Residential Habilitation

(A) Conditions of Payment. Residential habilitation is covered solely when authorized in the participant’s service plan. Residential habilitation is covered when a participant requires ongoing services and supports delivered to a participant in a provider-operated 24-hour staffed residential setting. (B) Nonpayable Services. Residential habilitation is not covered for participants who live with their immediate family unless the immediate family (for example, grandparent, parent, sibling, or spouse) is also eligible for residential habilitation and, if applicable, has received prior authorization from the MassHealth agency or its designee for residential habilitation. The following waiver services are not available to participants receiving residential habilitation: assisted living, shared living – 24-hour supports. (C) Payer for Residential Habilitation. DDS is responsible for payment to providers for residential habilitation.