Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.state.ma.us/dma	
		
		MassHealth
		Day Habilitation Bulletin 5
		July 2002

	TO:	Day Habilitation Providers Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	Nursing Responsibilities, Documentation Requirements, and Coordination of Specialized Services

Background	Day Habilitation Bulletin 4, published in October 2001, outlined day-habilitation providers’ responsibilities for coordinating specialized services.  The following information supplements the requirements delineated in Day Habilitation Bulletin 4.  Attached to this bulletin is a new form, Quarterly Day Habilitation Report.  Neither the Division nor Unisys will maintain supplies of the form, so please make extra copies of it for your use.

Medication Administration Procedure-certified staff is not eligible to provide medication administration within the day-habilitation setting.  These services must be performed by licensed nurses.  To ensure that day habilitation programs have adequate nursing coverage, the July 2000 day-habilitation rate increase was determined, in part, by calculating the cost of a full-time RN at each site.  

Nursing Responsibilities	Day-habilitation regulations state that each provider is required to have, at a minimum, a half-time health-care supervisor (see 130 CMR 419.426(A)(2)). 
			
In addition to the half-time health-care supervisor, each program site must employ sufficient licensed nursing professionals to do the following for each member:

•    administer all medication (or supervise members who self-medicate), 
      nursing services, and medical treatment needed during the member’s 
      participation in the day habilitation program;

Nursing Responsibilities	•    coordinate the member’s care with all relevant parties (for example, 
(cont.)				      family members, physicians, nursing facilities, and residential  
	      providers);
•	provide nursing assessment for each member upon admission, upon significant change, and annually thereafter;
•	provide direct care and training in all relevant areas;
•	participate in the interdisciplinary process for each member;
•	obtain reports and approval of treatment plans from primary care physicians;
•	review the nursing and medical services, developmental-skills program, and needs of each member monthly;
•	participate in the quarterly review process for each member;
•	participate in the completion of participant severity profiles;
•	coordinate the Day Habilitation Service Plan and/or Individual Service Plan with the Nursing Facility Plan of Care; and
•	complete monthly nursing progress notes for each member, addressing, at a minimum:
o	medical and nursing services;
o	any possible impact the member’s medical status may have on his or her developmental skills-training program; 
o	conversely, any possible impact the member’s developmental skills-training program may have on his or her medical status; and 
o	medical interventions.

Reporting Requirements	Day-habilitation providers must submit on a quarterly basis the following information.  Information for each site for the time period specified must be included on the attached Quarterly Day Habilitation Report:

•	average daily attendance each month;    
•	number of members (unduplicated) enrolled in the program; 
•	number of members who require medication administration at the day-habilitation program;
•	types of medical interventions provided by the nursing staff and the number of participants for each intervention;
•	number of nursing hours provided to the program; and 
•	number of individuals reported in each severity level.

										

Reporting Requirements 	Reports should be completed and submitted to the Division according to 
(cont.) 	the following schedule:
	
•	the report for the period covering January 1 through March 31 must be received by the Division by April 30.
•	the report for the period covering April 1 through June 30 must be received by the Division by July 31.
•	the report for the period covering July 1 through September 30 must be received by the Division by October 31.
•	the report for the period covering October 1 through December 31 must be received by the Division by January 31.

Submit reports to:

Division of Medical Assistance
Day Habilitation Program Manager
	600 Washington St., Fifth Floor
Boston, MA  02111
	__________________________________________________________

Coordination of 	Provider responsibilities for specialized services are:
Specialized Services
•	to ensure consistency and coordination between the Nursing Facility Plan of Care and the Day Habilitation Service Plan;  
•	to meet with the nursing facility to develop the Day Habilitation Service plan;
•	to develop a Day Habilitation Service Plan that is consistent with the Nursing Facility Plan of Care; and
•	to resolve inconsistencies between the Day Habilitation Service Plan and the Nursing Facility Plan of Care concerning goals and/or strategies. 
	__________________________________________________________

Questions	If you have any questions about this bulletin, please contact the MassHealth Provider Services Department at (617) 628-4141 or 1‑800‑325-5231.