GAFC Clinical Eligibility Criteria

A member must meet the following clinical eligibility criteria for receipt of GAFC: (A) GAFC has been ordered by the member’s PCP; and (B) The member has a medical or mental condition that requires daily assistance with at least one of the ADLs described at 130 CMR 408.506(C). Such assistance must be either: (1) hands-on (physical) assistance, or (2) cueing and supervision throughout the entire ADL. (C) The following activities constitute ADLs applicable to GAFC eligibility: (1) bathing: a full-body bath or shower or a sponge (partial) bath which must include washing and drying of face, chest, axillae (underarms), arms, hands, abdomen, back and peri-area that may include personal hygiene such as combing or brushing of hair, oral care (including denture care and brushing of teeth), shaving, and, when applicable, applying make-up; (2) dressing: upper and lower body, including street clothes and undergarments, but not solely help with shoes, socks, buttons, snaps, or zippers; (3) toileting: member is incontinent (bladder or bowel) or requires assistance or routine catheter or colostomy care; (4) transferring: member must be assisted or lifted to another position; (5) mobility (ambulation): member must be physically steadied, assisted, or guided during ambulation indoors and outdoors, or is unable to self-propel a wheelchair appropriately without the assistance of another person; and (6) eating: if the member requires constant supervision and cueing during the entire meal, or physical assistance with consuming a portion or all of the meal.