130 CMR, § 458.402

Current through Register 1538, January 3, 2025

Section 458.402 - Definitions

The following terms used in 130 CMR 458.000 have the meanings given in 130 CMR 458.402 unless the context clearly requires a different meaning.

Acute Care Hospital. A facility that

(1) is licensed as a hospital by the Massachusetts Department of Public Health (DPH) under M.G.L. c. 111, § 51 (if in-state) or by the governing or licensing agency in its state (if out-of-state);

(2) is Medicare-certified and participates in the Medicare program;

(3) participates in the Medicaid program;

(4) has more than 50% of its beds licensed as medical/surgical, intensive care, coronary care, burn, pediatric (Level I or Level II), pediatric intensive care (Level III), maternal (obstetrics), or neonatal intensive care beds (Level III) as determined by DPH (or if out-of-state, the governing or licensing agency in its state, and as determined by MassHealth); and

(5) utilizes more than 50% of its beds exclusively as either medical / surgical, intensive care, coronary care, burn, pediatric (Level I or Level II), pediatric intensive care (Level III), maternal (obstetrics), or neonatal intensive care beds (Level III), as determined by MassHealth. An acute hospital is not a chronic disease and rehabilitation hospital or a hospital licensed primarily to provide mental health services, or any unit of a facility that is licensed as a nursing facility, chronic disease unit, or rehabilitation unit.

Adverse Incident. An occurrence that represents actual or potential serious harm to the well-being of a member or to others under the care of the medical respite provider. Adverse incidents may result from the actions of a member served, actions of a staff member rendering services, or incidents that compromise the health and safety of the member, or operations of the provider.

Behavioral Health Disorder. Any disorder pertaining to mental health or substance use as defined by the Diagnostic and Statistical Manual of Mental Disorders.

Community Support Program for Homeless Individuals (CSP-HI). A specialized community support program service, operated in accordance with 130 CMR 461.000: Community Support Program Services, to address the health-related social needs of MassHealth members who

(1) are experiencing homelessness and are frequent users of acute health MassHealth services, as defined by MassHealth; or

(2) are experiencing chronic homelessness, as defined by the U.S. Department of Housing and Urban Development.

Homelessness. A condition of any person who

(1) lacks a fixed, regular, and adequate nighttime residence, and who has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car, park, abandoned building, bus or train station, airport, or camping group;

(2) is living in a supervised publicly or privately operated emergency shelter designated to provide temporary living arrangements, including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals; or

(3) is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution.

Homeless Medical Respite or Medical Respite. Post-hospital or pre-procedure services delivered by a medical respite provider in accordance with 130 CMR 458.410(B) and (C) respectively to eligible MassHealth members as set forth in 130 CMR 458.403.

Homeless Medical Respite Provider or Medical Respite Provider. An entity that meets all conditions of participation of the MassHealth Medical Respite program described in 130 CMR 458.404 is enrolled as a provider in the MassHealth Medical Respite program.

Low-barrier Access. An approach that eliminates as many preconditions to medical respite program entry as possible and responds to the needs and concerns of individuals seeking assistance.

Low-demand Setting. A residential setting that relies on harm reduction practices to serve hard-to-reach and hard-to-engage individuals experiencing homelessness with severe mental illness and/or substance use disorder that does not require sobriety or compliance with treatment for admission or continued stay.

Medical Leave of Absence (MLOA). A short-term absence from a medical respite provider service location, during which a member does not receive medical respite services because the member is temporarily admitted to a hospital, nursing facility, or other medical setting. Absences may be planned or unplanned.

Medical Respite Service Period. Up to 183 days, whether consecutive or non-consecutive, that a member can receive medical respite, including post-hospital medical respite, pre-procedure medical respite, and medical and nonmedical leave of absence days, during a 12-month period starting with a member's first day of admission at a homeless medical respite provider service location. A new medical respite service period can begin following the completion of the 12-month period if the member meets clinical eligibility requirements.

Memorandum of Understanding. An agreement that defines the intention of parties to work together and outlines the roles and responsibilities of each party.

Mental Health Disorder. Any disorder pertaining to mental health as defined by the Diagnostic and Statistical Manual of Mental Disorders.

Non-congregate Room. A private room or semi-private room.

Nonmedical Leave of Absence (NMLOA). A short-term absence from a medical respite provider service location, during which a member does not receive medical respite services for nonmedical reasons. Absences may be planned or unplanned.

Post-hospital Medical Respite. Services delivered by a medical respite provider in accordance with 130 CMR 458.410(B) for a member who: is currently experiencing homelessness; has a primary acute medical issue that is not yet resolved but no longer requires or does not require a hospital level of care and does not meet a skilled nursing facility level of care; and is being discharged from a hospital after an inpatient stay or leaving from an emergency department visit.

Pre-procedure Medical Respite. Services delivered by a medical respite provider, in accordance with 130 CMR 458.410(C) for members currently experiencing homelessness, who do not have consistent access to a private bathroom and have a colonoscopy procedure scheduled that a medical professional has indicated as needing preparation. Each pre-procedure medical respite stay is limited to two full consecutive calendar days.

Private Room. A non-congregate room with a bed for a single person that is not shared with more than one person at a time.

Progressive Engagement. A services approach to addressing a member's homelessness that is based on tailoring assistance to each member's needs and assessing what works best for them, with their specific strengths, and in their specific situation. This services approach offers members support to address their immediate housing needs first, with ability to scale assistance up or down dependent on the member's needs for services to address their homelessness.

Release of Information. A document through which a member establishes parameters for whether and how they authorize their personal health information to be shared (including specifying what information may be shared, with whom and for what timeframes) and which specifies under what statutes, guidelines, or other authorities such information may be released.

Safe Haven. Safe, low-demand settings for people with mental health or substance use disorders utilizing non-traditional, non-threatening methods of progressive engagement and are an alternative model to shelter for people experiencing homelessness. There are no treatment demands or requirements placed on safe haven residents. However, expectations for residents include eventual transition to stable housing and engagement or re-engagement with services.

Semi-private Room. A non-congregate room with up to four beds to allow up to four people at a time to share the room, with at least a physical barrier (e.g., a curtain) in place to designate each person's space.

Substance Use Disorder. Any disorder pertaining to substance use as defined by the Diagnostic and Statistical Manual of Mental Disorders.

130 CMR, § 458.402

Adopted by Mass Register Issue 1538, eff. 1/3/2025.