130 CMR, § 419.421 - Day Habilitation Staff Qualifications, Responsibilities, and Training

(A) General Staffing Requirements.

(1) Prior to hiring or contracting with any staff, the DH provider must

(a) check the candidate's references and job history and ensure that the candidate meets all of the required experience, education, and qualifications before hiring;

(b) conduct a Criminal Offender Records Information (CORI) check and determine whether any offender records may disqualify the individual for employment;

(c) conduct a Sex Offender Registry Information (SORI) check and determine whether any offender records may disqualify the individual for employment;

(d) search the DPPC Abuser Registry prior to hiring staff or contracting with care providers of persons with ID/DD to align with Nicky's Law (M.G.L. c. 19C, § 15);

(e) check the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) to determine whether the candidate appears on the LEIE and is thus disqualified from employment;

(f) conduct a national criminal background check in accordance with the administrative procedures described at 115 CMR 12.00: National Criminal Background Checks;

(g) conduct license and certification checks and validate that the candidate has obtained all necessary licenses and certifications and that all licenses and certifications are current;

(h) ensure that each DH staff person is not providing direct care to any member whom that staff person is related to or legally responsible for; and

(i) ensure that each DH staff person has received a tuberculosis screening within the previous 12 months.

(2) On an ongoing basis, the DH provider must

(a) ensure that all staff receive tuberculosis screenings in accordance with current guidelines issued by the Centers for Disease Control and Prevention (CDC) and DPH; (b) conduct an OIG LEIE check for all staff each month;

(c) ensure that all staff are appropriately trained and managed, which must include but not be limited to training in recognition and reporting of abuse;

(d) have available at all times a sufficient number of educated, experienced, trained, and competent personnel to provide DH to individuals with ID or DD;

(e) evaluate staff annually using standardized evaluation measures;

(f) maintain a separate personnel file for each staff member with all applicable information including performance evaluations; and

(g) include in each staff member's personnel file any staff incident or accident reports.

(B) Professional Interdisciplinary Team (IDT).

(1) The DH provider must have an IDT that consists of the health care supervisor, developmental specialist, DHSM, and program director. Responsibilities of the IDT include, but are not limited to, designing the implementation, supervision, and continued review of the DH provider's provision of DH to members in accordance with members' individual DHSP.

(2) Additional Interdisciplinary Team Members.

(a) For the purposes of completing each member's SNA, the IDT must also include the clinicians noted at 130 CMR 419.416(C)(2) as well as other health care professionals as applicable to the member's need. These team members are responsible for reassessing a member's areas of need in the event of a significant change in the member's condition.

(b) Circumstance for continued participation of additional IDT members

1. if, based on a member's SNA, it is determined that a member needs to receive formal direct therapy, which would be implemented by the therapist or pathologist, the recommending therapist or pathologist must continue to participate in the member's IDT reviews;

2. if, based on a member's SNA, it is determined that a member does not require continued formal direct therapy, the applicable therapist or pathologist does not need to continue to participate in the member's interdisciplinary reviews; and

3. if a significant change in the member's condition occurs, the appropriate clinician(s) must reevaluate the member's SNA and the recommendations.

(C) Administrator.

(1) Qualifications. The administrator must hold either a bachelor's degree in business management or a related field or have at least two years of experience in health care management. One year of that experience must have been in a supervisory capacity.

(2) Responsibilities. The administrator must

(a) manage day-to-day activities, if acting as the program director;

(b) report to the MassHealth agency or its designee and other involved agencies;

(c) monitor compliance with all applicable laws and regulations governing DH; and

(d) implement the DH provider's policies and procedures.

(D) Program Director.

(1) Qualifications. The program director must hold a bachelor's degree in a health-related field, with at least three years of relevant health care experience, of which at least two of those years must have been spent in a supervisory role. Six years of relevant health care experience, with three of those years serving in a supervisory role, may be substituted in lieu of a bachelor's degree.

