GAFC Non-covered Days

The MassHealth agency does not pay a GAFC provider when: (A) the member is receiving any other personal care services including, but not limited to, personal care services under 130 CMR 422.000: Personal Care Attendant Services; (B) the member receives home health aide services provided by a home health agency under 130 CMR 403.000: Home Health Agency; (C) the member is a resident or inpatient of a hospital, nursing facility, ICF/IID, or other provider- operated residential facility subject to state licensure such as group homes licensed by the Department of Developmental Services (DDS) or the Department of Mental Health (DMH), or other facility that provides the member’s medically necessary personal care; or (D) the GAFC provider has not received prior authorization from the MassHealth agency.