Community-based Day Supports

(A) Conditions of Payment. Community-based day supports are covered when the participant requires support to develop, enhance, and maintain a range of skills and competencies needed to engage in integrated activities in the community. (B) Nonpayable Services. (1) Community-based day supports services will not be covered on the same day as waiver per diem day services are covered, but are allowable on the same day as partial per diem day services. (2) Day services, community-based day supports, supported employment, and prevocational services, in combination, are limited to no more than 156 hours per month, with each day of day services considered to be six hours. The MassHealth agency or its designee may grant individualized exceptions to the limit on a 30-day basis in order to maintain a participant’s tenure in the community, to facilitate transitions to a community setting, or to otherwise facilitate the participant’s successful engagement in community-based waiver services. Exceptions to the 156-hour-per-month limit must be included in the participant’s waiver plan of care. (C) Recordkeeping. In addition to the requirements of 130 CMR 630.441, the provider must maintain records that include detailed descriptions of community-based day supports services provided and documentation of all units of service provided.