Section 408.416 - Clinical Eligibility Criteria for AFCA member must meet the following clinical eligibility criteria for receipt of AFC.
(A) AFC must be ordered by the member's PCP.(B) The member has a medical or mental condition that requires daily hands-on (physical) assistance or cueing and supervision throughout the entire activity in order for the member to successfully complete at least one of the following activities:(1) Bathing - a full-body bath or shower or a sponge (partial) bath that may 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.Amended by Mass Register Issue 1338, eff. 5/5/2017.Amended by Mass Register Issue 1472, eff. 7/1/2022.Amended by Mass Register Issue 1520, eff. 4/26/2024.