Code of Massachusetts Regulations
651 CMR - EXECUTIVE OFFICE OF ELDER AFFAIRS
Title 651 CMR 3.00 - Home Care Program Regulations
Section 3.02 - Definitions
When used in 651 CMR 3.00, unless the context otherwise requires, the following terms shall have the following meanings:
Abuse. Consistent with 651 CMR 5.00: Elder Abuse Reporting and Protective Services Program, an act or omission, including emotional abuse, financial exploitation, neglect, physical abuse, sexual abuse, and/or self-neglect.
Activities of Daily Living (ADLs). Tasks, including the ability to bathe, dress/undress, eat, toilet, transfer in and out of bed or chair, move while in bed, and ambulate inside the home, and management of incontinence which are used to measure the Functional Impairment Level (FIL) of an Applicant or Consumer.
Applicant. An individual who has applied for Home Care Program services.
ASAPs. Aging Services Access Points as authorized in M.G.L. c. 19A, § 4B and defined in 651 CMR 14.01: Purpose and Scope.
Assisted Living Residence. An entity certified by Elder Affairs under 651 CMR 12.00: Certification Procedures and Standards for Assisted Living Residences which provides room, board, and personal care services to residents.
Caregiver. A person, regardless of place of residence, who is 18 years of age or older and provides assistance with Activities of Daily Living and/or Instrumental Activities of Daily Living, supervision, or social and emotional support as required by a Consumer on a daily basis without pay.
Comprehensive Service Plan. A person centered plan of care that delineates all services and funding sources to be provided to a Consumer that is developed by an ASAP using EOEA guidelines in conjunction with the Consumer and/or the Consumer's Designated Representative.
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 support services.
Consumer. An adult who is enrolled in a Home Care program.
Consumer Record. An aggregate file of all documentation associated with a Consumer maintained by an ASAP in compliance with Documentation Standards. Documents requiring signature or that are otherwise unable to be recorded electronically shall be stored in a hard copy file for each Consumer.
Copayment. A monthly dollar amount billed to a Consumer for Home Care Program Services based on the Consumer's income.
Designated Representative. A person who is either:
(a) affirmatively identified and designated by the Consumer to share personal health information and provide assistance in making decisions related to the provision of Home Care Services, provided that the Consumer is competent; or
(b) a person serving as a durable power of attorney or as a guardian appointed by a court on behalf of a Consumer, regardless of the Consumer's competency.
Division of Medical Assistance (DMA). A government agency within the Executive Office of Health and Human Services that is responsible for the administration of the Title XIX (Medicaid) Program known as MassHealth.
Documentation Standards. Standards issued by Elder Affairs regarding the procedures for gathering and maintaining Consumer information.
Elder Affairs. The Executive Office of Elder Affairs.
Family. An Applicant or Consumer and his or her spouse.
Frail Elder Home and Community Based Waiver. A waiver of federal requirements granted to the Commonwealth, by the U.S. Department of Health and Human Services under 42 U.S.C. § 1396n(d), that allows DMA to pay for home and community-based services for MassHealth members who meet MassHealth criteria for Nursing Facility services but continue to reside in the community and agree to receive a waiver service.
Functional Impairment Level (FIL). The degree of functional impairment experienced by an Applicant or Consumer as evidenced by an inability to complete Activities of Daily Living and Instrumental Activities of Daily Living.
