Provider Eligibility

(A) Requirements for Participation. An individual or organization seeking to participate as a provider of services under an HCBS waiver must (1) be duly authorized to conduct a business in Massachusetts that delivers health or human services to elderly or disabled adult populations; (2) comply with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of services under an HCBS waiver; (3) meet the applicable HCBS waiver service provider application qualifications; (4) comply with all standards, requirements, policies, and procedures established by the MassHealth agency for the participation of providers in MassHealth, including all provider participation requirements described in 130 CMR 630.000 and 130 CMR 450.000: Administrative and Billing Regulations; (5) obtain, as required, a MassHealth provider number; and (6) accept MassHealth payment, DDS payment, or MRC payment where applicable, as payment in full for all services provided under an HCBS waiver. (B) Required Documentation. All required MassHealth application documentation will be specified by the MassHealth agency. In order to participate as an HCBS waiver provider, an applicant must submit all required documentation, and the MassHealth agency or its designee must approve it. (C) Periodic Inspections. The MassHealth agency or its designee may conduct periodic inspections of HCBS waiver providers to ensure compliance with all provider participation requirements described in 130 CMR 630.000 and 130 CMR 450.000: Administrative and Billing Regulations. An HCBS waiver provider must cooperate with any inspection and furnish any requested records. (D) HCBS Waiver Provider Eligibility Requirements by Service Type. (1) Adult Companion. In order to participate as a provider of adult companion services under an HCBS waiver, a provider must be a health or human service organization or an individual with experience providing nonmedical care, supervision, and socialization for persons with disabilities in accordance with all standards, requirements, policies, and procedures established by the MRC for the provision of such services. (2) Assisted Living Services. In order to participate as a provider of assisted living services under a HCBS waiver, a provider must be certified as an assisted living residence by the Executive Office of Elder Affairs in accordance with 651 CMR 12.00: Certification Procedures and Standards for Assisted Living Residences, meet all applicable requirements of 42 CFR 441.301(c)(4) (Home and Community-based Settings Rule), and maintain compliance with all standards, requirements, policies, and procedures established by DDS for the provision of such services. (3) Assistive Technology Evaluation and Training Services. In order to participate as a provider of assistive technology evaluation and training services under an HCBS waiver, a provider must have a bachelor’s degree or training in a related technology field and at least one year of proven experience providing adaptive technological assessment. A provider must have knowledge and experience in evaluating the needs of individuals with disabilities, including functionally evaluating the individual in the individual's environment. (4) Assistive Technology Devices. In order to participate as a provider of assistive technology devices under the HCBS waiver, a provider must ensure that all devices and accessories have been examined and/or tested by Underwriters Laboratory (or other appropriate organization), and comply with FCC regulations, as appropriate. In addition, providers licensed, certified, and qualified by DDS in accordance with 115 CMR 7.00: Standards for All Services and Supports (Department of Developmental Services (DDS) regulations for all DDS supports and services provided by public and private providers and those services subject to regulation by the Massachusetts Rehabilitation Commission, which provide social and pre-vocational supports and work training) will be considered to have met these standards. (5) Chore. In order to participate as a provider of chore services under an HCBS waiver, a provider must be a health or human service organization or an individual with experience providing services needed to maintain the home in a clean, sanitary, and safe condition, in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services. (6) Community-based Day Supports. In order to participate as a provider of community- based day supports under an HCBS waiver, a provider must be a human service agency or rehabilitation agency with experience providing functional, community-based services and living skills training and a demonstrated commitment to the philosophy of maximizing independence and supporting meaningful community membership with an appropriate blend of comprehensive services, in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services. Community-based day supports must be provided in settings that are physically and programmatically distinct from day habilitation services settings (see 130 CMR 419.000: Day Habilitation Center Services) and waiver day services settings. All provider-owned or -operated settings in which waiver participants may gather must meet all requirements of 130 CMR 630.438. (7) Community Behavioral Health Support and Navigation. In order to participate as a provider of community behavioral health support and navigation under an HCBS waiver, a provider must be a not-for-profit or proprietary organization that provides mental health and/or substance use disorder services and be licensed within the Commonwealth of Massachusetts, and in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services. Organizations