Definitions

The following terms used in 130 CMR 630.000 have the meanings given in 130 CMR 630.402 unless the context clearly requires a different meaning. Acquired Brain Injury (ABI). All forms of brain injury that occur after 22 years of age, including without limitation, brain injuries caused by external force, but not including Alzheimer’s disease and similar neurodegenerative diseases of which the primary manifestation is dementia. Acquired Brain Injury Home- and Community-based Services Waivers (ABI Waivers). Home- and community-based services waivers approved by the Centers for Medicare and Medicaid Services (CMS) under §1915(c) of the Social Security Act for persons with acquired brain injury who are transitioning from long-stay facilities into the community. The two separate Acquired Brain Injury Waivers, each with different covered services and eligibility requirements are: the Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver and the Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver. Activities of Daily Living (ADL). Certain basic tasks required for daily living, including the ability to bathe, dress/undress, eat, toilet, transfer in and out of bed or chair, get around inside the home, and manage incontinence. Adult Companion Service. Non-medical care, supervision, and socialization provided to a participant. Companions may assist or supervise the participant with such light household tasks as meal preparation, laundry, and shopping. Assisted Living Services. Services consist of personal care and supportive services (for example, homemaker, chore, personal care services, meal preparation) that are furnished to participants who reside in an assisted living residence (ALR) that meets all applicable requirements of 42 CFR 441.301(c)(4) (Home and Community-based Settings Rule), and include 24-hour, on-site response capability to meet scheduled or unpredictable resident needs and to provide supervision, safety, and security. Services may also include social and recreational programs, and medication assistance (consistent with ALR certification and to the extent permitted under State law). Nursing and skilled therapy services are incidental rather than integral to the provision of Assisted Living Services. Intermittent skilled nursing services and therapy services may be provided to the extent allowed by applicable regulations. Assistive Technology Device. An item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the assistive technology devices that enable the individual to participate in telehealth. Assistive Technology Evaluation and Training. The evaluation of the assistive technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Chore. An unusual or infrequent household maintenance task that is needed to maintain the participant’s home in a clean, sanitary, and safe environment. Chores include heavy household work, such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture to provide safe access and exit. Community-based Day Supports. A service designed to enable a participant to enrich their life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal, social interactions and community engagement. Community-based Day Supports uses a small group model to provide a flexible array of individualized supports through activities primarily in non-center-based settings separate from the participant’s private residence or other residential living arrangement. Community Behavioral Health Support and Navigation. A service that provides outreach and support services to enable participants to access and utilize clinical behavioral health treatment services and other supports. Community Behavioral Health Support and Navigation services are staffed by paraprofessionals, supported by clinical supervision, and are designed to be maximally flexible in supporting participants to implement the goals in their plan of care and attain the skills and resources needed to successfully maintain community tenure. Community Family Training. A service designed to provide training and instruction about the treatment regimes, behavior plans, and the use of specialized equipment that support a participant in the community. Community Family Training may also include training in family leadership, support of self-advocacy, and independence for the family member. The service enhances the skills of the family to assist the waiver participant to function in the community and at home. Coverage Type. A scope of services that are available to MassHealth members who meet specific eligibility criteria. Day Services. A structured, site-based, group program for participants that fosters community integration and offers assistance with the acquisition, retention, or improvement in self-help, socialization, and adaptive skills, and that takes place in a nonresidential setting separate from the participant’s private residence or other residential living arrangement. Services often include assistance to learn ADLs and functional skills; language and communication training; compensatory, cognitive, and other strategies; interpersonal skills; prevocational skills; and recreational and socialization skills. Department of Developmental Services (DDS). The state agency within the Executive Office of Health and Human Services that is organized pursuant to M.G.L. c. 19B, to provide specialized services and supports to individuals with intellectual disabilities and developmental disabilities and to promote full and meaningful participation of the individuals as valued members of their communities. Electronic Visit Verification (EVV). The method or system designated or approved by EOHHS to electronically verify service delivery in the form and format as required by the MassHealth agency. Executive Office of Health and Human Services (EOHHS). The Executive Office of Health and Human Services