101 CMR, § 310.02
As used in 101 CMR 310.00, terms have the meanings set forth in 101 CMR 310.02.
Adult. Any person 18 years of age or older.
Adult Day Health Services. Programs approved by the MassHealth agency under 130 CMR 404.000: Adult Day Health Services and that provide for adult recipients an alternative to 24-hour long-term institutional care through an organized program of health care and supervision, restorative services and socialization.
Admission Services. Services provided to ensure safe and appropriate care planning for adult day health members enrolling in adult day health services for the first time. This is a one-time only claim per MassHealth member ID.
Basic Level of Care. The level of care for publicly aided clients receiving adult day health services as defined in 130 CMR 404.402: Basic Payment Level.
Center. The Center for Health Information and Analysis (CHIA) established under M.G.L. c. 12C.
Complex Level of Care. The level of care for publicly aided clients receiving adult day health services as defined in 130 CMR 404.402: Complex Payment Level.
Day Setting. Any single physical facility that is open at least Monday through Friday for eight hours per day that has been reviewed and approved by the MassHealth agency and other proper authorities for the operation of adult day health services program.
Eligible Provider. Any person, partnership, corporation, or other entity that is authorized in the Commonwealth of Massachusetts to engage in the business of furnishing adult day health services to the public and who also meets such conditions of participation as may be adopted by a governmental unit.
EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.
Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.
Non-wheelchair Transportation. Transportation services provided by a motor vehicle for members who are ambulatory and can be transported on a van while seated in a bench or single seat passenger chair.
Partial Per Diem. Adult day health services provided for a period equal to or less than three hours per day.
Per Diem. Adult day health services provided for a period greater than three hours per day. MassHealth will not pay for services that exceed six hours per day.
Publicly Aided Individual. A person whose medical and other services a governmental unit is in whole or part liable for under a statutory program.
Re-engagement Services. Services provided to ensure successful re-engagement of members who have not received site-based services during the period of March 24, 2020, through June 30, 2023. This is a one-time only claim per MassHealth member ID on or after the 45th day of service with sustainable re-engagement in site-based services.
Restorative Services. Indirect services including, but not limited to, case conferences or those of an in-service educational therapist, speech pathologist, or other qualified restorative therapist.
Transportation. Method by which a member is brought from their home to the adult day health provider or from the adult day health provider to the member's home. Transportation service includes assisting the member while they enter and exit the vehicle, as appropriate. A member's home may include a temporary housing environment such as a shelter or transitional housing.
Wheelchair Transportation. Transportation service provided to a member who requires a wheelchair.
101 CMR, § 310.02