providing community behavioral health support and navigation must employ a multi-disciplinary staff with established experience, skills, and training in the acute treatment of mental health and co- occurring mental health and substance use conditions, including a minimum of one full-time master’s or doctorate-level, licensed behavioral health clinician responsible for operation of the program and supervision of staff. Supervision must include participant-specific supervision, as well as a review of mental health, substance use disorder and medical conditions, and integration principles and practices. (8) Community Family Training and/or Residential Family Training. In order to participate as a provider of community family training and/or residential family training under an HCBS waiver, a provider must be an organization or an individual with experience in providing training and instruction about treatment regimes, behavior plans, and the use of specialized equipment that supports the waiver participant to participate in the community, in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services to participants of an HCBS waiver. If an agency or individual is providing services where licensure or certification is necessary, the agency or individual must have the necessary licensure and certifications. (9) Day Services. In order to participate as a provider of day services under an HCBS waiver, a provider must be a health or human service organization with experience providing day services to persons with disabilities in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of day services to participants of an HCBS waiver. Day services must be provided at a provider-operated site in the community and not in a participant's residence. A provider of day services must meet all applicable requirements of 42 CFR 441.301(c)(4) (Home and Community-based Settings Rule), and meet the location requirements of 130 CMR 630.438. (10) Home Accessibility Adaptations. In order to participate as a provider of home accessibility adaptations under an HCBS waiver, a provider must be qualified to perform environmental and minor home adaptations in accordance with applicable state and local building codes, and comply with any applicable registration or licensure requirements. Providers must also be under contract with MRC in accordance with its standards, requirements, policies, and procedures for the provision of home accessibility adaptations. (11) Home Delivered Meals. In order to participate as a provider of home delivered meals under an HCBS waiver, a provider must have current local Board of Health inspection or certification. If the town or city where the program will be sited does not require a Board of Health inspection, the provider must submit supporting documentation. (12) Home Health Aide. In order to participate as a provider of home health aide services under an HCBS waiver, a provider must be an organization engaged in the business of home health aide services in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services, and meet the following requirements: (a) employ registered nurses who have a current license by the Massachusetts Board of Registration in Nursing and who supervise the home health aides; and (b) employ home health aides who have certification in CPR and either a certificate of home health aide training or certificate of certified nurse’s aide training. (13) Homemaker. In order to participate as a provider of homemaker services under an HCBS waiver, a provider must be an individual homemaker or an organization engaged in the business of homemaker services in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services. Homemakers must have at least one of the following qualifications: (a) certificate of home health aide training; (b) certificate of nurse’s aide training; (c) certificate of 40-hour homemaker training; or (d) certificate of 60-hour personal care training. (14) Independent Living Supports. In order to participate as a provider of independent living supports services under an HCBS waiver, a provider must be a site-based organization 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, in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services. (15) Individual Support and Community Habilitation. In order to participate as a provider of individual support and community habilitation under an HCBS waiver, a provider must be a health or human service organization or an individual with experience providing services that are designed to develop, maintain, or maximize independent functioning in self-care, physical and emotional growth, socialization, communication, and vocational skills for persons with disabilities in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services. (16) Laundry. In order to participate as a provider of laundry services under an HCBS waiver, a provider must be a not-for-profit or proprietary organization that is engaged in the business of providing laundry services at a separate laundry facility, and must have provisions in place for the handling of soiled laundry to minimize personnel exposure to contaminants and the separation of cleaned and soiled laundry during transportation to prevent spillage or cross contamination during transport. (17) Orientation and Mobility Services. In order to participate as a provider of orientation and mobility services under an HCBS waiver, a provider must be an individual, or an agency that employs individuals, with a master’s degree in special education with a specialty in orientation and mobility or a bachelor’s degree with a