established under M.G.L. c. 6A. Family Member. A spouse or any legally responsible relative of the participant. Fiscal Intermediary (FI). An entity under contract with EOHHS to perform employer-required tasks and related administrative tasks as described in 130 CMR 422.419(B). Home Accessibility Adaptations. Physical modifications to the participant’s home that are necessary to ensure the health, welfare, and safety of the participant or that enable the participant to function with greater independence in the home. Home- and Community-based Services (HCBS) Waiver. A federally approved program operated under §1915(c) of the Social Security Act that authorizes the U.S. Secretary of Health and Human Services to grant waivers of certain Medicaid statutory requirements so that a state may furnish home- and community-based services to certain Medicaid beneficiaries who need a level of care that is provided in a hospital, nursing facility, or Intermediate Care Facility for Individuals with Intellectual Disability (ICF/ID). For the purpose of 130 CMR 630.000, Home- and Community- based Services Waiver refers to the two ABI waivers and the two MFP waivers. Home Health Aide. A person who performs certain personal care and other health-related services as described in 130 CMR 403.000: Home Health Agency. Home Delivered Meals. The provision of well-balanced meals to participants to maintain optimal nutritional and health status. Home Delivered Meals service includes the preparation, packaging, and delivery of meals by trained and supervised staff. Homemaker. A person who performs light housekeeping duties (for example, cooking, cleaning, laundry, and shopping) for the purpose of maintaining a participant’s household. Independent Living Supports. A service that ensures 24-hour, seven-days-per-week access to supportive services for participants who have intermittent, scheduled, and unscheduled needs for various forms of assistance, but who do not require 24-hour supervision. It provides participants with services and supports in a variety of activities such as: ADLs and instrumental activities of daily living (IADLs), support and companionship, emotional support, and socialization. This service is provided by a site-based provider and is available to participants who choose to reside in locations where a critical mass of individuals reside who require such support and where providers of such supports are available. Individual Support and Community Habilitation. Regular or intermittent services designed to develop, maintain, and/or maximize the participant’s independent functioning in self-care, physical and emotional growth, socialization, communication, and vocational skills, to achieve objectives of improved health and welfare and to the support the ability of the participant to establish and maintain a residence and live in the community. Instrumental Activities of Daily Living (IADL). Certain basic environmental tasks required for daily living, including the ability to prepare meals, do housework, laundry, and shopping, get around outside, use transportation, manage money, and use the telephone. Laundry. Service provided to a participant which includes pick up, washing, drying, folding, wrapping, and returning of laundry. Legally Responsible Individual. Any person who has a duty under state law to care for another person, including but not limited to, a legal guardian or a spouse of a participant. Massachusetts Rehabilitation Commission (MRC). The state agency within the Executive Office of Health and Human Services that is organized pursuant to M.G.L. c. 6, §§ 74 through 84, to provide comprehensive services to individuals with disabilities, which maximize their quality of life and economic self-sufficiency. MRC accomplishes its work through multiple programs in its Community Living Division, the Disability Determination Service Division, and the Vocational Rehabilitation Division. MassHealth. The medical assistance and benefit programs administered by EOHHS pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396), Title XXI of the Social Security Act (42 U.S.C. 1397), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services for eligible members. Moving Forward Plan Waivers (MFP Waivers). Two Massachusetts Home- and Community- based Services Waivers approved by CMS under §1915(c) of the Social Security Act for persons with disabilities who are transitioning from long-stay facilities. Massachusetts operates two separate MFP Waivers – the Moving Forward Plan Residential Supports (MFP-RS) Waiver and the Moving Forward Plan Community Living (MFP-CL) Waiver – each with different covered services and eligibility requirements. Occupational Therapist. A person who is licensed by the Massachusetts Division of Registration in Allied Health Professions and registered by the American Occupational Therapy Association (AOTA) or is a graduate of a program in occupational therapy approved by the Committee on Allied Health Education and Accreditation of the American Medical Association and engaged in the supplemental clinical experience required before registration by AOTA. Occupational Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, maintain, or prevent the worsening of functions that affect the activities of daily living that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Occupational therapy programs are designed to improve quality of life by recovering competence and preventing further injury or disability, and to improve the individual’s ability to perform tasks required for independent functioning, so that the individual can engage in activities of daily living. Occupational therapy services may include the performance of a maintenance program beyond the scope of coverage in the state plan. Services may also include training and oversight for the participant or a family