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

TO:       Day Habilitation Providers Participating in MassHealth FROM:       Mark E. Reynolds, Acting Commissioner 
RE:       Supplemental Staffing

Background

The Division has undertaken an initiative called supplemental staffing for community day habilitation programs. The purpose of this initiative is to enable programs to serve clinically eligible MassHealth members who require additional support with activities of daily living (ADL), behavioral interventions, or both. It is the responsibility of day habilitation programs to care for each member’s ADL and behavioral needs, to train members in self-care, self-preservation, receptive and expressive communication, self-direction, ADL skills, hygiene, grooming, and first aid. However, the Division realizes that certain members may need greater assistance in certain activities of daily living and behavioral interventions than is currently provided for in the standard program structure.

Payment for
Supplemental
Staffing

It is important to note that the Division requires all day habilitation providers to follow the instructions and documentation requirements in this bulletin. However, the Division will not reduce any claim for supplemental staffing for MassHealth members delivered from November 1, 1999, through May 1, 2000. After May, 2000, all claims for supplemental staffing will be audited and adjusted if applicable, on a periodic basis, by the Division.

Training Sessions

The Division will be conducting in-service training sessions as follows.
Date:	December 2, 1999
Location:	China Trade, 2 Boylston Street, Boston, MA
Time:	10:30 to 1:00
Date:	December 7, 1999
Location:	Seven Hill Foundation, 81 Hope Ave., Worcester, MA
Time:	10:30 to 1:00
Date:	December 10, 1999
Location:	Cooperative Productions, 14 Merchants Lane, Taunton, MA
Time:	10:30 to 1:00

MassHealth
Day Habilitation Program Bulletin 2B
November 1999
Page 2

Additional Training

In addition to the training sessions, during the six-month implementation period each day habilitation provider claiming supplemental staffing for a MassHealth member will receive individual on-site training and an assessment of documentation by the Division’s clinical staff to assist providers with this program implementation.

Eligibility Criteria for Supplemental Staffing

The Division will pay for supplemental staffing for Mass Health members in a community day habilitation site who have mental or physical limitations that require higher than normal staff intervention.
The two areas for which the Division will pay for supplemental staffing are enhanced assistance in one or more ADL and staff intensive behavioral interventions. The Division will pay for supplemental staffing when, based on the Division’s criteria found in the Community Day Habilitation Supplemental Staffing Instructions, the need for enhanced physical assistance results in a reduction of the program’s established staffing pattern in order to care for the needs of a member for all or a portion of a day.
NOTE: The Division pays for supplemental support only for members who attend a community day habilitation program. Providers may not bill the Division for supplemental staffing if they receive payment from the Department of Mental Retardation for any form of supplemental staffing.

Attachments and Procedures

Community Day Habilitation Supplemental Staffing Instructions
This is a complete set of instructions for the determination and documentation of supplemental staffing needs for community day habilitation programs.
Day Habilitation Billing Instructions   A copy of Subchapter 5 of your provider manual is attached for your reference. Community day habilitation providers must bill on the same claim form used for day habilitation services and follow current procedures identified in the Day Habilitation Billing Instructions. The instructions have been modified to include instructions for supplemental staffing. The modifications include:
Billing Rate: The Division of Health Care Finance and Policy has established a supplemental staffing rate of $5.26 per 30 minutes. Attachment A , Community Day Habilitation Supplemental Staffing Instructions, describes the allowable time allotments for each activity or intervention. Providers must bill in accordance with those instructions.

MassHealth
Day Habilitation Program Bulletin 2B
November 1999
Page 3

Attachments and Procedures
(cont.)

The following procedure code has been added to Subchapter 6 (attached) and must be used when billing for supplemental support.
X2325 – Procedure Code for Day Habilitation Supplemental Staffing when the member resides in nursing facility
Providers may only bill for members who meet the clinical criteria for supplemental staffing described in the Community Day Habilitation Supplemental Staffing Instructions. Under no circumstances may the time billed for supplemental staffing exceed the length of time the individual is receiving services at the day habilitation program.
Severity Profile A copy of the Day Habilitation Severity Profile is attached for your reference. Day habilitation providers must now indicate, in Column 4 of the Severity Profile, whether the member is receiving supplemental support for an ADL a behavioral issue, or both. A copy of the new Day Habilitation Severity Profile Form with the additional column added is attached. All previous versions of the Severity Profile should be discarded.

Effective Date

The day habilitation program changes described in this bulletin are effective November 1, 1999.

Questions

If you have any questions about the information in this Bulletin please contact Edward Bondi at (617) 210-5629.