A member must meet the following clinical eligibility criteria for receipt of AFC.

1. (A) AFC must be ordered by the member’s PCP.

2. (B) The member has a medical or mental condition that requires daily hands-on (physical) assistance or cueing and supervision throughout the entire activity in order for the member to successfully complete at least one of the following activities:

   1. (1) Bathing: a full-body bath or shower or a sponge (partial) bath that may include washing and drying of face, chest, axillae (underarms), arms, hands, abdomen, back and peri-area that may include personal hygiene such as: combing or brushing of hair, oral care (including denture care and brushing of teeth), shaving, and, when applicable, applying make-up;
   2. (2) Dressing: upper and lower body, including street clothes and undergarments, but not solely help with shoes, socks, buttons, snaps, or zippers;
   3. (3) Toileting: member is incontinent (bladder or bowel) or requires assistance or routine catheter or colostomy care;
   4. (4) Transferring: member must be assisted or lifted to another position;
   5. (5) Mobility: (ambulation) - member must be physically steadied, assisted, or guided during ambulation indoors and outdoors, or is unable to self-propel a wheelchair appropriately without the assistance of another person; and
   6. (6) Eating: if the member requires constant supervision and cueing during the entire meal, or physical assistance with consuming a portion or all of the meal.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-9

Provider Manual Series (130 CMR 408.000)

Transmittal Letter Date

Adult Foster Care Manual

AFC-20 04/26/24