member or other person to carry out a maintenance program. Orientation and Mobility Services. Services that teach a participant with vision impairment or legal blindness how to move or travel safely and independently in their home and community. Orientation and mobility services include participant training, environmental evaluations, and caregiver/direct care staff training on sensitivity to blindness/low vision. Orientation and Mobility Services are tailored to the participant’s needs and may extend beyond residential settings to other community settings as well as public transportation systems. Participant. A MassHealth member determined by the MassHealth agency to be eligible for enrollment in one of the HCBS waivers, who chooses to receive HCBS waiver services, and for whom a service plan has been developed that includes one or more HCBS waiver services. Peer Support. Ongoing services and supports designed to assist participants to acquire, maintain, or improve the skills necessary to live in a community setting. This service provides supports necessary for the participant to develop the skills that enable them to become more independent, integrated into, and productive in their communities. The service enables the participant to retain or improve skills related to personal finance, health, shopping, use of community resources, community safety, and other adaptive skills needed to live in the community. Personal Care. Services provided to a participant, which may include physical assistance, supervision or cuing of participants, for the purpose of assisting the participant to accomplish activities of daily living (ADLs), including, but not limited to, eating, toileting, dressing, bathing, transferring, and ambulation. Physical Therapist. A person licensed by the Massachusetts Division of Registration in Allied Health Professions to provide physical therapy. Physical Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, maintain, or prevent the worsening of physical functions that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Physical therapy emphasizes a form of rehabilitation focused on treatment of dysfunctions involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or integumentary systems through the use of therapeutic interventions to optimize functioning levels. Physical therapy services may include the performance of a maintenance program beyond the scope of coverage in the state plan. Services may also include training and oversight for the participant or a family member or other person to carry out a maintenance program. Prevocational Services. A service that consists of a range of learning and experiential type activities that prepare a participant for paid or unpaid employment in an integrated, community setting. Services are not job-task oriented but instead, aimed at a generalized result (e.g., attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving, and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant’s employability in integrated, community settings. Provider Agreement. The contract between the MassHealth agency and a person or organization under which the provider agrees to furnish services to MassHealth members in compliance with state and federal Title XIX requirements. Federal regulations concerning provider agreements are located in 42 CFR § 431.107. Residential Family Training. A service designed to provide training and instruction about treatment regimes, behavior plans, and the use of specialized equipment that support a participant in the community. Residential family training may also include training in family leadership, support of self-advocacy, and independence for the family member. The service enhances the skill of the family to assist the waiver participant to function in the community and at home when the waiver participant visits the family home. Residential Habilitation. Ongoing services and supports provided to a participant in a provider- operated residential setting that are designed to assist participants in acquiring, maintaining, or improving the skills necessary to live in a community setting. Residential habilitation provides participants with daily staff intervention including care, supervision, and skills training in activities of daily living, home management, and community integration in a qualified residential setting with 24-hour staffing. This service may include the provision of medical and health-care services that are integral to meeting the daily needs of participants. Respite. Services provided to individuals unable to care for themselves; furnished on a short- term basis because of the absence or need for relief of unpaid caregivers. Room and Board. The term Room means shelter-type expenses, including all property-related costs, such as rental or purchase of real estate, maintenance, utilities, and related administrative services. The term Board means up to three meals a day or any other full nutritional regimen. Self-directed Services. A model of service delivery in which a waiver participant has decision making authority over certain aspects of the delivery of their care. Service Plan. A written document that specifies the waiver and other services (regardless of funding source) along with any informal supports that are furnished to meet the participant’s needs and goals, as assessed and identified through a person-centered planning process, and to assist a participant in remaining in the community. Service Plan is also known as the individual service plan and can include the waiver plan of care. Shared Home Supports. An individually tailored supportive service that assists with the acquisition, retention, or improvement in skills related to living in the community. A participant is matched with a shared home supports caregiver. Shared home supports are overseen by a residential