certificate in orientation and mobility from a university program certified by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP), and maintain compliance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services to participants of an HCBS waiver. (18) Peer Support. In order to participate as a provider of peer support services under an HCBS waiver, a provider must be an agency or individual with relevant competencies and experiences in peer support, in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services to participants of an HCBS waiver. For an agency providing this service, the agency needs to employ individuals who meet all relevant state and federal licensure or certification requirements in their discipline. (19) Personal Care. In order to participate as a provider of personal care services under an HCBS waiver, a provider must be an individual personal care worker or an organization engaged in the business of (a) providing assistance with the performance of ADLs to persons with disabilities in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such service; and (b) providing personal care services through personal care workers who must have a certificate in CPR and at least one of the following qualifications: 1. certificate of home health aide training; or 2. certificate of nurse’s aide training; or 3. certificate of 60-hour personal care training. (20) Prevocational Services. In order to participate as a provider of prevocational services under an HCBS waiver, a provider must be a prevocational service agency with experience in providing services that prepare a participant for paid or unpaid employment in an integrated, community setting, in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services to participants of an HCBS waiver. (21) Residential Habilitation. Residential habilitation under an HCBS waiver must be provided by organizations under contract with DDS in accordance with its standards, requirements, policies, and procedures for the provision of residential habilitation services to persons with disabilities, and must demonstrate compliance with applicable requirements under: (a) 115 CMR 7.00: Standards for All Services and Supports and 115 CMR 8.00: Licensure and Certification of Providers or (b) 104 CMR 28.00: Licensing and Operational Standards for Community Services. (22) Respite. In order to participate as a provider of respite services under an HCBS waiver, a respite provider must be in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services to participants of an HCBS waiver, and be: (a) licensed as a hospital by the Massachusetts Department of Public Health under 105 CMR 130.00: Hospital Licensure; (b) certified as an assisted living residence by the Executive Office of Elder Affairs under 651 CMR 12.00: Certification Procedures and Standards for Assisted Living Residences; (c) licensed as a nursing facility by the Massachusetts Department of Public Health under 105 CMR 153.000: Licensure Procedure and Suitability Requirements for Long Term Care Facilities; (d) able to meet site-based respite requirements established by the Massachusetts Department of Developmental Services under 115 CMR 7.00: Standards for All Services and Supports; (e) licensed as a respite care facility by the Department of Developmental Services in accordance with 115 CMR 7.00: Standards for All Services and Supports and 115 CMR 8.00: Licensure and Certification of Providers; (f) licensed as a rest home by the Massachusetts Department of Public Health under 105 CMR 153.000: Licensure Procedure and Suitability Requirements for Long Term Care Facilities; or (g) enrolled in MassHealth as a participating adult foster care provider under 130 CMR 408.000: Adult Foster Care. (23) Self-directed Services. Participants who choose to self-direct waiver services will have the authority and responsibility for recruiting and hiring workers to provide their self-directed services, subject to the standards, requirements, policies and procedures for the hiring of such workers under the participant’s HCBS waiver. (24) Shared Home Supports. In order to participate as a provider of shared home supports, a provider must be an organization licensed by DDS as a provider of placement services in accordance with its standards, requirements, policies, and procedures for the provision of these services to persons with disabilities, and must demonstrate compliance with applicable requirements under: (a) 115 CMR 7.00: Standards for All Services and Supports and 115 CMR 8.00: Licensure and Certification of Providers; or (b) 104 CMR 28.00: Licensing and Operational Standards for Community Services. (25) Shared Living – 24-Hour Supports. In order to participate as a provider of shared living – 24-hour supports under an HCBS waiver, organizations must be under contract with DDS in accordance with its standards, requirements, policies, and procedures for the provision of shared living – 24-hour supports services to persons with disabilities, and must demonstrate compliance with applicable requirements under: (a) 115 CMR 7.00: Standards for All Services and Supports and 115 CMR 8.00: Licensure and Certification of Providers; or (b) 104 CMR 28.00: Licensing and Operational Standards for Community Services. (26) Skilled Nursing. In order to participate as a provider of skilled nursing services under an HCBS waiver, a provider must be an organization engaged in the business of providing nursing services that employs nurses who are a registered nurse or a licensed practical nurse by the Massachusetts Board of Registration in Nursing, and maintains