Definitions

As used in 101 CMR 356.00, unless the context requires otherwise, terms have the meanings in 101 CMR 356.02. Assistive Technology. Assistive technology includes: (a) devices, controls, or appliances that enable an individual to increase their ability to perform activities of daily living; (b) devices, controls, or appliances that enable an individual to perceive, control, or communicate with the community environment in which they live; (c) items necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items; (d) such other durable and non-durable medical equipment that is necessary to address an individual’s functional limitations; (e) necessary medical supplies; and (f) assistive technology evaluation and training, which includes the evaluation of the assistive technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate assistive technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of assistive technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, or replacement of assistive technology devices; coordination and use of necessary therapies, interventions, or services with assistive technology devices that are associated with other services contained in the plan of care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Community Engagement Navigation. Outreach and support services to MFP Demonstration participants both as they prepare to transition out of facilities and after they have transitioned. Services may include: (a) accompaniment and transportation from facilities to community housing and service options; (b) supporting service exploration and linkage; and (c) assistance with connections to and engagement with community services. Executive Office of Health and Human Services (EOHHS). The executive agency within Massachusetts government that is the single state agency responsible for the administration of the MassHealth program (Medicaid), pursuant to M.G.L. c. 118E, Titles XIX and XXI of the Social Security Act, and other applicable laws and waivers thereto. Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth. Individual Consideration (IC). Payment rates for certain services are designated as Individual Consideration (IC). Where IC rates are designated, the purchasing governmental unit will determine the appropriate payment rate in accordance with the following standards and criteria: (a) the amount of time required to complete the service or item; (b) the degree of skill required to complete the service or item; (c) the severity or complexity of the service or item; (d) the lowest price charged or accepted from any payer for the same or similar service or item, including, but not limited to any shelf price, sale price, advertised price, or other price reasonably obtained by a competitive market for the service or item; and (e) the established rates, policies, procedures, and practices of any other purchasing governmental unit in purchasing the same or similar services or items. MassHealth. The Medicaid program of the Commonwealth of Massachusetts, administered by EOHHS pursuant to M.G.L. c. 118E, Titles XIX and XXI of the Social Security Act, and other applicable laws and waivers thereto. Money Follows the Person Demonstration. A MassHealth demonstration program authorized pursuant to a federal grant received by EOHHS that seeks to assist eligible MassHealth members residing in facility-based long-term care settings to transition to a community-based setting, where they can receive home- and community-based services. Money Follows the Person Demonstration Services. Services that are either allowable Medicaid services not currently included in the state’s array of home- and community-based services (HCBS) or qualified services above what would be available to non-MFP Demonstration Medicaid beneficiaries, and which include assistive technology, and transitional assistance. Money Follows the Person Demonstration Supplemental Services. One-time services to support the transition of MFP Demonstration participants that are otherwise not allowable under the Medicaid program. Services address critical barriers to transition for MFP Demonstration participants, including Community Engagement Navigation, the lack of affordable and accessible housing, food insecurity, and financial and administrative barriers to transitions. Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been adopted by a purchasing governmental unit. Transitional Assistance. Non-recurring set-up expenses and short-term services necessary to facilitate an individual’s transition from a facility-based long-term care setting to the community. Allowable expenses are those that are necessary to enable a person to establish a basic household and do not constitute room and board.