Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
		
	MassHealth
	Group Adult Foster Care Bulletin 2
	August 2002

	TO:	Group Adult Foster Care Providers Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	Changes in Clinical Assessment for Group Adult Foster Care Services  

Background	To be eligible for MassHealth, individuals must meet financial standards.  To be covered for certain MassHealth programs, members or applicants must meet clinical criteria.  The Division or its clinical screening agent, Coastline Elderly Services, Inc. (Coastline), determines clinical eligibility for coverage of group adult foster care services based upon documentation submitted by the provider and the member’s physician.

New Forms	This bulletin provides you with copies of the following forms:
•	the Request for Services (formerly called the MassHealth Long 
	Term Care Assessment form);
•	the Minimum Data Set for Home Care (MDS-HC) version 2.0, 
which replaces the current GAFC participant assessment form; and 
•	the Physician’s Summary.

	These forms are the basis for determining clinical eligibility for group adult 
foster care services.  

Begin using these forms as soon as you receive them.  As of September 1, 2002, the clinical screening agent will not accept the old forms.

Supplies of the Forms	You may photocopy the forms as needed.  To obtain supplies of the
forms, use the information below to mail or fax your request.  Include your provider number, address, telephone number, the exact title of the publication, and the date of issuance.

	MassHealth Forms Distribution
P.O. Box 9101
Somerville, MA 02145
Fax:  703-917-4937

	

Additional		In addition to the MDS-HC, the Request for Services, and the Physician’s
Documentation	Summary, GAFC providers must supply the Division’s clinical screening  agent with any other additional information that the agent requests to determine clinical eligibility.

GAFC/Assisted Living Residence (ALR) providers must also complete and mail the Residence Verification/Group Adult Foster Care Form to Coastline for the SSI State Living Arrangement G (SSI-G) Assisted Living application process through the Social Security Administration.

Clinical Screening	The provider must mail these forms to the Division’s clinical assessment 
Agency Address	agent for this program to the following address.

Coastline Elderly Services, Inc.
Nursing Department
1646 Purchase Street
New Bedford, MA  02740-6819 

			As of September 1, 2002, Coastline Elderly Services will no longer issue verbal approvals for the GAFC program.  All approvals will be in writing as of September 1, 2002.

Who May Complete	The program registered nurse is the assessment coordinator.  The
the MDS-HC 	assessment coordinator’s signature certifies the accuracy and
Assessment 	completeness of the MDS-HC assessment.  

The program-registered nurse must complete the MDS-HC; however, a licensed social worker (LSW, LCSW or LICSW) may complete the following sections of the MDS-HC: AA – Name and Identification Numbers, BB – Personal Items, CC – Referral Items, B – Cognitive Patterns, C – Communication/Hearing Patterns, E – Mood and Behavior Patterns, F – Social Functioning, G – Informal Support Services, and O – Environmental Assessment.

Each individual who completes a portion of the MDS-HC should sign and certify those sections completed in Section R.  (Assessment Information: signatures, title, sections, date).
				______________________________________________________________________

Annual Updates 	GAFC providers must complete the MDS-HC annually for current participants.  The annual assessment must be completed within 15 days of the anniversary date of admission.  The GAFC provider must maintain a copy of the annual MDS-HC in the member’s medical record.   

	

ICD-9 Codes	The MDS-HC assessment requires the use of ICD-9-CM Codes for medical diagnoses.  ICD-9-CM code books are available at local medical supply stores and some local bookstores.  ICD-9-CM codes are also available on the Internet.

Future Trainings	Periodic trainings will be held for new providers.  Please contact the
	Division for dates and locations.

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.