compliance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services to participants of an HCBS waiver. (27) Specialized Medical Equipment. In order to participate as a provider of specialized medical equipment and supplies under an HCBS waiver, a provider must be an individual or entity engaged in the business of furnishing durable medical equipment, medical/surgical supplies, or customized equipment, or a provider participating in MassHealth under 130 CMR 409.000: Durable Medical Equipment Services or a pharmacy participating in MassHealth under 130 CMR 406.000: Pharmacy Services, in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services to participants of an HCBS waiver. (28) Supported Employment. In order to participate as a provider of supported employment services under an HCBS waiver, a provider must be a human service organization with experience providing supported employment programs in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of supported employment to persons with disabilities. (29) Supportive Home Care Aide. In order to participate as a provider of supportive home care aide services under an HCBS waiver, a provider must be an organization engaged in the business of supportive home care aide services in accordance with all standards, requirements, policies, and procedures established by MRC for the provision of such services to participants of an HCBS waiver, that employs supportive home care aides who: (a) have a certification in CPR and either a certificate of home health aide training or certificate of certified nurse’s aide training; and (b) have completed an additional 12 hours of training in the area of serving individuals with behavioral health needs or the 12-hour training developed by the Alzheimer’s Association, Massachusetts Chapter on serving individuals with Alzheimer’s disease or related disorders. (30) Therapy Services. (a) Occupational Therapy. In order to participate as a provider of occupational therapy under an HCBS waiver, a provider must be an occupational therapist participating in the MassHealth program under 130 CMR 432.000: Therapist Services, a rehabilitation center participating in MassHealth under 130 CMR 430.000: Rehabilitation Center Services, a home health agency participating in MassHealth under 130 CMR 403.000: Home Health Agency, a chronic disease and rehabilitation inpatient hospital participating in MassHealth under 130 CMR 435.000: Chronic Disease and Rehabilitation Inpatient Hospital Services, or a chronic disease and rehabilitation outpatient hospital participating in MassHealth under 130 CMR 410.000: Outpatient Hospital Services, in accordance with all standards, requirements, policies, and procedures established by MRC or DDS for the provision of such services to participants of an HCBS waiver. (b) Physical Therapy. In order to participate as a provider of physical therapy under an HCBS waiver, a provider must be a physical therapist participating in the MassHealth program under 130 CMR 432.000: Therapist Services, a rehabilitation center participating in MassHealth under 130 CMR 430.000: Rehabilitation Center Services, a home health agency participating in MassHealth under 130 CMR 403.000: Home Health Agency, a chronic disease and rehabilitation inpatient hospital participating in MassHealth under 130 CMR 435.000: Chronic Disease and Rehabilitation Inpatient Hospital Services, or a chronic disease and rehabilitation outpatient hospital participating in MassHealth under 130 CMR 410.000: Outpatient Hospital Services, in accordance with all standards, requirements, policies, and procedures established by MRC or DDS for the provision of such services to participants of an HCBS waiver. (c) Speech Therapy. In order to participate as a provider of speech therapy under an HCBS waiver, a provider must be a speech/language therapist participating in MassHealth under 130 CMR 432.000: Therapist Services, a speech and hearing center participating in MassHealth under 130 CMR 413.000: Speech and Hearing Center Services, a rehabilitation center participating in MassHealth under 130 CMR 430.300: Rehabilitation Center Services, a home health agency participating in MassHealth under 130 CMR 403.000: Home Health Agency, a chronic disease and rehabilitation inpatient hospital participating in MassHealth under 130 CMR 435.000: Chronic Disease and Rehabilitation Inpatient Hospital Services, or a chronic disease and rehabilitation outpatient hospital participating in MassHealth under 130 CMR 410.000: Outpatient Hospital Services, in accordance with all standards, requirements, policies, and procedures established by MRC or DDS for the provision of such services to participants of an HCBS waiver. (31) Transitional Assistance Services. Transitional assistance services under an HCBS waiver must be provided by organizations under contract with MRC or DDS in accordance with its standards, requirements, policies, and procedures for the provision of transitional assistance services to persons with disabilities. (32) Transportation. In order to participate as a provider of transportation under an HCBS waiver, a provider must be an organization engaged in the business of transporting persons with disabilities in accordance with all standards, requirements, policies, and procedures established by DDS or MRC for the provision of such services. (33) Vehicle Modification. In order to participate as a provider of vehicle modifications under an HCBS waiver, a provider must be an individual or organization engaged in the business of vehicle modification and be under contract with MRC for the provision of vehicle modification to persons with disabilities.