support agency. Shared home supports do not include 24-hour care. Shared Home Supports include such supports as adaptive skill development, assistance with ADLs and IADLs, adult educational supports, social and leisure skill development, and supervision. Shared Living–24-Hour Supports. A residential service that matches a participant with a shared living caregiver, an arrangement overseen by a residential support agency. Shared Living – 24- Hour Supports is an individually tailored 24-hour, seven-days-per-week, supportive service available to a participant who needs daily structure and supervision. This service includes supportive services that assist with the acquisition, retention, or improvement of skills related to living in the community. This includes such supports as: adaptive skill development, assistance with ADLs and IADLs, adult educational supports, social and leisure skill development, protective oversight, and supervision. Short-term Alternative Shared Home Support Days. A short-term placement during which a member receives shared home supports from an alternative caregiver when the shared home supports caregiver is temporarily unavailable or unable to provide care. Short-term Alternative Shared Living – 24-Hour Support Days. A short-term placement during which a member receives 24-hour shared living supports from an alternative caregiver when the Shared Living – 24-Hour Supports caregiver is temporarily unavailable or unable to provide care. Skilled Nursing. The assessment, planning, provision, and evaluation of goal-oriented nursing care that requires specialized knowledge and skills acquired under the established curriculum of a school of nursing approved by a board of registration in nursing. Such services include only those services that require the skills of a nurse. Skilled nursing services are provided by a person licensed as a registered nurse or a licensed practical nurse by a state’s board of registration in nursing. Specialized Medical Equipment and Supplies. Devices, controls, or appliances to increase abilities in activities of daily living, or to control or communicate with the environment. Speech/Language Therapist. A person who is licensed by the Massachusetts Division of Registration in Speech-language Pathology and Audiology and has either a Certificate of Clinical Competence from the American Speech-Language-Hearing Association (ASHA) or a statement from ASHA of certification equivalency. Speech/Language Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, that are designed to improve, develop, correct, rehabilitate, maintain, or prevent the worsening of speech/language communication and swallowing disorders that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Speech therapy services may include the performance of a maintenance program beyond the scope of coverage in the state plan. Services may include training and oversight for the participant or a family member or other person to carry out a maintenance program. Supported Employment. Regularly scheduled services that enable participants, through training and support, to work in integrated work settings in which individuals are working toward compensated work, consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals. Supportive Home Care Aide. Services provided to participants with Alzheimer’s/dementia or behavioral health needs to assist with ADLs and IADLs. These services include personal care, shopping, menu planning, meal preparation including special diets, laundry, light housekeeping, escort, and socialization /emotional support. Telehealth. The delivery of services to participants via telephone, video-conferencing, or other electronic modality. Services that may be delivered via telehealth modalities are described in HCBS Waiver Provider Bulletin 23. EOHHS may publish updates or clarifications related to the provision of telehealth for HCBS Waiver Services by bulletin or other written issuance. Transitional Assistance Services. Non-recurring residential set-up expenses for participants who are transitioning from a nursing facility or hospital to a community living arrangement where the participant is directly responsible for their own set-up expenses. Allowable expenses are those that are necessary to enable a person to establish a basic household and do not constitute Room and Board. Transportation. Conveyance of participants by vehicle, from their residence to and from the site of HCBS waiver services and other community services, activities, and resources, including physical assistance to participants while entering and exiting the vehicle. Tuberculosis Screening. Administration of the Massachusetts Tuberculosis Risk Assessment published by the Massachusetts Department of Public Health or a similar tool by a medical provider to identify asymptomatic individuals for testing for latent tuberculosis infection. Vehicle Modification. Necessary adaptations or alterations to an automobile or van that is the participant’s primary means of transportation and that is not owned or leased by an entity providing services to the participant. Vehicle modifications are necessary when they are required to accommodate special needs of the participant. Examples of vehicle modifications include van lift, tie downs, ramp, specialized seating equipment, and seating/safety restraint. Visit. A face-to-face or telehealth contact with the participant for the purpose of providing an HCBS waiver service. Waiver Provider. A qualified individual or organization that meets the requirements of 130 CMR 630.000, provides waiver services to participants, and has signed a provider agreement with the MassHealth agency. Waiver Services. Home- and community-based services that are covered in accordance with the requirements of 130 CMR 630.000 for participants enrolled under an ABI waiver or MFP waiver.