Preadmission and Admission Procedures

(A) Preadmission Procedures and Activities. (1) Preadmission Procedures. Before admitting a member in AFC, the AFC provider must perform all of the activities in 130 CMR 408.431(A)(2). Intake and assessment services are provided to members seeking admission to AFC but who may have not yet received prior authorization by the MassHealth agency or its designee, for AFC. The AFC provider must conduct a preadmission meeting with the member, and if applicable or requested, the member’s family, other informal caregivers, and any other health or social service provider involved in the member’s care. The nurse must determine that the AFC provider is able to meet all of the ADL and IADL needs of the member prior to admitting the member to AFC, as well as use the meeting to obtain information about the member’s overall health characteristics, psychosocial condition, nutritional habits, financial and health insurance information, housing situation, formal and informal supports in place, and ethnic and cultural background. The AFC provider must also use this meeting to inform the member and the member’s family about the scope of AFC to be provided and any other relevant information; (2) Preadmission Activities. Prior to admitting the member, the AFC provider must perform the following intake and assessment services: (a) conduct clinical evaluations of the need for AFC; (b) review and approve AFC caregiver applicants; (c) instruct members on the rules, policies, and procedures of the AFC program; (d) identify appropriate potential AFC caregivers and qualified settings, including conducting on-site interviews in the qualified setting; (e) schedule meetings with the member or responsible party and potential AFC caregiver; (f) match the member with the most appropriate potential AFC caregiver; (g) provide information on the member’s rights and responsibilities when receiving AFC services; (h) provide instruction and initial training of AFC caregivers; and (i) schedule the member’s move-in date with the AFC caregiver in circumstances in which the member is moving into the AFC caregiver’s home. (B) Admission Activities. Upon the AFC provider’s receipt of the MassHealth agency’s initial prior authorization authorizing the member to receive services and, by the end of the fifth day of service, the AFC provider must perform the following activities: (1) Complete and submit a written notification to the member and, if applicable, the member’s legal guardian. The notice must at a minimum specify the following: (a) that the member has been admitted to AFC; (b) the member’s interim AFC plan of care, as outlined in 130 CMR 408.430(C)(1); (c) the respective responsibilities of the member and the member’s family, the AFC provider, and the AFC caregiver; (d) emergency procedures; and (e) reasons for discharge from the AFC provider. (2) Create a member record. By the first day of AFC, the AFC provider must obtain all the necessary documentation from the member’s PCP and other service providers on or before the first date of service. The documentation must include (a) the PCP Summary Form and order for AFC that documents that the member has been examined in the past 12 months and that the MassHealth member’s condition requires support with activities of daily living that is provided by the AFC provider; (b) the member’s medical history; (c) results of a PCP visit within the past three months; however if the PCP has completed a physical examination in the past 12 months and there has been no change in the members medical status, and the PCP has deemed a second physical is not medically necessary, the PCP may document and sign such a statement on the PCP Summary Form; (d) results of a physical examination given within the past 12 months. If the individual has been hospitalized in the preceding three months, a complete discharge summary may be used to fulfill the physical examination requirement; (e) a list of current medications, treatments, and other services provided; (f) a statement of special dietary requirements; (g) a statement indicating any contraindications or limitations to the individual’s participation; (h) recommendations for other services, if applicable; and (i) a list of known allergies, if any. (3) Conduct on-site visits according to the member’s AFC service payment level. (a) For members receiving AFC level I service payment, the initial visit must be conducted on the first day of AFC and may be conducted by the registered nurse, licensed practical nurse, or care manager. (b) For members receiving AFC level II service payment, the initial visit must be conducted on the first day of AFC and must be conducted by the AFC provider’s registered nurse or licensed practical nurse. For the first month of service, weekly visits must be made by the registered nurse or licensed practical nurse. (4) Provide the member by day 30 a written copy of the member’s completed AFC plan of care.