Subsection 144-101-II-26.01 - DEFINITIONS26.01-1Day Health Services are health services that are needed to insure the optimal functioning of the member that are provided through a day health service. These services must be provided under an individual plan of care and outside the member's residence.26.01-2Day Health Program is a service that provides day health services and is licensed by the Department of Health and Human Services (DHHS or Department), Bureau of Elder and Adult Services.26.01-3Nursing Services are services provided by a registered nurse and/or a licensed practical nurse within appropriate professional licensing regulations. They include, but are not necessarily limited to, monitoring health problems, monitoring and administering medication, and performing skilled tasks.26.01-4Cuing is any spoken instruction or physical guidance, which serves as a signal to do something. Cuing is typically used when caring for individuals who are cognitively impaired.26.01-5Limited Assistance describes an individual's self-care performance in activities of daily living, as defined by the Minimum Data Set (MDS) assessment process. It means that although the individual was highly involved in the activity over the last seven(7) days, or twenty-four (24) to forty-eight (48) hours if in a hospital setting, help of the following type(s) was provided: - Guided maneuvering of limbs or other non-weight-bearing assistance three (3) or more times, or
- Guided maneuvering of limbs or other non-weight-bearing assistance three (3) or more times plus weight-bearing support provided only one (1) or two (2) times.
26.01-6One-person Physical Assist requires one (1) person to provide either weight-bearing or non-weight-bearing assistance for an individual who could not perform the activity independently in the preceding seven (7) days, or twenty-four (24) to forty-eight (48) hours if in a hospital setting. This does not include cuing. 26.01-7Extensive Assistance means although the member performed part of the activity over the last seven (7) days, or twenty-four(24) to forty-eight (48) hours in a hospital setting, help of the following type(s) was provided: - Weight-bearing support three (3) or more times, or
- Full staff performance during part (but not all) of the last seven (7) days.
26.01-8Medical Eligibility Determination (MED) Form is the form approved by the Department for medical eligibility determinations and service authorization for the plan of care based upon the assessment outcome scores. The definitions, scoring mechanisms and time frames relating to this form are outlined in the MED form and provide the basis for services and the care plan. The care plan summary contained in the MED form documents the authorized service plan. The care plan summary also identifies other services the member is receiving, in addition to the authorized services provided under this Section.26.01-9Authorized Agent is the contractor selected by the Department of Health and Human Services to conduct face-to-face assessments and reassessments of member eligibility, using the DHHS Medical Eligibility Determination form, and the time frames and definitions within it, to determine medical eligibility for covered services.26.01-10Significant Change means a major change in the member's status that is not self limiting, affects more than one (1) area of functional health status, and requires a multi-disciplinary review or revision of the authorized plan of care. A self-limiting condition is one that will normally resolve itself within two (2) weeks without further intervention or by staff implementing standard disease related clinical intervention.26.01-11Significant Change Assessment means the process by which the Department or its authorized agent determines whether a member has sustained a Significant Change. A Significant Change Reassessment is appropriate if the member exhibits two (2) or more instances of either improvement or decline that affect the member's physical condition. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-26, subsec. 144-101-II-26.01