1. (A) Staff Supervision Requirements. Medical Respite staff must have access to a licensed, at least master’s-level practitioner, with training and experience in providing services to adults experiencing homelessness, to provide supervision. Each staff member must receive supervision appropriate to the staff member’s skills, training, and level of professional experience.
2. (B) Staff Training. Staff should have appropriate training on relevant topics set forth in 130 CMR 458.412(C) to fulfill their roles, with all staff minimally receiving training on administering opiate antagonists; first aid and basic life support services (e.g., CPR provision and use of AEDs); trauma-informed de-escalation and appropriate staff responses to threatening behavior or violence; motivational interviewing and Progressive Engagement; principles of harm reduction, recovery and wellness; and management of urgent and emergent issues and escalation strategies, including contacting emergency providers, as needed.

3. (C) Staff Training Topics. The program must ensure that medical respite staff receive training to enhance and broaden their skills. Recommended training topics include, but are not limited to:

   1. (1) common diagnoses across medical and behavioral health care;
   2. (2) engagement and outreach skills and strategies;
   3. (3) service coordination skills and strategies;
   4. (4) behavioral health and medical services, community resources, and natural supports;(5) cultural competence;
   5. (6) managing professional relationships with members including but not limited to boundaries, confidentiality, and peers as workers;
   6. (7) service termination;
   7. (8) assertive engagement;
   8. (9) accessibility and accommodations;
   9. (10) communicating to outside emergency assistance;
   10. (11) responding to life-threatening emergencies;
   11. (12) strategies to maximize member and staff safety;
   12. (13) trauma-informed care;
   13. (14) traumatic brain injuries;
   14. (15) conflict resolution and mediation
   15. (16) the handling of alcohol, illegal drugs, and unauthorized prescription drugs found on site;
   16. (17) the handling of weapons brought into the medical respite program; and
   17. (18) medication administration treatment (MAT).
4. (D) Staff Professional Standards. Any staff, of any discipline, operating in the medical respite service location must comport with the standards and scope of practice delineated in their professional licensure and be in good standing with their board of professional licensure, as applicable.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-19

Provider Manual Series (130 CMR 458.000)

Transmittal Letter Date

Homeless Medical Respite Services Manual

HMR-1 01/03/25

1. (E) Staffing Plan. The medical respite provider must maintain a staffing plan that includes policies and procedures to ensure all staffing and supervision requirements pursuant to 130 CMR 458.000 are met.
2. (F) Conflict of Interest. The medical respite provider must ensure appropriate protections against conflicts of interest in its medical respite services.
3. (G) CSP-HI Staffing. CSP-HI providers providing intensive housing navigation services for members shall receive supervision while at the medical respite site in accordance with the terms of the memorandum of understanding between the medical respite provider and CSP-HI. For staffing and supervision requirements applicable to CSP-HI providers, see 130 CMR 461.000.

458.413 Transfers to Another Homeless Medical Respite

1. (A) Transfer Reasons. Members may transfer from one homeless medical respite service location to a different homeless medical respite service location operated by the same or a different provider. Acceptable reasons for transfer shall be limited to the following circumstances:

   1. (1) the member’s medical needs require transfer to a different medical respite service location to facilitate access to needed medical services; or
   2. (2) transfer to a different medical respite service location will enhance the member’s social supports (e.g., the member’s family lives in the new community).
2. (B) Discharge Planning. In accordance with requirements for planned discharges in 130 CMR 458.410(B)(10), the medical respite provider shall provide a discharge summary with required elements and coordinate transportation of the member and their belongings to the new medical respite service location. As part of the discharge summary, the medical respite provider shall notify the receiving medical respite provider about the number of medical respite days left in the member’s medical respite service period.