Section 408.524 - GAFC Staff Qualifications and ResponsibilitiesAll staff directly employed by the GAFC provider, as well as any contract staff, per diem staff, backup staff, or anyone providing GAFC on behalf of the GAFC provider to members must meet the following requirements.
(A)General Staff Requirements. (1) Prior to hiring or contracting with any staff the GAFC 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;(d) conduct Office of Inspector General (OIG) check;(e) conduct licenses and certification checks and validate that the candidate has obtained all necessary licenses and certifications and that all licenses and certifications are current;(f) ensure that each GAFC staff person is not related to or legally responsible for the member receiving GAFC; and(g) ensure that each GAFC direct care aide, registered nurse, licensed practical nurse, and care manager has received a tuberculosis screening within the previous 12 months.(2) On an ongoing basis, the GAFC provider must:(a) ensure that all GAFC direct care aides, registered nurses, licensed practical nurses, and care managers receive tuberculosis screenings in accordance with current guidelines issued by the Centers for Disease Control and Prevention (CDC) and Massachusetts Department of Public Health;(b) ensure that all staff are appropriately trained and managed, which must include, but not be limited to, training in recognition and reporting of abuse of elders and persons with disabilities and provider services;(c) evaluate staff annually using standardized evaluation measures;(d) maintain a record of each performance evaluation in a separate personnel file for each staff member; and(e) include in each staff member's personnel file any staff incident or accident reports.(B)The Multidisciplinary Professional Team Staff Qualifications and Responsibilities. (1)Program Director. The GAFC provider must employ a program director who is a healthcare professional.(a)Qualifications. The care manager must have 1. a bachelor's degree, a social worker license from the Massachusetts Board of Registration in Social Work, and at least two years of recent experience working with elders or adults with disabilities; or2. a bachelor's degree and two years of clinical experience in the care of elders or people with disabilities.(b)Responsibilities. The responsibilities of the program director include:1. development and implementation of the GAFC provider's policies and procedures in 130 CMR 408.521(A);2. direction and supervision of all aspects of the GAFC program;3. oversight of the hiring, training, supervision, firing, and evaluation of all GAFC employees and contractors;4. the fiscal administration of the GAFC program, including billing, budget preparation, and required program statistical and financial reports;5. ensuring the MDT reviews GAFC direct care aide logs every six months;6. ensuring that either the nurse or the case manager reviews the GAFC direct care aide logs every month; and7. ensuring that the GAFC provider meets all of the requirements in 130 CMR 408.000 and 130 CMR 450.000: Administrative and Billing Regulations.(2)Registered Nurse. The GAFC provider must employ or independently contract with a registered nurse. The registered nurse may function as the program director, provided that a nurse functioning as the program director is employed by the GAFC provider and is not an independent contractor. (a)Qualifications. The registered nurse must be fully licensed by the Massachusetts Board of Registration in Nursing. The registered nurse must have at least two years of recent experience in the direct care of elders or adults with disabilities.(b)Responsibilities. The responsibilities of the registered nurse include:1. completing and coordinating all applicable clinical assessments and clinical evaluations;2. developing and reviewing on an ongoing basis each member's GAFC plan of care;3. selecting, training, evaluating, and supervising GAFC direct care aides in conjunction with the care manager;4. reviewing the PCP Summary Form;5. monitoring the health status and treatment plans of all members to ensure that all needed GAFC is properly delivered;6. reporting changes in the health status of any member to the member's PCP;7. reviewing GAFC direct care aide logs at a minimum of every 30 days;8. conducting on-site visits with each member at the qualified setting in accordance with 130 CMR 408.505(B)(6);9. completing a nursing progress note corresponding with each on-site visit or encounter, or more often as the member's condition warrants;10. submitting semiannual health-status reports to the member's PCP;11. planning for and implementing discharges and transition from the GAFC program;12. conducting an orientation for each GAFC direct care aide before the GAFC direct care aide begins personal care; and13. providing ongoing training to GAFC direct care aides on health and aging.(3)GAFC Care Manager. The GAFC provider must employ or independently contract with a care manager. The GAFC care manager may function as the program director, provided that a care manager functioning as the program director is employed by the GAFC provider and is not an independent contractor. (a)Qualifications. The care manager must have1. a bachelor's degree, a social worker license from the Massachusetts Board of Registration in Social Work, and at least two years of recent experience working with elders or adults with disabilities; or2. a bachelor's degree and two years of clinical experience in the care of elders or people with disabilities.(b)Responsibilities. The responsibilities of the care manager include:1. obtaining a social history and conducting a psychosocial evaluation;2. participating in the development, implementation, and ongoing review of the GAFC plan of care;3. conducting on-site visits with each member at the member's home in accordance with 130 CMR 408.505(C)(5);4. completing a care-management progress note corresponding with each on-site visit or encounter and upon significant change;5. reviewing GAFC direct care aide logs at a minimum of every 30 days6. assisting with obtaining information and accessing other healthcare and community services;7. reviewing and documenting the fire and safety procedures for the qualified setting;8. participating in discharge and transition planning and implementation; and9. conducting an initial review of the suitability of the member's home, and conducting a review at least annually, or more often as needed, the suitability of the member's home.(4)Staff Qualification Substitution. For any staff member on the MDT who does not meet the qualifications as stated in 130 CMR 408.524, the GAFC provider must receive a written approval from the MassHealth agency for substitution of the qualification prior to hiring.