(2) Responsibilities. The program director must

(a) manage the day-to-day activities of the provision of DH;

(b) monitor compliance with all applicable laws and regulations governing the provision of DH;

(c) implement and oversee the DH provider's policies and procedures;

(d) hire; oversee training of; supervise; evaluate; and, when necessary, fire staff members;

(e) oversee member services and participate on IDTs; and

(f) report to the MassHealth agency and other involved agencies, as requested and required by the agency or agencies.

(E) Health Care Supervisor.

(1) Qualifications. The health care supervisor must be licensed as a registered nurse in the Commonwealth of Massachusetts with relevant experience.

(2) Responsibilities. The health care supervisor is responsible for overseeing the indirect and direct nursing care provided to members receiving DH from the DH provider and must (a) supervise or provide direct care and training in relevant areas;

(b) coordinate medical services with each member's PCP or medical clinic;

(c) oversee all health care services provided to the member while at the program;

(d) complete nursing assessments;

(e) participate on all interdisciplinary teams;

(f) obtain reports and approval of medical care plans from PCPs;

(g) ensure that nurse progress notes are recorded quarterly, or more often if the member's condition requires more frequent monitoring;

(h) advise the program director and other DH provider staff of any medical problems that may hinder a member's participation in DH or in a specific activity; and

(i) supervise any other nursing staff.

(F) Developmental Specialist.

(1) Qualifications. Each developmental specialist must have a high school diploma or GED.

(2) Responsibilities. Each developmental specialist must

(a) participate in member IDT reviews;

(b) ensure member training programs are implemented according to their DHSP; and

(c) provide assistance with activities of daily living.

(G) Day Habilitation Service Manager (DHSM). Each member must be assigned a DHSM. The DHSM can be the program director or developmental specialist or other personnel that meet the qualifications set forth in 130 CMR 419.421(G)(1).

(1) Qualifications. The DHSM must have experience with case managing and case reviews in a relevant health care setting.

(2) Responsibilities include

(a) supervising the implementation of the DHSP;

(b) reviewing members' DHSP;

(c) ensuring plan updates are made to the DHSP;

(d) participating in interdisciplinary team meetings; and

(e) maintaining member records.

(H) Other Licensed Nursing Staff.

(1) Qualifications. Other licensed nursing staff must be licensed in the Commonwealth of Massachusetts as either a practical nurse or registered nurse.

(2) Responsibilities. Under the direction of the health care supervisor, other licensed nursing staff must

(a) provide direct care and training in relevant areas;

(b) coordinate medical services with each member's PCP or medical clinic;

(c) complete nursing assessments;

(d) obtain reports and approval of medical care plans from PCPs;

(e) complete all nursing documentation and quarterly nursing notes or more often if the member's condition requires more frequent monitoring; and

(f) advise the program director and other DH staff of any medical problems that may hinder a member's participation in DH or in a specific activity.

(I) Other Direct Care Staff (Paraprofessionals).

(1) Qualifications. Other direct care staff must be able to complete the duties of the position.

(2) Responsibilities include

(a) assisting with ADLs;

(b) assisting with implementation member individual programs; and

(c) providing input for interdisciplinary team reviews.

(J) Behavioral Professionals.

(1) Qualifications.

(a) Behavioral Specialist. The behavioral specialist must have one year's relevant work experience in developing behavioral programming for individuals.

(b) Psychologist. The psychologist must be currently licensed by the Massachusetts Board of Registration of Psychologists, or have at least a master's degree in clinical psychology and at least three years of full-time, supervised, postgraduate experience.

(c) Behavioral Aide. A behavioral aide must have at least one year's experience with data collection and with implementing behavioral programming.

(2) Responsibilities.

(a) Behavioral Specialists. A behavioral specialist must

1. assess each individual's behavioral and affective development need areas, except for those individuals with no documented history of behaviors or who, at the time of assessment, are not exhibiting behaviors noted in their history; and

2. make recommendations, based upon assessment, on the behavioral programming and habilitation services necessary to meet the members identified needs.

(b) Psychologist. If the DH provider includes psychological testing, a psychologist must perform such testing.

(c) Behavioral Aides. A behavioral aide must assist with assessment and implementation of behavioral programming to address identified need areas.

