130 CMR 419.416 - Day Habilitation Provider Responsibilities
In addition to meeting all of the qualifications set forth in 130 CMR 419.000 and 130 CMR 450.000: Administrative and Billing Regulations, the DH provider must meet all of the following requirements.
(A)
Policies
and Procedures Manual. Each DH provider must develop, maintain,
and periodically review and update policies and procedures governing the
delivery of DH. The policy and procedures manual must at minimum include
(1) governance documentation, including, but
not limited to
(a) a mission
statement;
(b) the goals and
objectives of the program;
(c) an
organizational chart describing the lines of authority and communication needed
to manage the DH program, including the lines of authority for delegation of
responsibility down to the member care level;
(d) job descriptions that include titles,
reporting authority, qualifications, and responsibilities;
(e) a description of the governing body;
and
(f) a description of the
fiscal/business management system that clearly specifies the use of funds
within budgetary constraints and fiscal restrictions and fiscal reporting by
month, reflecting all sources of income and program expenses.
(2) administrative policies and
procedures, including, but not limited to
(a)
human resources and personnel;
(b)
staff and staffing requirements;
(c) backup staff in the event coverage is
required due to illness, vacation, or other reasons;
(d) staff education and training;
(e) DH provider staff evaluation and
monitoring;
(f) emergencies
including fire, safety, and disasters, including notifying the fire department
and police in emergencies and relocating members during an emergency;
(g) MassHealth member rights;
(h) human rights and
nondiscrimination;
(i) incident and
accident reporting;
(j) staff and
member grievances;
(k) cultural
competency;
(l) quality assurance
and improvement;
(m) emergency
services and plans;
(n) first aid
and cardiopulmonary resuscitation requirements;
(o) Health Insurance Portability and
Accountability Act (HIPAA);
(p)
food storage and preparation areas;
(q) coordination of DH with other services
the member is receiving; and
(r)
procedures to be followed if a member is missing or lost.
(3) clinical policies and procedures,
including, but not limited to
(a) evaluations
and assessments;
(b) privacy and
confidentiality;
(c) medication
administration, management, storage, and disposal;
(d) universal precautions;
(e) infection control and communicable
diseases;
(f) recognizing and
reporting abuse (physical, sexual, emotional, psychological), neglect,
self-neglect and financial exploitation;
(g) description and use of positive
behavioral supports (PBS);
(h)
admission criteria; and
(i)
discharge planning and follow-up.
(4) All documentation required in
130
CMR 419.416(A) must be kept
on-site or readily accessible.
(B)
Recordkeeping and Reporting
Requirements.
(1)
Recordkeeping. The DH provider must maintain records
in compliance with the requirements set forth in
130 CMR
450.000: Administrative and Billing
Regulations and all other applicable state and federal laws. All
records, including, but not limited to, the following, must be accessible and
made available on site for inspection by the MassHealth agency or its designee.
(a)
Member Records.
The record must contain information necessary to identify the member. Each
member's record also must include all documentation pertaining to the DHSP and
the design of an appropriate DHSP, including, but not limited to, the
following:
1. the member's name, member
identification number, address, telephone number, sex, age, marital status,
next of kin or authorized representative, school or employment status, the date
of initial contact with the program, and the emergency fact sheet in accordance
with 130 CMR
419.430(D);
2. a member profile that includes a brief
history, including diagnoses and clinical and behavioral needs. If applicable,
the member profile must also include specialized service needs, the name of the
DHSM assigned to the member, and the name and contact information of the DDS
service coordinator, if applicable;
3. an educational, social, medical, and
vocational history with assessment reports from providers, as
applicable;
4. an updated record of
past and present immunizations and tuberculin tests or screening, based on the
recommendations of the CDC;
5. a
copy of the initial clinical assessment, and copies of any
reassessments;
6. a report of the
member's most recent annual physical examination or wellness visit;
7. the name, address, and telephone number of
the PCP serving the member;
8.
written approval of the DHSP from the IDT and the member or the member's
authorized representative;
9.
documentation that the PCP was notified in writing of the approved
DHSP;
10. documentation supporting
the level of payment associated with services provided to the member;
11. DH staff documentation of all conferences
with the member, the member's authorized representatives, and with outside
professionals;
12. daily attendance
records;
13. transportation records
when MassHealth DH or subcontracted transportation is provided;
14. progress notes updated monthly by the
DHSM when appropriate and available, and by other people significantly involved
in implementing the DHSP;
15.
