Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Home Health Agency Bulletin 45 November 2006 TO: Home Health Agencies Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Changes in Screening Procedures for Members Aged 60 or Older Background MassHealth has required home health agencies to obtain approval from an Aging Services Access Points (ASAP), before providing part-time or intermittent skilled nursing and home health aide services to those members aged 60 or older, in accordance with 130 CMR 403.411. Change in Requirement Effective December 1, 2006, MassHealth will no longer require home health agencies to complete a MassHealth Home Health Screening Request form and obtain approval from an ASAP before providing part-time or intermittent skilled nursing and home health aide services to those members aged 60 or older. The following forms will be obsoleted as a result of this change: • MassHealth Home Health Screening Request [HHA-002 (01/98)] • MassHealth Skilled Nursing/Home Health Aide Service Increase Notification [HHA-003 (01/98)] ASAP Referral Form Effective December 1, 2006, home health agencies must complete an ASAP Referral form for those MassHealth members aged 60 or older who could benefit from ASAP services. Home health agencies should forward the completed referral form to the member’s local ASAP whenever the agency determines a MassHealth member could benefit from ASAP services and the member consents to a referral. A referral may occur upon assessment or reassessment for home health services or upon discharge from home health services, depending on the member’s needs. A copy of the completed ASAP Referral form must be kept in the member’s record. If a home health agency determines that a member aged 60 or older should not be referred, the home health agency must complete only Sections A and B on the ASAP Referral Form and keep the form in the member’s record. (continued on next page) MassHealth Home Health Agency Bulletin 45 November 2006 Page 2 Choosing the Appropriate ASAP The member’s location determines which ASAP should receive the ASAP Referral form. You will find a list and contact information for each ASAP in Appendix A of your provider manual, available at www.mass.gov/masshealth and www.800ageinfo.com. Supplies of Forms Attached to this bulletin is a sample ASAP Referral form (HHA-4). You can also download this form from the Web at www.mass.gov/masshealth. Once you are there, go to MassHealth Regulations and Other Publications/Provider Library/MassHealth Provider Forms. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. Aging Services Access Point (ASAP) Referral Form Instructions for MassHealth Providers Home health agencies (HHAs) must refer MassHealth members aged 60 or older to their local ASAP if the member could benefit from services provided by an ASAP. The referral may occur during home health services, or upon discharge, depending on the member’s needs. The member or the member’s representative must consent and sign this referral form. A completed copy of this form must be kept in the member’s home health record. If an HHA determines that a member does not require ASAP services, the HHA must complete Sections A and B only. Section A (Required) Home Health Agency (HHA) Information HHA Name: HHA Nurse or Therapist (print name): HHA Nurse or Therapist (signature): Section B (Required) MassHealth Member Information Name: Telephone No.: Date of Referral: Is member appropriate for ASAP services? □ Yes □ No Section C Attach current Center for Medicare and Medicaid Services form 485 to this referral form, andexplain how this member can benefit from ASAP services.__________________ __________________________________________________________________________________ __________________________________________________________________________________ Name of ASAP:_________________________________________________ Member’s primary spoken language is:_____________________________________ Does member require assistance with activities of daily living? □ Yes □ No Does member require assistance with instrumental activities of daily living? □ Yes □ No Section D (Member consent required for referral to be made) Member Consent The home health agency (HHA) described to me the services provided by an ASAP. I understand that I can decide if I want the HHA to make a referral to my local ASAP. If I agree that I want a referral, then someone from the ASAP will contact me and assess whether I could benefit from ASAP services. If I do not want a referral, then no referral will be made and this form will be kept in my record with the HHA. Check one of the boxes below: □ I want the home health agency to make a referral for me to the ASAP. □ I do not want the home health agency to make a referral for me to the ASAP. Member or member’s representative signature: Date: HHA-4 (11/06)