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Massachusetts Adult Day Health Services Policy Manual

Massachusetts Adult Day Health Services Policy Manual

$4,199.00Price
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The Massachusetts Adult Day Health Services Policy Manual provides a comprehensive framework for operating state-compliant agencies delivering adult day health (ADH) services to individuals in Massachusetts. This manual aligns with the Massachusetts Code of Regulations (130 CMR 404.000), Department of Public Health (DPH) licensing standards, and MassHealth requirements to ensure full regulatory compliance and high-quality care delivery.
Key Features of the Manual:
  • Regulatory Compliance: The manual adheres to state-specific regulations, including 130 CMR (Adult Day Health Services) and DPH licensing rules for ADH programs. It ensures providers meet all operational, safety, and documentation standards required for adult day health services.
  • Service Scope: Adult day health services are delivered in a structured, community-based setting and include skilled nursing care, medication administration, supervision, assistance with Activities of Daily Living (ADLs), nutritional support, therapeutic activities, socialization, and case management. Specialized services for individuals with Alzheimer’s disease or other dementias are in this manual.
  • Eligibility Criteria: ADH services are available to individuals aged 18+ who have cognitive, medical, or mental health conditions requiring daytime care and supervision. 
  • Conditions of Payment: Payment for ADH services requires prior authorization from MassHealth. Providers must adhere to established billing procedures and ensure services align with the participant’s individualized service plan (ISP). Reimbursement is typically made at a per diem rate based on the level of care provided (basic or complex).
  • Operational Standards: Policies include staffing qualifications such as trained nursing personnel, maintaining a clean and safe environment, compliance with emergency preparedness protocols, and regular monitoring of participants' health and functional needs. Programs must operate Monday through Friday for a minimum of 8 hours per day.
  • Nonpayable Services: The manual specifies exclusions such as services provided in institutional settings or duplicative care covered under other Medicaid programs. 
  • Quality Assurance: Implementation of quality assurance measurement, including periodic inspections by DPH or MassHealth to ensure compliance with state regulations. 
This policy manual serves as a guide for agencies seeking licensure or certification to provide adult day health services in Massachusetts. It supports the delivery of comprehensive daytime care while ensuring adherence to the state's regulatory framework for long-term services and supports (LTSS).
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