Section 408.506 - GAFC Clinical Eligibility CriteriaA 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.Adopted by Mass Register Issue 1472, eff. 7/1/2022.Amended by Mass Register Issue 1520, eff. 4/26/2024.