651 C.M.R. 3.02
When used in 651 CMR 3.00, unless the context otherwise requires, the following terms shall have the following meanings:
Abuse. Consistent with 651 CMR 5.00: Elder Abuse Reporting and Protective Services Program, an act or omission, including emotional abuse, financial exploitation, neglect, physical abuse, sexual abuse, and/or self-neglect.
Activities of Daily Living (ADLs). Tasks, including the ability to bathe, dress/undress, eat, toilet, transfer in and out of bed or chair, move while in bed, and ambulate inside the home, and management of incontinence which are used to measure the Functional Impairment Level (FIL) of an Applicant or Consumer.
Applicant. An individual who has applied for Home Care Program services.
ASAPs. Aging Services Access Points as authorized in M.G.L. c. 19A, § 4B and defined in 651 CMR 14.01: Purpose and Scope.
Assisted Living Residence. An entity certified by Elder Affairs under 651 CMR 12.00: Certification Procedures and Standards for Assisted Living Residences which provides room, board, and personal care services to residents.
Caregiver. A person, regardless of place of residence, who is 18 years of age or older and provides assistance with Activities of Daily Living and/or Instrumental Activities of Daily Living, supervision, or social and emotional support as required by a Consumer on a daily basis without pay.
Comprehensive Service Plan. A person centered plan of care that delineates all services and funding sources to be provided to a Consumer that is developed by an ASAP using EOEA guidelines in conjunction with the Consumer and/or the Consumer's Designated Representative.
Congregate Housing. A joint program between Elder Affairs and the Department of Housing and Community Development that offers a shared living environment and integrates housing and support services.
Consumer. An adult who is enrolled in a Home Care program.
Consumer Record. An aggregate file of all documentation associated with a Consumer maintained by an ASAP in compliance with Documentation Standards. Documents requiring signature or that are otherwise unable to be recorded electronically shall be stored in a hard copy file for each Consumer.
Copayment. A monthly dollar amount billed to a Consumer for Home Care Program Services based on the Consumer's income.
Designated Representative. A person who is either:
Division of Medical Assistance (DMA). A government agency within the Executive Office of Health and Human Services that is responsible for the administration of the Title XIX (Medicaid) Program known as MassHealth.
Documentation Standards. Standards issued by Elder Affairs regarding the procedures for gathering and maintaining Consumer information.
Elder Affairs. The Executive Office of Elder Affairs.
Family. An Applicant or Consumer and his or her spouse.
Frail Elder Home and Community Based Waiver. A waiver of federal requirements granted to the Commonwealth, by the U.S. Department of Health and Human Services under 42 U.S.C. § 1396n(d), that allows DMA to pay for home and community-based services for MassHealth members who meet MassHealth criteria for Nursing Facility services but continue to reside in the community and agree to receive a waiver service.
Functional Impairment Level (FIL). The degree of functional impairment experienced by an Applicant or Consumer as evidenced by an inability to complete Activities of Daily Living and Instrumental Activities of Daily Living.
Home Care Program Services. Services provided to a Consumer, including but not limited to the following:
Home Care Service Plan. A plan of care that identifies all authorized Home Care Services.
Information and Referral Services. Activities related to the maintenance and dissemination of current information regarding the services available to elders and individuals with disabilities. Such activities include assessments of the type of assistance needed, referral to appropriate services, and follow-up to determine whether the referrals accomplished the desired objectives. Information and Referral services may be conducted by mail, by telephone, electronically, or in person.
Instrumental Activities of Daily Living (IADLs). Basic tasks, including the ability to prepare meals, do housework, do laundry, go shopping, manage medication, ambulate outside the home, use transportation, manage money, and use the telephone, which are used to measure the Functional Impairment Level (FIL) of an Applicant or Consumer.
Interdisciplinary Case Management. A person-centered approach to assessment, service acquisition, reassessment, and monitoring of services provided to Consumers to help them live independently and remain in the community. The approach includes working cooperatively, coordinating Comprehensive Service Plans and maintaining ongoing communication with the elder, family members, informal and formal supports, as necessary. Interdisciplinary Care Management is provided by registered nurses and case managers working in consultation with physicians, nurses and therapists from home health agencies, hospice providers, nutritionists, housing managers, mental health professionals, and other home and health care professionals and complies with the Interdisciplinary Case Management Standards issued by Elder Affairs.
Long Term Care (LTC) Assessment. The process to determine eligibility for Home Care Program Services through the use of the comprehensive data set (CDS) assessment tool issued by Elder Affairs and used by the ASAPs.
MassHealth. The Medical assistance program known as MassHealth administered by the Executive Office of Health and Human Services pursuant to M.G.L. c. 118E and Title XIX of the Social Security Act.
MassHealth Member. An individual who has been determined eligible to receive benefits under MassHealth.
Medicaid. The federal designation for eligibility and benefits administered under MassHealth.
Medication Management. Services provided to a Consumer to help ensure adherence with medication requirements, including cueing and providing access to medications.
Notice of Action. A procedural notification created in accordance with 801 CMR 1.00: Standard Adjudicatory Rules of Practice and Procedure and 651 CMR 1.00: Adjudicatory Rules of Practice and Procedures.
Nursing Facility. A facility that is licensed to provide skilled nursing care to residents in accordance with the requirements of 130 CMR 456.000: Long Term Care Services.
Peer Review. A process by which ASAPs convene in groups to review Consumer Records for the purpose of providing feedback to one another regarding how cases were handled and ensure more consistent operations among providers. The Peer Review process must be implemented according to Peer Review Program Instructions issued by Elder Affairs.
Program Instruction. A document issued by Elder Affairs that sets forth required procedures and protocols for the management of the Home Care Program.
Protective Services. Services provided by an Elder Protective Services Program in accordance with M.G.L. c. 19A, §§ 14 through 26 and 651 CMR 5.00: Elder Abuse Reporting and Protective Services Program, which are deemed necessary to prevent, eliminate or remedy the effects of Abuse to an elder.
Provider. An entity which has entered into a contract with an ASAP to provide one or more Home Care Program Services.
Service Priority. A method used to prioritize Applicants to the Home Care Program which is based on an assessment of Critical Unmet Needs and Non-critical Unmet Needs.
Suspension. The temporary cessation of Home Care Program Services.
Termination. The permanent cessation of Home Care Program Services or Enrollment(s).
Unmet Need(s). The Applicant's or Consumer's identified care needs which are not being met by other sources available to the Consumer or Applicant as determined by the Long Term Care Assessment. Unmet Needs consist of two sub-categories:
Voluntary Copayment. A copayment which may be contributed at the option of a Consumer.