Definitions

The following terms used in 130 CMR 449.000 have the meanings given in 130 CMR 449.402 unless the context clearly requires a different meaning. Eligibility for reimbursement of services defined in 130 CMR 449.000 is not determined by these definitions, but by application of 130 CMR 449.000 and 130 CMR 450.000: Administrative and Billing Regulations. Adjudication. The court process that determines if an individual committed the act for which they are charged. Adverse Incident. An occurrence that represents actual or potential serious harm to the wellbeing of a member or to others under the care of a participating provider. Adverse incidents may be the result of the actions of a member served, actions of a staff member providing services, or incidents that compromise the health and safety of the member, or operations of the provider. Clinical Laboratory. As defined in 130 CMR 401.402: Clinical Laboratory. Consolidated Appropriations Act (CAA, 2023). The Consolidated Appropriations Act of 2023 that was signed into law by Congress on December 29th, 2022, thereby amending 42 U.S.C. 1396(a)(84), 42 U.S.C. 1396a(nn)(3), 42 U.S.C. 1396d(a), 42 U.S.C. 1397bb, 42 U.S.C. 1397jj(b). Correctional Facility. Any building, enclosure, space, or structure used for the custody, control, and rehabilitation of committed offenders and of such other persons as may be placed in custody therein in accordance with law. Former Foster Care Youth. Youth who meet the eligibility criteria for former foster care children, including individuals younger than age 26 who meet the criteria for the group upon attaining either age 18 or a higher age (up to 21). Inmate. A committed offender or such other person as is placed in custody in a correctional facility in accordance with law. Inmate of a Participating Correctional Facility. A committed offender or such other person as is placed in custody in a participating correctional facility in accordance with law. ORP Provider. A provider who orders, refers, or prescribes a covered service to a MassHealth member. Participating Correctional Facility (Facility). Any correctional facility that is enrolled as a MassHealth provider, that is not an institution of mental diseases as defined in 42 CFR 435.1010: Definitions relating to institutional status, and that is either (1) a Department of Corrections state prison; (2) a county jail or house of correction; or (3) a Department of Youth Services hardware-secure or staff-secure track 1 facility or unit. Post-adjudication. The time period following adjudication. Reentry Demonstration. The initiative authorized through MassHealth’s Section 1115 Demonstration which allows for the provision of certain MassHealth services to inmates of participating correctional facilities in the 90 days prior to their release from such institutions. Rendering Provider. A Massachusetts licensed practitioner providing covered services to MassHealth members. Warm Hand-off. A continuity of care tool to transition case management activities from a pre- release case management to a post-release case manager. Warm hand-offs should include a meeting between the individual, and both the pre-release and post-release case manager. It should also include a review of the person-centered care plan and the next steps to ensure continuity of case management and follow-up as the individual transitions into the community.