GAFC Preadmission and Admission Procedures

Before admitting a member in GAFC, the GAFC provider must perform all of the activities in 130 CMR 408.522(A)(2). Intake and assessment services are provided to members seeking admission to GAFC but who may have not yet received prior authorization by the MassHealth agency or its designee for GAFC. (A) Preadmission Procedures and Activities (1) Preadmission Procedures. Before admitting a member in GAFC the GAFC 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 GAFC provider is able to meet the ADL and IADL needs of the member prior to admitting the member to GAFC, as well as use the meeting to obtain information about the member’s overall health characteristics, psychosocial condition, nutrition habits, financial and health insurance information, housing situation, formal and informal supports in place, and ethnic and cultural background. The GAFC provider must also use this meeting to inform the member and the member’s family about the scope of GAFC to be provided and any other relevant information; (2) Preadmission Activities. Prior to admitting the member, the GAFC provider must perform the following intake and assessment services: (a) conduct clinical evaluations of the need for GAFC; (b) instruct members on the rules, policies, and procedures of the GAFC program; and (c) provide information on the member’s rights and responsibilities when receiving GAFC services. (B) Admission Activities. Upon the GAFC 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 after admission, the GAFC provider must perform all four of 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 GAFC; (b) the member’s interim GAFC plan of care as outlined in 130 CMR 408.521(C)(1); (c) the respective responsibilities of the member and the GAFC provider; (d) emergency procedures; and (e) reasons for discharge from the GAFC provider. (2) Create a member record. By the first day of GAFC services, the GAFC 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 GAFC 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 GAFC provider. If the member has a behavior health need, the provider must obtain supporting documentation from the PCP if applicable that may include a psychiatric diagnosis and treatment plan from the member’s behavioral health 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 indicating any contraindications or limitations to the individual’s participation; (g) recommendations for other services, if applicable; and (h) a list of known allergies, if any. (3) Conduct an on-site visit on the day of admission by the GAFC nurse. (4) Conduct on-site visits at least weekly for the first four weeks, including the first visit on the day of admission. Such on-site visits must be conducted by the nurse and care manager on alternating weeks. (5) Provide the member by day 30, a written copy of the member’s completed GAFC plan of care.