(K) Therapists.

(1) Physical Therapist.

(a) Qualifications.

1. A physical therapist must be licensed by the Massachusetts Board of Registration in Allied Health Professions.

2. Any additional physical therapy personnel must be licensed by the Massachusetts Board of Registration in Allied Health Professions or must be graduates of an approved physical-therapy-assistant program and be licensed by the Massachusetts Board of Registration in Allied Health Professions. A physical therapy assistant must work under the direct supervision of the licensed physical therapist.

(b) Responsibilities of the physical therapist include

1. assessing each individual's therapy and developmental skill need areas; and

2. recommending, based upon the assessments, the DH necessary to meet the member's identified areas of need.

(2) Occupational Therapist.

(a) Qualifications.

1. Occupational therapists must be licensed by the Massachusetts Board of Registration in Allied Health Professions.

2. Any additional occupational therapy personnel must be licensed by the Massachusetts Board of Registration in Allied Health Professions or must be graduates of an approved occupational therapy assistant program and be licensed by the Massachusetts Board of Registration in Allied Health professions. An occupational therapy assistant must work under the direct supervision of the licensed occupational therapist.

(b) Responsibilities of the occupational therapist include

1. assessing each member's therapy and developmental skill need areas; and

2. recommending, based upon the assessments, the DH necessary to meet the member's identified areas of need.

(3) Speech and Language Pathologist.

(a) Qualifications.

1. Speech and language pathologists must be licensed by the Massachusetts Board of Registration in Speech-language Pathology and Audiology and have a Certificate of Clinical Competence (CCC) from the American Speech, Language, and Hearing Association (ASHA).

2. Any additional speech and language pathology personnel must work under the direct supervision of the licensed pathologist as a speech and language pathologist assistant (SLPA). SLPAs must be enrolled in a professional training program or must have obtained at least a bachelor's degree in speech pathology and audiology.

(b) Responsibilities of the speech and language pathologist include

1. assessing each member's communication needs; and

2. recommending, based upon the assessments, the DH necessary to meet the member's identified areas of need.

(L) DH Staff Training Requirements. The DH provider must provide initial and annual training to all staff members who are responsible for the care of a member. Records of completed training must be kept on file and updated regularly by the DH provider. The initial training must be completed for new staff within three months of hire and must include, but is not limited to, the following topics:

(1) delivery of DH by the DH provider;

(2) DH provider written policies and procedures;

(3) DH provider staff roles and responsibilities;

(4) caring for people with ID/DD, behavioral health issues including positive behavioral supports (PBS), behavior acceptance, and accommodations;

(5) observation, reporting, and documentation of the member's status;

(6) emergency procedures (including, but not limited to, administering prescribed rescue medications to members as necessary and in accordance with 105 CMR 700.003(C): Registration of Persons for a Specific Activity or Activities in Accordance with M.G.L. c. 94C, § 7(g));

(7) universal precautions and infection control practices;

(8) advance directives;

(9) prevention of, and reporting of, abuse, neglect, mistreatment and misappropriation/financial exploitation;

(10) techniques of providing safe personal care assistance and good body mechanics;

(11) human rights, non-discrimination, and cultural sensitivity;

(12) recognizing, responding to, and reporting change in condition, emergencies, and knowledge of emergency procedures, including the DH provider's fire, safety, and disaster plans and including administering rescue medications in a life-threatening emergency;

(13) the requirements of 130 CMR 419.000;

(14) information about local health, fire, safety, and building codes;

(15) privacy and confidentiality;

(16) interdisciplinary professional team approach;

(17) communication and interpersonal skills;

(18) completing and filing critical incident reports; and

(19) recognizing the physical, emotional, and developmental needs of the individuals in their care and working in a manner that respects them, their privacy, and their property.

Notes

130 CMR, § 419.421

Amended by Mass Register Issue 1373, eff. 9/7/2018. Amended by Mass Register Issue 1481, eff. 10/28/2022. Amended by Mass Register Issue 1532, eff. 10/11/2024.