Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111
MassHealth
Day Habilitation Bulletin 2A
May 1999

TO:       Day Habilitation Providers Participating in MassHealth FROM:       Bruce M. Bullen, Commissioner
RE:       DAY HABILITATION SERVICES IN NURSING FACILITIES

Background

This bulletin establishes the requirements for the provision of day-habilitation services in nursing facilities under MassHealth. Providers of day-habilitation services in nursing facilities must comply with all the conditions in this bulletin and with the Division’s day-habilitation-center regulations (130 CMR 419.000 et seq.), except as otherwise specified in this bulletin. Revisions to the Day Habilitation Program Manual, including changes to the billing instructions, will be sent to you at a later date. These new services are effective for dates of service on and after May 27, 1999.

Definition

A nursing facility is defined, for the purposes of this bulletin, as a facility participating in MassHealth pursuant to the Division’s nursing-facility regulations at 130 CMR 456.000 and (1) in which at least one member who has been determined to need specialized services resides and (2) where day-habilitation services are provided.

Provider Eligibility

To qualify to provide day-habilitation services in nursing facilities, an applicant must meet the following requirements:
 (1)	be a MassHealth day-habilitation provider operating at least one site outside of a nursing facility;
 (2)	submit an application to the Division that demonstrates both the qualifications and willingness of the applicant to provide services in nursing facilities; and
 (3)	agree to provide services at times mutually agreed-upon by the nursing facility, the day-habilitation provider, and the member.
The Division must approve a provider’s application to offer day-habilitation services in nursing facilities before the provider can furnish services.

MassHealth
Day Habilitation Bulletin 2A
May 1999
Page 2

Scope of Services

Day-habilitation providers furnishing services in nursing facilities must make available all the services required to be available at day-habilitation sites pursuant to 130 CMR 419.408, except that the day-habilitation provider in a nursing facility is not required to provide nursing services and health-care supervision.

Coordination with Nursing Facilities

The day-habilitation provider must communicate with the nursing facility to ensure the coordination of the member’s services. The day-habilitation provider must report at least quarterly to the nursing facility the status, including medical considerations, of each member in the program. The day-habilitation provider must submit this report whenever there are any changes that might affect the delivery of services.

Noncovered Services

The Division will not pay for day-habilitation services furnished to a member in a nursing facility in any of the following instances:

 (1)	the Department of Mental Retardation (DMR) determines that the member is no longer in need of specialized services;
 (2)	the member is transferred to a day-habilitation program outside the nursing facility in which the member resides; or
 (3)	the member no longer resides in the nursing facility.

Termination of Services

A day-habilitation provider that terminates services to a member must coordinate the termination of service with DMR, the nursing facility, and the member.

Staff Requirements

The day-habilitation provider must use qualified staff as needed to meet the service needs of the members who are eligible for day-habilitation services. The provider must ensure that there are no more than seven participants for one staff member for any service furnished in the nursing facility.

MassHealth
Day Habilitation Bulletin 2A
May 1999
Page 3

Site Requirements

Day-habilitation services furnished in a nursing facility must take place in a space that is appropriate for the particular service being furnished.

Payment for Services

Day-habilitation providers furnishing services in a nursing facility will be paid in accordance with the Division’s regulations at 130 CMR 419.407, and may bill for services in one-quarter day, half-day, three-quarter day, and full-day increments.

New Service Code

The Division is introducing a new service code to accommodate providers traveling to furnish day-habilitation services in a nursing facility. Day-habilitation-service providers must use Service Code X2320 (Travel to nursing home (round trip)) when billing the Division.

Questions

If you have any questions, please call the Unisys Provider Services Unit at (617) 628-4141 or 1-800-325-5231.