The MassHealth agency does not pay an AFC provider when

1. (A) the member is receiving any other personal care services including, but not limited to, personal care services under 130 CMR 422.000: Personal Care Attendant Services;
2. (B) the member receives home health aide services provided by a home health agency under 130 CMR 403.000: Home Health Agency;
3. (C) the member is a resident or inpatient of a hospital, nursing facility (with the exception of MLOA days), resident care facility, ICF/IID, ALR, or any other residential facility subject to state licensure or certification;

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-29

Provider Manual Series (130 CMR 408.000)

Transmittal Letter Date

Adult Foster Care Manual

AFC-20 04/26/24

1. (D) the AFC provider has not received prior authorization from the MassHealth agency; or
2. (E) the provider is seeking payment for alternative caregiver days in excess of 14 days within a calendar year, or payment for NMLOA days in excess of 15 days within a calendar year, or payment for MLOA days in excess of 40 days within a calendar year.