C.M.R. 10, 149, ch. 6, 149-6-5, subsec. 149-6-5.04

Current through 2024-25, June 19, 2024

Subsection 149-6-5.04 - NUTRITION SERVICES PROVIDED

Nutrition services shall be provided in conformance with this rule. AAAs must provide Congregate Nutrition Services, Home Delivered Nutrition, Nutritional Counseling and Nutrition Education throughout their designated planning and service areas either by directly providing services, subject to a Department approved direct service waiver, or through a subcontracted entity.

1.Congregate Nutrition Services

Congregate Nutrition services provide meals, socialization and nutrition information in a community setting in conformance with the following requirements.

A. Eligibility & Priority

The following individuals are eligible for Congregate Nutrition and shall be prioritized for receiving Congregate Nutrition Services from Providers in the following order:

(1) Individuals referred by OADS Adult Protective Services (APS);

(2) Individuals age 60 or older in Greatest Social Need and/or Greatest Economic Need;

(3) Individuals age 60 or older;

(4) Spouses, of any age, of eligible individuals age 60 or older;

(5) Volunteers of the Nutrition Services Program age 60 or older who provide services during the meal hours;

(6) Individuals with a Disability under age 60 who reside in housing facilities occupied primarily by Older Individuals where Congregate Nutrition is served;

(7) Individuals with a Disability under age 60 who reside with and accompany Older Individuals to the community dining site;

(8) Volunteers of the Nutrition Services Program under age 60 who provide services during the meal hours.

B. Otherwise, Ineligible

(1) Provider staff and their guests may receive meals so long as it does not deprive an otherwise eligible individual of a meal, and they pay the full cost of the meal.

C. Congregate Meal Site Requirements

(1) Providers of Congregate Nutrition services receiving federal funds shall:

(a) Utilize a paid or volunteer meal site manager who is responsible for all nutrition activities at the site. The manager must have experience working with and communicating effectively with Older Individuals.

(b) Provide notice to individuals, the public, and OADS regarding openings, closings, relocations, changes in days or hours of a congregate meal site at least ten (10) business days in advance unless emergency or unforeseen event exists that prevents such notice.

(2) Providers of Congregate Nutrition services are prohibited from charging participants age 60 or older a fee for a congregate meal.

D. Service Reduction, Denial or Termination

(1) Providers may deny, reduce, or terminate Congregate Nutrition services for an individual when:

(a) The individual does not meet the eligibility requirements in this Section;

(b) Physician-ordered dietary requirements for the individual cannot be met by the modified diets available in the program;

(c) The individual engages in sexual or other illegal harassment of an employee, volunteer, or another participating individual;

(d) The individual's participation puts others, including service Providers, in danger; or

(e) Funds are not available.

(2) Notice of any denial, reduction, or termination of services must be provided in accordance with 10-149 C.M.R. ch. 5, Section 40, § 40.01.

2.Home Delivered Nutrition

Home Delivered Nutrition services are home delivered meals provided to eligible individuals on a daily or less frequent basis. Providers shall make Home Delivered Nutrition services available in conformance with the following:

A. Eligibility

In order to be eligible to receive home delivered meals, an individual must be either:

(1) 60 years of age or over and:

(a) Homebound;

(b) Unable to prepare their own meals or lacking support with meal preparation;

(c) Not residing in assisted housing where Congregate Nutrition is available;

(d) Unable to participate in Congregate Nutrition services; or

(2) Under 60 years of age, and:

(a) The individual has a disability and eligible under Social Services Block Grant Funds or its successor(s) (and those funds are available) who:

i. Resides with others receiving home delivered meals; or

ii. Was referred by APS staff.

