Section 458.404 - Provider Eli gibilityAn entity is eligible to enroll as a provider in the MassHealth medical respite program only if they meet all provider participation requirements as specified in 130 CMR 458.404 and 130 CMR 450.000: Administrative and Billing Regulations. To be eligible for participation in MassHealth as a Medical Respite Provider, an entity must meet all of the criteria below.
(A) Have at least two years of experience providing services to persons experiencing homelessness.(B) Be able to ensure timely access to primary care services, as necessary, including the provision or coordination of orders, referrals and prescriptions for services to address physical, mental or functional needs, through a licensed medical provider whose scope of practice allows for delivery of medical services in a home setting, including the medical respite service location. If such licensed medical provider is not employed by or part of the same entity as the medical respite provider, the medical respite provider must execute a memorandum of understanding with such licensed medical provider, prior to initiating services, which must describe the proposed roles and responsibilities of the medical respite provider and the licensed medical provider for timely access to and provision of primary care services for the purposes of the medical respite program. The provider must make a copy of the memorandum of understanding available to MassHealth upon request.(C) Demonstrate, through attestation or such other method as determined appropriate by MassHealth, comprehensive knowledge of:(1) available community resources, including but not limited to health care, behavioral health, and home health services;(2) how to access these resources in a timely manner;(3) how to arrange for services to be delivered onsite at the medical respite, if applicable; and(4) how to arrange for transportation to receive services in the community.(D) Be able to ensure the provision of intensive housing navigation services through a CSP-HI provider in accordance with 130 CMR 461.000: Community Support Program Services. The medical respite provider and the CSP-HI provider may be part of a single entity or may be operated by different entities. If the medical respite provider is not operated by the same entity as the CSP-HI provider, the Medical Respite Provider must execute a memorandum of understanding with such CSP-HI provider, prior to initiating services, which must describe the proposed roles and responsibilities of the medical respite provider and the CSP-HI provider for the provision of intensive housing navigation services for the purposes of the medical respite program. The provider must make a copy of the memorandum of understanding available to MassHealth upon request.(E) Have dedicated confirmed access to a building structure to provide medical respite services that: (1) is a community-based setting that: (a) complies with all state and local fire, safety, and health codes; and(b) has a written disability access plan that ensures the setting can be accessed and used by people who have disabilities, including, but not limited to, mobility impairments and other physical disabilities;(2) provides access to the following rooms/spaces and services:(a) Non-congregate rooms for each member to have a personal bed for 24 hours a day, including at least one private room to allow for distance and disease control as medically necessary (e.g. for members with highly infectious conditions, who are immunocompromised, etc.);(b) Sufficient bathrooms with bath and shower facilities, including at least one private bathroom that is accessible for members with disabilities;(c) Sufficient space for members to receive safe and private, as appropriate, access at the medical respite service location to clinical services that the member would have otherwise been able to receive at home had they not been experiencing homelessness, such as home health, physical therapy, speech therapy, etc.(3) Free laundry facilities for member's personal belongings;(4) Secure storage for member's personal belongings;(5) Access to and secure storage for medications;(6) Access to a phone/tablet for telehealth and/or communications related to medical needs for members;(7) Linens (i.e., bedding and towels) for sleeping and bathing, with linen laundering services arranged for by the medical respite provider;(8) At least two working refrigerators of appropriate size to:(a) store medications; and(b) store food and meals for members.(9) Access to safety devices and emergency medications, including onsite availability of over-the-counter opiate antagonists such as Narcan to reverse the life-threatening effects of a known or suspected opiate overdose, an automated external defibrillator (AED), and Epinephrine, as appropriate.(10) For locations where the medical respite service location is co-located in a building that already receives state funding from the Executive Office of Housing and Livable Communities (EOHLC) for emergency shelter, the Department of Public Health (DPH) Bureau of Substance Addiction Services for Low-demand housing or Substance Use treatment, or the Department of Mental Health (DMH), the provider must:(a) Ensure that the medical respite is physically and functionally separated from other state-funded services provided in the building; and(b) Receive written permission to co-locate from the other state agency providing funding prior to beginning operations in accordance with 130 CMR 458.405(A)(2).Adopted by Mass Register Issue 1538, eff. 1/3/2025.