(C)Direct Care Aide. The GAFC provider must employ or contract with direct care aides.(1)Qualifications. The direct care aide must: (a) not be a family member as defined in 130 CMR 408.502;(b) have one or more years of experience working with elders and people with disabilities providing assistance with ADLs and IADLs; and(c) hold a valid certification as a home health aide; or(d) have been determined competent either through a competency evaluation program or by the GAFC provider's registered nurse in all of the following areas:1. techniques for providing safe personal care assistance;2. basic understanding of body functioning and changes in body function;3. assisting participants at various levels of functioning;4. caring for participants admitted at the Program and participants with Alzheimer's disease and related disorders, behavioral health issues, and cognitive impairments;5. observation, reporting, and documentation of the members status and the care provided;6. 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;7. preventing and reporting abuse, neglect, mistreatment and misappropriation;8. communication and interpersonal skills;9. safety and emergency procedures, including the Heimlich Maneuver;10. maintenance of a clean, safe, and healthy environment; and11. recognizing, responding to, and reporting emergencies and knowledge of emergency procedures.(2)Responsibilities. The responsibilities of the GAFC direct care aide include:(a) provision of hands-on or cueing and supervision with ADLs and IADLs, of a member in accordance with the individual's GAFC plan of care and that is necessary for the member's health and well-being including, but not limited to, identifying when a crisis intervention is necessary;(b) monitoring and reporting any nonurgent or nonemergency changes in the member's medical condition to the nurse or care manager. In cases of emergency, report directly to the most appropriate provider and follow-up with a member of the MDT;(c) providing ongoing supervision of health-related activities, such as:1. Issuing reminders to the member about prescribed medications; and2. Timely refilling of the member's prescriptions.(d) completing a direct care aide log for each visit;(e) sending the completed direct care aide log at the end of each month to the nurse where it is maintained as part of the member's file;(f) notifying the GAFC provider of the need for alternative care of the member;(g) immediately notifying the GAFC provider when any of the following events occur:2. a medical emergency or any significant change in a member's health or level of functioning;3. a fire, accident, injury, or contraction of a serious communicable disease by the member or GAFC direct care aide;4. any planned or unexpected departure from the member's home by the member; and5. all other member or caregiver incidents or accidents.(h) use electronic visit verification (EVV) in the form and format as required by the MassHealth agency.(D)Licensed Practical Nurse. The GAFC provider may employ or independently contract with a licensed practical nurse.(1)Qualifications. The licensed practical nurse must be licensed by the Massachusetts Board of Registration in Nursing and in good standing with the Board.(2)Responsibilities. Under the direction and supervision of the GAFC provider RN, licensed practical nurses may: (a) complete and coordinate all applicable clinical assessments and clinical evaluations;(b) develop and review on an ongoing basis each member's GAFC plan of care;(c) review the PCP Summary Form;(d) monitor the health status of all members to ensure that all needed GAFC is properly delivered;(e) report changes in the health status of any member to the member's PCP;(f) review GAFC direct care aide logs at a minimum of every 30 days;(g) conduct on-site visits with each member at the qualified setting in accordance with 130 CMR 408.505(B)(6);(h) complete a progress note corresponding with each on-site visit or encounter, or more often as the member's condition warrants;(i) submit semiannual health-status reports to the member's PCP;(j) plan for and implementing discharges and transition from the AFC program;(k) conduct an orientation for each GAFC Direct Care Aide before the GAFC Direct Care Aide begins personal care; and(l) provide ongoing training to GAFC Direct Care Aides on health and aging.(E)GAFC Staff Training Requirements.(1) GAFC providers must provide initial and periodic 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 GAFC provider.(2) The GAFC provider must hold an orientation for new staff within one month of hire. This orientation must include the following topics:(a) techniques of providing safe delivery of ADLs, IADLs, and good body mechanics;(b) delivery of GAFC by the GAFC provider;(c) written policies and procedures of the GAFC provider;(d) the requirements of 130 CMR 408.000;(e) GAFC provider staff roles and responsibilities;(f) caring for people with disabilities, elders, individuals with Alzheimer's disease and related disorders, behavioral health issues and cognitive impairments including behavioral interventions, behavior acceptance, and accommodations;(g) observation, reporting and documentation of the member's status and the care provided, including GAFC direct care aide log entries;(h) basic first aid, cardiopulmonary resuscitation (CPR), and emergency procedures, including the Heimlich Maneuver;(i) universal precautions and infection control practices;(j) information about local health, fire, safety, and building codes;(k) privacy and confidentiality;(l) multidisciplinary team approach;(m) medication management;(n) communication and interpersonal skills;(p) prevention of, and reporting of, abuse, neglect, mistreatment and misappropriation/financial exploitation;(q) completing and filing critical incident reports;(r) human rights, nondiscrimination and cultural sensitivity;(s) 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;(t) recognizing, responding to, and reporting change in condition, emergencies and knowledge of emergency procedures, including the GAFC provider's fire, safety, and disaster plans; and(u) relevant provisions of the Health Insurance Portability and Accountability Act of 1996.(F)GAFC Backup Staff Coverage. The GAFC provider must ensure the availability of professional and direct care backup staff if coverage is required due to illness, vacation, or other reasons. All staff providing backup coverage must possess an equal or greater level of licensure and certification required for each position, and must meet all requirements of staff members.Adopted by Mass Register Issue 1472, eff. 7/1/2022.Amended by Mass Register Issue 1520, eff. 4/26/2024.