B. Priority

(1) Individuals newly receiving home delivered meals shall have the following priority order:

(a) Older Individuals referred by APS;

(b) Older Individuals who are at high nutritional risk as indicated by the OADS-approved assessment;

(c) Older Individuals who are Frail;

(d) Older Individuals who live in Rural Areas;

(e) Older Individuals in the Greatest Economic and/or Social Need;

(f) Older Individuals who have the greatest Risk of Institutionalization;

(g) Older Individuals who have been on the waiting list for the greatest number of days;

(h) A spouse, of any age, of a qualifying individual above, if, according to criteria determined by the AAA or its subcontracted agency, receipt of the meal by the spouse is in the best interest of the Homebound Older Individual;

(i) Individuals with a Disability, under age 60, who reside in housing facilities occupied primarily by Older Individuals at which Congregate Nutrition services are provided;

(j) Individuals with a Disability, under age 60, who reside with Older Individuals receiving home delivered meals if, according to criteria determined by the AAA or its subcontracted entity, receipt of the meal by the Individuals with a Disability under age 60 is in the best interest of the Homebound Older Individual;

(k) Individuals under age 60 referred by APS (subject to the availability of funds that support such individuals); and

(l) Individuals with a Disability under age 60 (subject to the availability of funds that support such individuals).

C. Home Delivered Nutrition Services Requirements

(1) All home delivered meal Providers receiving state and federal funds shall:

(a) Complete an in-person assessment of applicants for Home Delivered Nutrition services, using an OADS-approved assessment tool, within ten (10) business days from Referral, if it appears, based on the telephonic screening, that the individual may be eligible for home delivered meals.

Providers are prohibited from providing meals to applicants prior to the completion of an in-person assessment and determination of applicant eligibility, except for in an emergency. In an emergency, Providers may provide meals to applicants prior to the completion of an in-person assessment and determination of eligibility but Providers must complete the in-person assessment within ten (10) business days of service initiation and adjust services based on the in-person assessment. An emergency includes, but is not limited to, the following: a public health emergency, a weather emergency, a natural or man-made disaster, and a referral from APS. Providers may request permission from the Department to provide meals prior to an in-person assessment in emergencies that do not the meet the definition above.

(b) Provide home delivered meals to the eligible individual within two (2) business days of the in-person assessment, or on the next scheduled delivery date for the individual's geographic area, whichever is sooner, unless the individual is placed on the waiting list.

(c) Inform individuals of other available benefits and programs, and with the individual's documented permission, provide Referral and follow up to obtain other services.

(2) Subsequent telephonic or virtual reassessments of eligible individuals must be conducted at least every six (6) months.

D. Waiting List

(1) When a Provider has insufficient funding to accept new eligible individuals into their home delivered meals program, the Provider shall establish a waiting list for Home Delivered Nutrition services. Eligible individuals on the waiting list shall begin receiving services, when funding permits, according to the priorities listed in § 5.04-2(B).

(2) Notwithstanding the establishment of a waiting list, the Provider shall continue to telephonically screen each individual referred to the Provider for Home Delivered Nutrition within two (2) business days, using an OADS-approved preliminary telephone screening tool, and assess potentially eligible individuals within ten (10) business days before the individual may be entered on the waiting list.

(3) Providers will continue to inform referred individuals about other potentially available nutrition services and, if appropriate and with their permission, to refer the individuals to those services.

(4) Once removed from the waiting list, the Provider shall begin providing the individual with Home Delivered Nutrition within two (2) business days, or on the next scheduled delivery day for that individual's geographic location, whichever is sooner.

(5) If more than six (6) months pass after an individual is found eligible, the Provider must conduct an updated telephonic of the individual before the individual can begin receiving meals.

E. Service Reduction, Denial or Termination

(1) A Provider may deny or terminate Home Delivered Nutrition services only when:

(a) The individual does not meet the eligibility requirements in § 5.04-2(A);

(b) The individual declines services;

(c) Physician-ordered dietary requirements for the individual cannot be met by the modified diets available in the program;

(d) The individual engages in sexual or other illegal harassment of a Provider's employee or volunteer;

(e) The individual's participation puts others, including service Providers, in danger; or

(f) Funds are not available.

(2) A Provider may reduce an individual's Home Delivered Nutrition services:

(a) To match the individual's needs if, upon re-assessment, their need for Home Delivered Nutrition services has been reduced; or

(b) If federal funding for Home Delivered Nutrition services has been reduced.

