Definitions

As used in 101 CMR 413.00, unless the context requires otherwise, terms have the meanings in 101 CMR 413.02. Add-on Rate. A rate that is intended to provide an additional, necessary programmatic or client specific service, not included in the current programmatic model, which will be instituted at the discretion of the purchasing governmental unit. Adjudicated Youth Residential Treatment. Post-assessment programs that are either hardware- or staff-secure for clients 12 through 20 years of age committed by the juvenile court to the care and custody of the Department of Youth Services (DYS). These programs are characterized by physical (by means of both staffing and hardware) and behavior management, clinical and health services, education, recreation, and family support. These programs also undertake community transition assistance, among other services, in a fully integrated manner with the goal of reducing risk and/or need and preparing the client for reentry into the community. Client. A child, adolescent, or young adult receiving youth intermediate-term stabilization services purchased by a governmental unit. Clinically Intensive Residential Treatment Program (CIRT). Residential care that is a comprehensive strength-based, trauma-informed, skill-oriented treatment. Clinically Intensive Youth Residential Substance Use Disorder Treatment. Residential programs for clients 13 through 17 years old that include gender specific services for medically stable youth with substance use disorders. Each youth participates in highly structured, developmentally appropriate individual, group, and family clinical services in addition to having their medical and psychiatric needs addressed. Community-based Services. Treatment options provided in a community setting where the client and their family typically live, work, or recreate. Community Services Network (CSN). Regional community services teams that effectively integrate the DYS casework staff with provider agency support staff in a combined effort to deliver high quality, individualized, and culturally responsive services and supports to the youth and families served by DYS. CSN programs provide service locations for youth who have completed residential stays and are returning to their home communities. Services provided by CSN include education, clinical treatment, and accountability (rewards and sanctions), as well as recreational activities and community service. Community Treatment Residence. A residential service that provides clients with moderate behavioral health needs a therapeutic milieu for receiving individualized treatment, rehabilitation, training in life skills, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, community living with permanency. Continuum/Intensive Home-based Therapeutic Care. This program is an integrated and intensive array of community-based therapeutic interventions designed in partnership with youth and families to meet their unique needs. A goal of treatment is to support youth in their home and community, but when clinically indicated and authorized, short-term therapeutic group care is integrated into the Continuum/Intensive Home-based Therapeutic Care treatment plan. Continuum/Intensive Home-based Therapeutic Care treatment continues during periods of hospitalization or out-of-home placement. Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required. Emergency Residence. A residential service, available for immediate 24/7 access, for clients requiring placement in a therapeutic milieu providing individualized treatment, rehabilitation, training in life skills, and supportive services to promote transition from the emergency setting to a treatment setting, to permanency in a family-based environment or, as developmentally appropriate, to community living with permanency. Enhanced Residential Treatment Program (ERTP). The federal Family First Prevention Services Act of 2017 introduced this term. An ERTP meets the following five requirements: (a) accreditation by an accrediting body named in the Family First Prevention Services Act of 2017 or subsequently approved by the U.S. Secretary of Health and Human Services; (b) operation within a trauma-informed treatment model that creates a culture of delivering trauma-informed care and treatment; (c) provision of 24/7 access to licensed or registered nursing staff and other licensed clinical staff; (d) facilitation, in accordance with the child’s best interest, of family members’, including siblings’, connections with the child and involvement in the child’s treatment plan and programs; and (e) provision of discharge planning and family-based aftercare support. EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A. Extraordinary Circumstances /Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client and/or provider across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to the client for specific support services or funds directed to a qualified provider for extraordinary circumstances. Full-time Equivalent (FTE). A staff position equivalent to a full-time employee. Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth. Group Home Program. Residential services that provide flexible individualized treatment, rehabilitation, and support/supervision services that vary in intensity based upon individual youth and family needs. The Group Home Program includes the following four service models: (a) Intensive Group Home programs with a 1:3 direct care staffing ratio; (b) Group Home 1:4 programs with a 1:4 direct care staffing ratio; (c) Pre-independent Living programs with a 1:5 direct care staffing ratio; and (d) Independent Living programs with no live-in staff and that occur in an apartment setting. 