130 CMR, § 419.433

Current through Register 1533, October 25, 2024

Section 419.433 - Day Habilitation for MassHealth Members with ID/DD Residing in NFs

For purposes of providing DH to MassHealth members with ID or DD who are residing in NFs, DH providers must comply with all of the requirements outlined in 130 CMR 419.433 as well as coordinate and communicate with the member, the DDS service coordinator, if applicable, and the NF, actively participate in the development of the RISP, and attend the NF plan of care meetings to ensure that the DHSP complements and reinforces the service plans referenced in the member's RISP.

(A)Admission Criteria. In addition to the criteria outlined in 130 CMR 419.406, a MassHealth member with ID or DD residing in a NF may receive DH designed to improve the member's level of independent functioning.

(B)Service Needs Assessment (SNA). In addition to the requirements outlined in 130 CMR 419.407, the SNA for a MassHealth member with ID or DD who is residing in a NF and who receives DH must

(1) be completed by a qualified professional who must possess a master's degree in a human-services-related field or other professional license in a human or health services field;

(2) include any and all applicable therapy or nursing assessments completed by the NF. In lieu of utilizing assessments completed by the NF, the provider may complete specialized assessments that take into consideration the member's disabilities;

(3) assess all specialized service need areas to determine if specialized services are needed and if so, what DH services are appropriate to meet those needs; and

(4) be completed upon a significant change involving a change in the member's Level II PASRR or as the member's RISP dictates.

(C)Day Habilitation Service Plan (DHSP).

(1) The comprehensive DHSP must meet all of the requirements set forth in 130 CMR 419.416 and must

(a) be completed and forwarded to the DDS service coordinator if applicable, together with the SNA, within 90 days of the referral for specialized services;

(b) be completed in conjunction with the DDS service coordinator as applicable, and the NF;

(c) provide DH that is adequate in frequency and intensity to lead to progress; and (d) ensure, in conjunction with the NF, that the DHSP interventions complement and reinforce the RISP.

(2) DH contained in the DHSP must be available and offered to the member.

(3) To ensure progress toward goals and objectives and to identify significant changes, the DHSP should be evaluated on the following schedule.

(a)Monthly Reviews. In addition to the requirements outlined in 130 CMR 419.419, the DHSM must notify the member's DDS service coordinator within seven business days if the monthly review demonstrates a significant change in the member's condition that may affect the Level II PASRR determinations, if applicable.

(b)Quarterly Reviews. The quarterly review must

1. include a reevaluation of continued need for in-facility DH; and

2. be conducted with the DDS service coordinator in conjunction with the NF quarterly plan of care meeting, when applicable.

(D)Communication and Coordination Requirements. For each NF resident with ID or DD that receives DH, the DH provider staff must

(1) meet with the NF at least twice each year, in addition to the annual plan of care meeting, to coordinate the development and update of the DHSP;

(2) provide copies of the interim DHSP to the members of the RISP interdisciplinary team at least three days prior to the initial RISP meeting;

(3) submit the final DHSP, and any changes to the plan, for approval by the RISP interdisciplinary team;

(4) incorporate any changes recommended by the RISP interdisciplinary team into the final DHSP within 45 days of the initial RISP meeting;

(5) determine what other care plans have been, or are in the process of being developed by other providers or agencies in an effort to avoid duplication;

(6) ensure that the goals and objectives of the DHSP are consistent with those in the other plans and forward a copy to the DDS area office, and the NF; and

(7) immediately notify the DDS service coordinator, where applicable, in the event of a disruption of DH.

(E)Ongoing Documentation and Recordkeeping Requirements.

(1)DH Providers. In addition to the requirements outlined at 130 CMR 419.416, DH providers must develop and maintain records that document the DH provided to members with ID or DD residing in an NF. Such documentation must include

(a) the date the member was referred for specialized services in a DH setting; and

(b) documentation that the RISP interdisciplinary team has approved the final DHSP and any subsequent plan revisions.

(2)Nursing Facilities. The DH provider must

(a) provide to the NF copies of the DHSP and any revisions to it, the SNA, and quarterly progress notes;

(b) attend the annual NF plan of care meeting at the NF to coordinate the development of the two plans; and

(c) accommodate requests from NFs to carry-over the strategies employed in the provision of DH to a member.

(3)DDS Service Coordinators. DH providers must communicate with DDS service coordinators as follows:

(a) contact the DDS service coordinator for instruction in the event that the DH provider determines that it is not appropriate to provide DH to a member in the specialized services need areas;

(b) communicate with the DDS service coordinator concerning all issues related to DH, including notification of any changes in the DHSP goals, objectives and/or strategies; and

(c) forward a copy of the DHSP and quarterly reviews to the DDS service coordinator for inclusion in the RISP at the NF.

(F)Provision of DH in an NF (In-facility). DH may be provided in the NF to a member with ID or DD when

(1) the member is so medically fragile that transport to a DH provider site outside of the NF presents a significant risk to the health and safety of the member;

(2) the member has declined to receive DH at the DH provider's community site; or

(3) as determined by the RISP interdisciplinary team, DH is the only service that is available to meet the member's specialized services needs.