Individual Support and Community Habilitation

(A) Conditions of Payment. (1) Individual support and community habilitation is covered when a participant needs assistance to develop, maintain, or maximize independent functioning in self-care, physical and emotional growth, socialization, communication, and vocational skills. This service includes training and education in self-determination and self-advocacy to enable the participant to acquire skills to exercise control and responsibility over the services and supports they receive, and to become more independent, integrated, and productive in the community. (2) Individual support and community habilitation may be provided regularly or intermittently. These services may not be provided on a 24-hour basis and must be determined necessary for the participant to remain in the community, as documented in the participant’s service plan. (B) Nonpayable Services. Homemaker, home health aide, personal care, adult companion, individual support and community habilitation, and supportive home care aide services, in combination are limited to no more than 84 hours per week. The MassHealth agency or its designee may grant exceptions to the limit on a 90-day basis in order to maintain a participant’s tenure in the community, to provide respite to a caregiver who lives with the participant, to facilitate transitions to a community setting, to ensure that a participant at risk for medical facility admission is able to remain in the community, or to otherwise stabilize a participant’s medical condition. Exceptions may also be granted for participants awaiting transition to a residential waiver. Exceptions to the 84 hour per week 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 individual support and community habilitation services provided and documentation of all units of services.