Definitions

As used in 101 CMR 420.00, unless the context requires otherwise, terms have the meanings in 101 CMR 420.02. Add-on Rate. A rate that is intended to provide an additional, necessary service not included in the current programmatic model, which will be instituted at the discretion of the purchasing governmental unit. Adult Long-term Residential (ALTR) Services. Residential site-specific programs that provide adult clients a place of overnight housing for an extended period in a residential facility with necessary daily living, physical, social, and clinical and/or medical support, and that are not subject to licensure under M.G.L. c. 111, § 71. Basic. The category of ALTR service models for clients who need daily intervention, supervision, and skills training in activities of daily living, managing within a home environment, and community integration. Individuals may require some physical assistance or accommodation due to cognitive and/or intellectual disability, including a mild-to-moderate developmental delay. Client. An individual receiving ALTR services purchased by a governmental unit. 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. Direct Care (DC) Staff Intensity Level. The number of full-time equivalent (FTE) positions for direct care staff included in each program model. The DC staff intensity level reflects the sum of the FTEs for direct care workers, including overnight staffs. Emergency Stabilization Residence. This service provides temporary, flexible, and individualized services to adults in a facility or home-like environment. The program is designed for adults who are not able to be stabilized in their current family home or residential program due to behavioral, mental health, or other care issues. The program is available 24 hours a day/seven days a week. Provider billing for emergency stabilization residence services using rates under 101 CMR 420.00 is pursuant to a contract with the purchasing governmental unit and beginning dates of service on or after July 1, 2016. EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A. Full-time Equivalent (FTE). 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. Intermediate. The category of ALTR service models designed to meet the needs of clients with support need beyond the basic level. These program models include specialized staffing, training or additional skills for staff, and/or additional operational support when compared to basic. The selection of intermediate tier programs is based on client need for behavioral supports, enhanced supervision, or interventions designed to address multiple disabilities. Medical/Clinical. The category of ALTR service models that delivers additional supports, when compared to the intermediate models, through the utilization of direct nursing services and highly experienced or credentialed direct care staff. At the discretion of the purchasing governmental unit, medical/clinical level 1 may alternatively reflect programs where specialized behavioral/clinical staff constitute a significant portion of the total staffing pattern. The intermediate models are used as the foundation for all medical models. For each intermediate model, there are three associated medical models, each reflecting the additional direct nursing resources available for the site. Model Type Model Nursing % Eligible Nursing % Medical/Clinical Level 1 20-29 Medical Level 2 30-39 Medical Level 3 40+ New Program/Replacement Rate. Rate for a new program site or replacement of an existing site. Program Per Diem. Program service unit based on a 24-hour period of care. 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. Remote Direct Supports. A service that provides for an off-site direct service provider to monitor and respond to an individual’s health, safety, and other needs using live communication and non- invasive monitoring technologies. Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the UFR. Service Model Rate. A rate that includes the programmatic resources to provide the client with focused direct care and support services, including consultants, materials and supplies, and administrative services attributed to the service portion of the program. It does not include the resources for provision of the physical space associated with the program and included in the site rate. Site Rate. A rate established by the purchasing governmental unit for the provision of the physical site housing the ALTR program, which may include, but is not limited to, lease or rental payments, depreciation, interest associated with long-term debt, insurance on buildings, maintenance, electricity, heat, water, and meals. Lease payments to related parties must not exceed the cost of what the provider would pay if the provider directly owned the property. Site Unit Cost. The result of dividing the total annualized cost of a program’s physical site for the period from July 1, 2011 through June 30, 2012, by the product of the capacity times 365. The purchasing governmental unit will determine the total annualized cost of a program’s physical site based on applicable line items in the UFR as determined by the purchasing governmental unit, and may approve adjustments to the site unit cost for unanticipated circumstances as determined by the purchasing governmental unit. Specialized Behavioral. The category of ALTR service models that delivers additional supports, when compared to the intermediate models, by using specialized behavioral staff. The selection of this program is based on client need for behavioral supports, enhanced supervision, or interventions designed to address multiple, complex behavioral needs by using highly experienced or credentialed interdisciplinary teams.