Home Care Program Services. Services provided to a Consumer, including but not limited to the following:
(a) Adult Day Health (ADH). Health care and supervision, restorative services, and socialization for elders who require skilled nursing or therapy, or assistance with Activities of Daily Living, nutrition, and personal care;
(b) Alzheimer's Day Program. Specialized day program services provided to address the needs of people with Alzheimer's Disease or related disorders;
(c) Alzheimer's/Dementia Coaching. Education and support to Consumers and their families who are experiencing the effects of Alzheimer's Disease or a dementia-related disorder;
(d) Chore. Services to maintain the home in a clean, sanitary and safe manner, including but not limited to minor home repairs, general maintenance, and heavy household chores such as washing floors, windows, and walls, and moving heavy items of furniture to provide safe access and egress;
(e) Companion. Non-medical services identified in the Comprehensive Service Plan, such as socialization, meal preparation, laundry, shopping, escort to appointments and light housekeeping tasks that are incidental to the care and supervision of the Consumer;
(f) Emergency Shelter. Temporary shelter not to exceed 14 calendar days in a six month period provided to an elder (and his or her household) who is without a home due to eviction, fire, flood, other natural disaster, Abuse, neglect, substance use disorder, economic incapacity, or unsafe/substandard housing conditions, including lack of fuel and/or utilities; (g) Environmental Accessibility Adaptations. Physical adaptations to the private residence of the Consumer and/or adaptive equipment as required by the Consumer's Comprehensive Service Plan;
(h) Grocery Shopping/Delivery Services. Ordering groceries, shopping for groceries, delivering groceries, and assisting with storage of groceries as needed;
(i) Home Based Wandering Response System. A device that transmits signals 24 hours per day/seven days per week using technology such as GPS or radio frequency to provide location assistance in the event the Consumer wanders;
(j) Home-delivered Meals. Meals provided to Consumers to maintain optimal nutrition and health status;
(k) Home Delivery of Pre-packaged Medications. Delivery of medications, including but not limited to pre-filled blister packs and pre-filled syringes by a pharmacy to a Consumer's residence;
(l) Home Health Services. Services defined in 130 CMR 403.000: Home Health Agency which include Skilled Nursing; Physical, Occupational, and Speech Therapy; and Home Health Aide;
(m) Homemaker Services. Services to assist a client with Instrumental Activities of Daily Living provided in accordance with homemaker standards issued by Elder Affairs.
(n) Laundry. Pick up, washing, drying, folding, wrapping, and/or returning of laundry;
(o) Medication Dispensing System. Provision of an automated medication dispenser that allows a Consumer to achieve adherence to medication requirements by receiving pill form medications at appropriate intervals through audible and/or visual cueing;
(p) Nutritional Assessment. A comprehensive nutritional assessment conducted by a qualified nutritionist;
(q) Personal Care. Hands-on assistance, prompting or cueing, and supervision to assist a Consumer to perform Activities of Daily Living provided in accordance with the Personal Care Guidelines issued by Elder Affairs;
(r) Personal Emergency Response System (PERS). Provision of an electronic device which can be used to alert trained third-party staff of an emergency 24 hours per day/seven days per week;
(s) Respite Care Services. The provision of one or more other Home Care Program Services, additionally including but not limited to short term placements in Adult Foster Care, Skilled Nursing Facilities, or Rest Homes, to temporarily relieve a Caregiver in emergencies, or in planned circumstances, to relieve the Caregiver of the daily stresses and demands of caring for a Consumer;
(t) Supportive Day Program. Services provided in a group setting, including assessments and care planning, health-related services, social services, therapeutic activities, and nutrition;
(u) Supportive Home Care Aide Services . Services that comply with the Supportive Home Care Aid Standards issued by Elder Affairs, including personal care and/or homemaking, emotional support, socialization, and escort services to Consumers with Alzheimer's Disease, a dementia-related disorder, or emotional and/or behavioral problems;
(v) Transitional Assistance. Non-recurring expenses associated with the transition of individuals who are moving from an institutional or other provider-operated living arrangement to a living arrangement in a private residence in which the person is directly responsible for his or her own living expenses;
(w) Transportation. The provision of transportation to enable a Consumer to gain access to community services, activities and resources;
(x) Vision Rehabilitation. A service intended to evaluate the needs of persons who are visually impaired and instruct the visually impaired in the use of compensatory skills and aids that will support safe, productive, and independent living; and,
(y) Wanderer Locator Service. Payment for registration in a national database established to help track and locate those with dementia-related disorders who are at-risk of wandering and becoming lost.
