LTC Assessment of Applicants.

Managed Care In Housing Program (MCIH) - MCIH provides a broad range of Home Care Program services including extended morning and evening services and 24-hour emergency response for high risk Clients residing in Elderly housing, congregate housing or designated neighborhoods. These Clients have functional or cognitive impairments such that they need added assistance and supervision to remain safely in the community.

MassHealth - The Medical Assistance Program administered by the Division of Medical Assistance pursuant to M.G.L. c.118E and Title XIX of the Social Security Act. MassHealth is the name the Commonwealth uses for the Medicaid Program.

MassHealth Member - An individual who has been determined eligible to receive benefits under the Medical Assistance Program (MassHealth).

Medicaid - see MassHealth.

Nursing Facility - A facility which is licensed by the Massachusetts Department of Public Health to provide skilled nursing care to residents which meets the provider eligibility requirements as specified in Division of Medical Assistance regulations at 130 CMR 456, et seq., or successor regulations.

Nursing Facility Screening - A clinical assessment of an Applicant for Nursing Facility services which is conducted by ASAP staff to determine eligibility for Nursing Facility services in accordance with the Division of Medical Assistance regulations at 130 CMR 456.408 et seq., or successor regulations.

Nutrition Services - Home-delivered Meals and Congregate Meals as defined in 651 CMR 3.00 and 651 CMR 4.00et seq.

PACE - The federal Health Care Financing Administration's (HCFA's) Program of All-inclusive Care for the Elderly service delivery model designed to keep elderly persons at risk of Nursing Facility placement in the community while providing for medical and social long term care needs. The model utilizes an Adult Day Health center and an interdisciplinary team to assess and monitor the needs of participants. In order to participate, an individual must be screened by an ASAP nurse and determined to meet the minimum criteria for Nursing Facility eligibility according to the Division of Medical Assistance Nursing Facility regulations.

Performance Measures - The method to determine ASAP performance and compliance with the ASAP contract, and the impact that services have on clients.

Purchased Services - Any service directly provided by a vendor under Contract with the ASAP.

Respite Care - The provision of one or more Home Care Program services to temporarily relieve the caregiver of a Client in emergencies, or in planned circumstances, to relieve the caregiver of the daily stresses and demands of caring for a Client in efforts to strengthen or support the Client's informal support system. In addition to services available under the Home Care Program, Respite Care services may include short term placements in Adult Foster Care, Nursing Facilities, Rest Homes, or Hospitals.

Screening - A determination of an individual's clinical eligibility for Community-Based Long Term Care Services or Nursing Facility Services.

Service Plan - A plan of care that delineates all services from all funding sources to be provided to a Client, developed in conjunction with the Client and/or the Client's designated representative.

Vendor - An entity which has entered into a contract with an ASAP to provide one or more Home Care Program Services.