Activities of Daily Living and Instrumental Activities of Daily Living

(A) Activities of Daily Living (ADLs). Activities of daily living include the following categories of activities. Any number of activities within one category of activity is counted as one ADL. (1) Mobility: physically assisting a member who has a mobility impairment that prevents unassisted transferring, walking, or use of prescribed durable medical equipment; (2) Assistance with medications or other health-related needs: physically assisting a member to take medications prescribed by a physician that otherwise would be self -administered; (3) Bathing or grooming: physically assisting a member with bathing, personal hygiene, or grooming; (4) Dressing: physically assisting a member to dress or undress; (5) Passive range-of-motion exercises: physically assisting a member to perform range-of- motion exercises; (6) Eating: physically assisting a member to eat. This can include assistance with tube- feeding and special nutritional and dietary needs; and (7) Toileting: physically assisting a member with bowel or bladder needs. (B) Instrumental Activities of Daily Living (IADLs). Instrumental activities of daily living include (1) household services: physically assisting with household management tasks that are incidental to the care of the member, including laundry, shopping, and housekeeping; (2) meal preparation and clean-up: physically assisting a member to prepare meals; (3) transportation: accompanying the member during transportation to and from medical providers; and (4) special needs: assisting the member with (a) the care and maintenance of wheelchairs and adaptive devices; (b) completing the paperwork required for receiving PCA services when an EVV live-in exemption has been approved; and (c) other special needs approved by the MassHealth agency as being instrumental to the health care of the member. (C) Determining the Number of Hours of Physical Assistance for IADLs. In determining the number of hours of physical assistance that a member requires under 130 CMR 422.410(B) for IADLs, the PCM agency must assume the following. (1) When a member is living with family members, the family members will provide assistance with most IADLs. For example, routine laundry, housekeeping, shopping, and meal preparation and clean-up should include those needs of the member. (2) When a member is living with one or more other members who are authorized for MassHealth PCA services, PCA time for homemaking tasks (such as shopping, housekeeping, laundry, and meal preparation and clean-up) must be calculated on a shared basis. (3) Meal preparation may be authorized for up to a maximum of seven hours per week. When discussing meal preparation, the PCM agency should request time based on the actual foods that the member consumes. Authorization of any time beyond seven hours per week requires a separate demonstration of medical necessity. All determinations of medical necessity—both for hours up to the seven-hour maximum and for any additional time—must be documented in the form and format specified by the MassHealth agency. (4) The MassHealth agency will consider individual circumstances when determining the number of hours of physical assistance that a member requires for IADLs. (D) Determining the Number of Hours of Physical Assistance for Minor Members. In determining the number of hours of physical assistance that a member requires under 130 CMR 422.410(A) and (B), and in addition to the assumptions described at 130 CMR 422.410(C), the member who is a minor (younger than 18 years old) will be evaluated with consideration to, and taking into account, reasonable expectations of parental responsibility and circumstances related to parental ability as well as whether and to what extent the minor member is substantially meeting developmental milestones, as detailed in the operating standards.