progress notes written by the health care supervisor, updated quarterly or more
often as necessary to address any significant changes in member's
status;
16. reports of all
semi-annual reviews conducted in accordance with
130
CMR 419.405(A)(1)(d) and
419.419(C)(3)
and any other reports generated in
compliance with
130 CMR
419.000;
17. written authorization from the member or
the member's authorized representative for the release of information, as
applicable;
18. the discharge
notice, if the member is discharged;
19. a copy of the Level II PASRR notice, if
applicable;
20. documentation that
the PA approval supporting the need for DH ISS was obtained prior to billing,
if applicable;
21. documentation of
each 15-minute unit of ISS delivered to the member, if applicable;
and
22. documentation received from
a hospice provider, if applicable, affirming DH services are not related to the
member's terminal illness.
(b)
Administrative
Records. The DH provider must maintain
1. payroll records;
2. personnel records, including requirements
set forth in
130
CMR 419.421(A), including
evidence of completed staff orientation and training;
3. financial and billing records;
4. member utilization records, including the
number of members being served and, if applicable, number of individuals on a
waiting list;
5. records of
staffing levels and staff qualifications;
6. records of complaints and grievances;
and
7. contracts for subcontracted
services.
(c)
Incident and Accident Records. The DH provider must
maintain an easily accessible record of member and staff incidents and
accidents. The record may be kept within the individual member medical record
or employee record or within a separate, accessible file.
(2)
Reporting
Requirements.
(a)
Program Reporting.
1. The DH provider must submit all of the
following information in the format and time frames as requested by the
MassHealth agency or its designee:
a. cost
and expense information in accordance with the requirements of
957
CMR 6.03: Reporting Requirements for
Type 1 Providers; and
b.
any change in DH provider contact information.
2. The DH provider must make available to the
MassHealth agency or its designee any additional information requested by
MassHealth or its designee related to the provider's provision of DH, including
information such as clinical and statistical or cost and expense information,
accreditation correspondence with CARF or Council on Quality and Leadership,
and other data necessary to measure the quality of the services delivered by
the DH provider.
3. The DH provider
must comply with all applicable reporting requirements of other state agencies
such as DDS.
(b)
Critical Incident Reporting. The DH provider must
immediately notify the MassHealth agency of any critical incidents outlined on
the MassHealth Critical Incident Report Form.
(C)
Staffing Ratios and
Requirements. A DH provider must have sufficient qualified
staffing in accordance with
130
CMR 419.421 to deliver DH and have specific
personnel policies, including procedures for monitoring current licensure or
certification of professional staff, staff training, supervision, and
evaluation. Definitions and minimum qualifications relating to these
disciplines can be found at
130
CMR 419.421.
(1) A DH provider must have a full-time
program director.
(2) A DH provider
must have the following clinicians, either by contract or direct hire, as part
of the interdisciplinary team:
(a) physical
therapist;
(b) speech and language
pathologist;
(c) occupational
therapist; and
(d) behavioral
professional.
(3) DH
providers must have a registered nurse health care supervisor available at all
times when members are receiving DH services. Licensed Practical Nurses may
carry out all duties as delegated and overseen by the nurse health care
supervisor, as appropriate. A nurse must be available to be on site within 30
minutes during the core hours of DH operation. The RN/health care supervisor
will provide supervision of Licensed Practical Nurses (LPNs). Additional
nursing supports should be provided to ensure all members' needs are
met.
(4) A DH provider may employ
direct care staff (paraprofessionals) to help meet the needs of its members and
reach the minimum staff-to-member ratio of one-to-seven. Additional staff may
be required to meet the needs of the members served.
(5) Staffing ratios will be based on the
average daily census of members enrolled with the DH provider at the specific
DH site during the rate year, calculated using data from the last
quarter.
(6) The DH provider must
designate one person as the administrator. The same person, if qualified, may
serve as both the administrator and the program director.
(D)
Referrals and Written
Agreements. To ensure that members receive all the services
required in their DHSPs, the DH provider must make prompt and appropriate
referrals for those services not provided by the DH program itself. The DH
provider must document all referrals in the member's clinical record and
coordinate such referrals with DDS in accordance with the requirements of the
contract (see
130 CMR
419.404(E)).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.