Home Care Service Plan. A plan of care that identifies all authorized Home Care Services.
Information and Referral Services. Activities related to the maintenance and dissemination of current information regarding the services available to elders and individuals with disabilities. Such activities include assessments of the type of assistance needed, referral to appropriate services, and follow-up to determine whether the referrals accomplished the desired objectives. Information and Referral services may be conducted by mail, by telephone, electronically, or in person.
Instrumental Activities of Daily Living (IADLs). Basic tasks, including the ability to prepare meals, do housework, do laundry, go shopping, manage medication, ambulate outside the home, use transportation, manage money, and use the telephone, which are used to measure the Functional Impairment Level (FIL) of an Applicant or Consumer.
Interdisciplinary Case Management. A person-centered approach to assessment, service acquisition, reassessment, and monitoring of services provided to Consumers to help them live independently and remain in the community. The approach includes working cooperatively, coordinating Comprehensive Service Plans and maintaining ongoing communication with the elder, family members, informal and formal supports, as necessary. Interdisciplinary Care Management 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 and complies with the Interdisciplinary Case Management Standards issued by Elder Affairs.
Long Term Care (LTC) Assessment. The process to determine eligibility for Home Care Program Services through the use of the comprehensive data set (CDS) assessment tool issued by Elder Affairs and used by the ASAPs.
MassHealth. The Medical assistance program known as MassHealth administered by the Executive Office of Health and Human Services pursuant to M.G.L. c. 118E and Title XIX of the Social Security Act.
MassHealth Member. An individual who has been determined eligible to receive benefits under MassHealth.
Medicaid. The federal designation for eligibility and benefits administered under MassHealth.
Medication Management. Services provided to a Consumer to help ensure adherence with medication requirements, including cueing and providing access to medications.
Notice of Action. A procedural notification created in accordance with 801 CMR 1.00: Standard Adjudicatory Rules of Practice and Procedure and 651 CMR 1.00: Adjudicatory Rules of Practice and Procedures.
Nursing Facility. A facility that is licensed to provide skilled nursing care to residents in accordance with the requirements of 130 CMR 456.000: Long Term Care Services.
Peer Review. A process by which ASAPs convene in groups to review Consumer Records for the purpose of providing feedback to one another regarding how cases were handled and ensure more consistent operations among providers. The Peer Review process must be implemented according to Peer Review Program Instructions issued by Elder Affairs.
Program Instruction. A document issued by Elder Affairs that sets forth required procedures and protocols for the management of the Home Care Program.
Protective Services. Services provided by an Elder Protective Services Program in accordance with M.G.L. c. 19A, §§ 14 through 26 and 651 CMR 5.00: Elder Abuse Reporting and Protective Services Program, which are deemed necessary to prevent, eliminate or remedy the effects of Abuse to an elder.
Provider. An entity which has entered into a contract with an ASAP to provide one or more Home Care Program Services.
Service Priority. A method used to prioritize Applicants to the Home Care Program which is based on an assessment of Critical Unmet Needs and Non-critical Unmet Needs.
Suspension. The temporary cessation of Home Care Program Services.
Termination. The permanent cessation of Home Care Program Services or Enrollment(s).
Unmet Need(s). The Applicant's or Consumer's identified care needs which are not being met by other sources available to the Consumer or Applicant as determined by the Long Term Care Assessment. Unmet Needs consist of two sub-categories:
(1) Non-critical Unmet Needs. Unmet Needs which include one or more of the following: laundry, housework, shopping other than food shopping, transportation other than transportation for medical treatment, socialization, and telephone use; or,
(2) Critical Unmet Needs. A Consumer's Unmet Needs which include one or more of the following: any Activity of Daily Living (ADL), meal preparation, grocery shopping, Medication Management, transportation for medical treatments, Respite Care Services, and Home Health Services.
Voluntary Copayment. A copayment which may be contributed at the option of a Consumer.