(3) Notice of any denial, reduction, or termination of services must be provided in accordance with 10-149 C.M.R. ch. 5, Section 40, § 40.01.

3.Nutrition Counseling

Nutrition Counseling is an individualized service for persons at high nutritional risk, as determined by the OADS-approved assessment. Providers shall provide Nutrition Counseling in conformance with the following:

A. Eligibility & Priority

The following individuals are eligible for Nutrition Counseling services, as resources and Provider capacity allow, in the following order of priority:

(1) Older Individuals referred by APS staff;

(2) Older Individuals with the Greatest Social Need or Greatest Economic Need;

(3) Individuals who are not 60 years or older, but who are individuals with a disability who are eligible for Congregate Nutrition or Home Delivered Nutrition services as defined in this Section.

(4) Spouses, of any age, of individuals who are eligible under § 5.04-1(A).

B. Nutrition Counseling Requirements

All providers receiving state and federal funds shall offer Nutrition Counseling to eligible individuals at high nutritional risk, determined by the OADS-approved assessment. Nutrition Counseling may be offered to individuals at moderate nutritional risk or who receive a good Nutrition Risk Score, subject to resources and Provider capacity.

C. Service Denial or Termination

(1) Services may be denied or terminated when:

(a) The individual does not meet the eligibility requirements in this Section;

(b) The individual engages in sexual or other illegal harassment of a Provider's employee or volunteer;

(c) The individual's participation puts others, including service Providers, in danger; or

(d) Funds are not available.

(2) Notice of any denial or termination of services must be provided in accordance with 10-149 C.M.R. ch. 5, Section 40, § 40.01.

4.Nutrition Education

Nutrition Education programs provide accurate and culturally sensitive nutrition, physical fitness, or health information to participants and/or their Caregivers in a group or individual setting overseen by a dietitian or individual with comparable expertise. Providers shall make Nutrition Education available in conformance with the following:

A. Eligibility & Priority

(1) Individuals are eligible for Nutrition Education program services, in the following order of priority:

(a) Older Individuals referred for Nutrition Education by APS;

(b) Older Individuals with the Greatest Social Need or Greatest Economic Need;

(c) Individuals who are not 60 years or older, but who have a disability and who are eligible for Congregate Nutrition or Home Delivered nutrition services as defined in this Section.

(d) Spouses, of any age, of individuals who are eligible under § 5.04-1(A).

B. Nutrition Education Requirements:

(1) Providers of Nutrition Education services must carry out integrated health promotion and disease prevention programs for Older Individuals that include Nutrition Education, physical activity, and other activities designed to modify behavior and to improve health literacy in accordance with 42 U.S.C. § 3030g-21(2)(J).

(2) Services may include those provided pursuant to 42 U.S.C. § 3002(14).

C. Service Denial or Termination

(1) Providers of Nutrition Education services may deny or terminate Nutrition Education services for an individual when:

(a) The individual does not meet the eligibility requirements in this Section;

(b) The individual engages in sexual or other illegal harassment of a Provider's employee or volunteer;

(c) The individual's participation puts others, including service Providers, in danger; or

(d) Funds are not available.

(2) Notice of any denial or termination services must be provided in accordance with 10-149 C.M.R. ch. 5, Section 40, § 40.01.

5.Social Services Block Grant

A. In the event that an individual is ineligible for Congregate Nutrition services, Home Delivered Nutrition services, Nutrition Counseling and/or Nutrition Education, OADS may reimburse Providers for providing services to ineligible individuals from the Department's Social Services Block Grant (SSBG) allocation, subject to availability of funds and the following SSBG eligibility requirements.

B. Eligible individuals include:

(1) Adults under public guardianship;

(2) Adults with active APS cases;

(3) Older Adults who are receiving case management services from an AAA; and

(4) Adults with physical disabilities.

C.M.R. 10, 149, ch. 6, 149-6-5, subsec. 149-6-5.04