We wanted to share a few Frequently Asked Questions from Daniel Tsai, Assistant Secretary for MassHealth. If you have any additional questions or want to see if Adult Foster Care of the North Shore can help you or a loved one, please give us a call.
Q: Does the AFC caregiver have to be in the room throughout an entire task or activity?
A: MassHealth recognizes and respects members’ right to privacy. There may be tasks where the member would like as much privacy as possible. For example, the caregiver may assist the member to the bathroom and transfer to the toilet, and then provide the member privacy to use the toilet, then go back in to assist with cleanup and transfer while maintaining supervision throughout the entire task/activity.
Q: To qualify a member for AFC that requires assistance with dressing, must the member need assistance with both upper and lower body dressing, or is a need for assistance with upper or lower body dressing, but not both, sufficient?
A: To qualify a member for AFC based on a need for assistance with dressing, the member must require assistance with both upper and lower body dressing in accordance with 130 CMR 408.416(B)(2). A member who requires assistance with upper or lower body dressing, but not both, does not meet the requirements for dressing to be a qualifying ADL for AFC.
Q: Must a member require assistance with mobility both indoors and outdoors for mobility to be a qualifying ADL for AFC?
A: Yes, a need for assistance with a particular ADL should be present in all applicable environments. Therefore, a member must require mobility assistance both indoors and outdoors for mobility to be considered a qualifying ADL need for purposes of AFC in accordance with 130 CMR 408.416(B)(5).
Q: What does “frequent caregiver intervention” mean when used to qualify a member for Level II service payment?
A: Caregiver intervention is “frequent” as used in the regulation at 130 CMR 408.419(D)(2)(b) when the member needs consistent or ongoing intervention to manage the identified behavior. Management of behaviors may include a need for a caregiver to proactively deter behaviors. The behaviors requiring frequent caregiver intervention must be defined in the plan of care.
Q: What if the member cannot sign a plan of care?
A: A responsible party, such as a legal guardian, is permitted to sign the plan of care on behalf of the member when being signed in accordance with 130 CMR 408.430(C)(2).