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 as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service. Intensive Emergency Residence. A residential service, available for immediate 24/7 access, for clients with severe behavioral health needs requiring placement in a therapeutic milieu providing individualized treatment, rehabilitation, training in life skills, and supportive services to promote transition from the emergency setting to a treatment setting, to permanency in a family-based environment or, as developmentally appropriate, to community living with permanency. Intensive 1:1 Supported Living. A specialty community-based residential treatment service for young adults 18 through 22 years old with a range of significant developmental needs. This service provides individualized 1:1 supervision and support services for all clients. Intensive 1:2 Group Home. A specialty service that provides flexible individualized treatment, rehabilitation, and support/supervision services at a more intensive 1:2 direct care staff ratio, based upon individual youth and family needs. Intensive Group Home with Expanded Nursing. Intensive Group Home with Expanded Nursing provides out-of-home treatment services that are integrated with community-based transitional support services. These services are designed for youth who present with complex medical needs and their families. Intensive Residential Treatment Program (IRTP). Residential programs that are class VII facilities, licensed by the Department of Mental Health (DMH), and designed for adolescents who have completed a thorough and aggressive course of acute psychiatric care. Intensive Transitional Independent Living. Programs for clients 16 through 20 years old who are preparing to live independently upon release or who have been determined to need more intensive transitional and community support services as they return to the community. The programs are staff secure and provide monitoring and supervision, as well as individualized services that reduce risk and/or need and develop independent living skills and experiences in the community and community-based support systems. Intensive Treatment Residence. A residential service that provides clients with severe behavioral health needs a therapeutic milieu that includes expertise about severe behavioral health conditions, individualized treatment, rehabilitation, training in life skills and self-regulation, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, to community living with permanency. Intensive Treatment Residence Emergency Intake Add-on. An add-on service to support additional costs associated with achieving an emergency placement, within 24 to 48 hours of referral, into an Intensive Treatment Residence. Medically Complex Behavioral Residence. A residential service for clients with complex medical needs that require out-of-home nursing services to meet their health-care needs and require individualized treatment to meet their behavioral health needs. Medically Complex Needs Group Home. Specialty service for children/youth and young adults with complex medical needs that require intensive out-of-home nursing services in order to meet their health-care needs. Medically Complex Residence. A residential service for clients with complex medical needs that require out-of-home nursing services to meet their health-care needs. Non-enhanced Residential Treatment Program (Non-ERTP). A program that does not meet all five requirements of an Enhanced Residential Treatment Program (ERTP). See the definition of an Enhanced Residential Treatment Program. Per Diem. Service unit based on a 24-hour period of care. Programmatic Add-on Rate. A rate that is intended to provide an additional, necessary service to all clients, that is not included in the current programmatic model, and that will be instituted at the discretion of the purchasing governmental unit. Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers youth intermediate-term stabilization 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. Provider Leased. The building housing an Adjudicated Youth Residential Treatment program that is leased by the provider. Provider Owned. The building housing an Adjudicated Youth Residential Treatment program that is owned by the provider. Recovery, Engagement, and Alliance with DYS Youth (READY, formerly MassSTART). A community-based program serving high-risk DYS-involved youth who are struggling with substance use and related behavioral health problems. Services provide ongoing engagement and psycho-education around substance use, increased support for education and employment, enhanced family engagement, expanded social support, out-of-school activities, one-on-one mentoring, behavioral incentives, and advocacy within DYS regarding the correlation between substance use and delinquent behavior. Residential Schools. Special education programs with rates established by the Operational Services Division. Residential Services. A setting away from the home that offers both housing and treatment. Specialty Treatment Residence. A residential service that provides clients who would benefit from specialized treatment (e.g., individuals with intellectual disabilities; transgender individuals) with a therapeutic milieu that includes expertise about the specialty population, individualized treatment, rehabilitation, training in life skills, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, community living with permanency. Specialty Treatment Residence for Commercially Sexually Exploited Children (CSEC). A residential service designed to meet the particular behavioral-health needs of clients who have been sexually exploited. Services are delivered within a therapeutic milieu that includes expertise about the CSEC population, individualized treatment, rehabilitation, training in life skills, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, to community living with permanency. Short-term Assessment and Rapid Reintegration Program (STARR). A flexible, residential service designed to meet the service needs of the child/youth and family. All children/youth referred receive stabilization services, while some children/youth require additional assessment and treatment services. Specialty Services. Specifically designed, low-incidence models of care. State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 413.00. State funding does not include any amounts attributable to federal funding or grant funds. State Owned – Co-located. The building housing an Adjudicated Youth Residential Treatment program that is owned by the state and is connected in any way to or on the same campus as another state-owned building. State Owned – Separate. The building housing an Adjudicated Youth Residential Treatment program that is owned by the state and is a stand-alone structure