Overview
MassHealth has promulgated regulations that specifically apply to adult foster care (AFC) but has not done so for group adult foster care (GAFC). Rather, as previously noted, MassHealth relies on a set of sub-regulatory guidelines it has promulgated to communicate program standards and requirements.
However, these guidelines are outdated; they were published in 1991, have not been updated since then, and refer to things like criteria from the state Department of Public Welfare even though that agency no longer exists. They are also unclear; they are titled Group Adult Foster Care Guidelines, but most of their discussion of program requirements refers to AFC, not GAFC. Therefore, in a 2016 audit of the Group Adult Foster Care Program, the Office of the State Auditor (OSA) recommended that MassHealth enact regulations specifically governing the Group Adult Foster Care Program. MassHealth’s response to this recommendation was as follows:
MassHealth agrees with this recommendation. MassHealth is in the process of enacting regulations to specifically govern the GAFC program.
However, as of the end of our audit period, MassHealth had not promulgated these regulations.
In OSA’s opinion, the lack of specific regulations and clear guidelines can cause confusion among GAFC providers regarding Group Adult Foster Care Program requirements. For example, until May 2017, MassHealth regulations only required prior authorization for AFC and GAFC once, before the first date of service. In May 2017, MassHealth amended Section 408.417(B) of Title 130 of the Code of Massachusetts Regulations to require prior authorizations for AFC before the first date of service and annually thereafter. However, because no such specific guidance was issued to GAFC providers, they may not be sure whether they must adhere to this regulatory requirement. As another example, during this audit, it appeared to be unclear to management at Beyond Healthcare Agency, LLC that the agency was not allowed to bill for GAFC provided to members who received home health services the same day.
OSA believes that to better ensure compliance with Group Adult Foster Care Program requirements, MassHealth should either promulgate regulations that are specific to that program’s services or issue new, clear, comprehensive guidelines for GAFC.
The Executive Office of Health and Human Services and MassHealth provided the following comments on this issue:
The MassHealth Office of Long Term Services and Supports (OLTSS) is in the process of developing and promulgating provider regulations for the GAFC program. OLTSS anticipates issuing its proposed provider regulations for the GAFC program in 2021.
| Date published: | September 21, 2020 |
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