in that it is not connected in any way to or on the same campus as another state-owned building. Stepping Out Program. Community-based individualized support provided to youth who have transitioned to living independently after receiving pre-independent living and independent living services. Service continuity is a critical feature of Stepping Out. To ensure continuity, Stepping Out services are provided by the case manager who has already been working with the youth. Summer Teacher Add-on Rate. An add-on rate for a licensed teaching position receiving a stipend to provide education in residential programs for the summer session, totaling six weeks during the months of July and August. Teen Parenting Emergency Beds (E-beds) Program. An add-on rate to support additional costs associated with providing emergency beds (E-beds), which include transportation, food, diapers, and other emergency incidentals, and monthly assessment reimbursement for teen parents. The add-on rate is utilized for young parents needing an emergency bed and services until a regular placement can be made. Teen Parenting Program. Programs designed to help teens develop a support system for themselves and their children including ensuring continuing contact with the baby’s father, teen’s parent(s), family members, paternal family members, and other supports through a residential setting. The Teen Parenting Program includes the following four service models: (a) Enhanced programs with a 1:4 direct care staff ratio; (b) Teen Living Programs (TLP) with a 1:5 direct care staff ratio; (c) House Parent programs with a 1:5 direct care staff ratio; and (d) Supportive Teen Parent Education and Employment Program (STEP), which has no live- in staff and is provided in an apartment setting. Therapeutic Group Care. A 24/7 out-of-home treatment service that provides flexible, individualized treatment and assessment with the goal of reintegrating youth to their families and communities; also provides short-term, planned respite. Transition to Intensive Foster Care (IFC) Add-on. Specialty service for transition to Intensive Foster Care. Serves as an add-on to a residential model. Transitional Age Youth Program. A specialty program for young adults, 18 through 25 years old, designed to promote health and wellness and recovery through person-centered services and supports that enable individuals to live, work, and participate in their communities. The Transitional Age Youth Program includes the following two service models. (a) The Transitional Aged Young Adult Continuum is an integrated array of services that includes both residential and community-based treatment. (b) The Young Adult Group Living Environment includes services provided in a group home or supported housing residential setting. Transitional Independent Living. Programs for clients 16 through 20 years old who are preparing to live independently upon release or who have been determined to need more transitional and community support services as they return to the community. The programs provide monitoring and supervision, as well as individualized services that reduce risk and/or need and develop independent living skills and experiences in the community and in community-based support systems. Utilization. The proportion of a program’s capacity that is filled by clients on a regularly measured basis, expressed as a percentage. Youth Intermediate-term Stabilization. Programs that provide a child, adolescent, or young adult temporary housing in a specialized residential or hospital setting to provide comprehensive services, and to promote stabilization and transition to (a) a less-restrictive setting; (b) a permanent family home; (c) independence; or (d) another type of adult program. Youth Residential Substance Use Disorder Treatment. Residential programs for clients 16 through 19 years old with moderate-to-severe substance use disorders that include intake and assessment, mental health counseling, case management and service coordination; psycho- and health education; life skills enhancement and vocational/educational support; recovery support and aftercare; and discharge planning. Youth and Young Adult Group Residence. A residential service that provides older adolescents or young adults with a supportive environment where there are opportunities for individualized treatment, training in life skills development, vocational and career planning, linkages with community services, and supportive services to promote community living with permanency. Youth and Young Adult Supported Living Community. Residential services offered to older adolescents or young adults living in multi-occupancy units (e.g., apartments, townhomes) that provide opportunities for linkages to community-based services, support with life skills development, vocational and career planning, and supportive services to promote community living with permanency. Young Adult Supported Living. Services, with no live-in staff, offered to young adults living independently in scattered apartments that provide opportunities for linkages to community-based services, support with life skills, vocational and career planning, and supportive services to promote community living with permanency. Young Parent Living Program. A residential service to support young parents in learning to care for themselves and their children, in developing positive support systems that include family members, extended kin, and friends, and in connecting with community-based supports. Young Parent Residence Add-on. An add-on rate to support additional costs associated with a one-time assessment of young parents upon intake to a young parent residence. Young Adult Therapeutic Care. This program is for young adults, 18 through 25 years old, and is designed to promote health, wellness, and recovery through person-centered services and supports that enable individuals to live, work, and participate in their communities. This service provides multiple levels of intensity to meet the individual needs, including the following. (a) Staffed Apartments. 24/7 group living with onsite staff support. (b) Supported Apartments. 24/7 individual apartments with intermittent onsite staff support. (c) Outreach. Community, team-based support for young adults living at home.