Section 408.433 - Adult Foster Care Staff Qualifications and ResponsibilitiesAll staff directly employed by the AFC provider, as well as any contract staff, per diem staff, backup staff, or anyone providing AFC on behalf of the AFC provider to members must meet the following requirements.
(A)General Staff Requirements.(1) Prior to hiring or contracting with any staff the AFC provider must: (a) check the candidate's references and job history and ensure that the candidate meets all of the required experience, education, and qualifications;(b) conduct a Criminal Offender Records Information (CORI) check and determine whether any offender records may disqualify the individual for employment;(c) conduct a Sex Offender Registry Information (SORI) check;(d) conduct Office of Inspector General (OIG) check;(e) conduct licenses and certification checks and validate that the candidate has obtained all necessary licenses and certifications and that all licenses and certifications are current;(f) ensure that each AFC staff person is not related to or legally responsible for the member receiving AFC; and(g) ensure that each AFC registered nurse, licensed practical nurse, care manager, and AFC community support specialist has received a tuberculosis screening within the previous 12 months;(2) On an ongoing basis, the AFC provider must(a) ensure that all registered nurses, licensed practical nurses, care managers, and AFC community support specialists receive tuberculosis screenings in accordance with current guidelines issued by the Centers for Disease Control and Prevention (CDC) and Massachusetts Department of Public Health;(b) ensure that all staff are appropriately trained and managed, which must include, but not be limited to, training in recognition and reporting of abuse of elders and persons with disabilities and provider services;(c) have available at all times a sufficient number of educated, experienced, trained, and competent personnel to provide AFC to elders or adults with disabilities;(d) evaluate staff annually using standardized evaluation measures;(e) maintain a record of each performance evaluation in a separate personnel file for each staff member; and(f) include in each staff member's personnel file any staff incident or accident reports.(B)Multidisciplinary Professional Team. Each AFC provider must have an MDT, which works in conjunction with the AFC caregiver, to meet the nursing, oversight, and care-management needs of members. The MDT must include a program director, a registered nurse or a licensed practical nurse, and an AFC care manager, and may include an AFC community support specialist. The registered nurse or the AFC care manager may assume the role of program director. For each employee and independent contractor, the AFC provider must maintain a job description that includes the title, reporting authority, qualifications, and responsibilities. The MDT must meet to discuss AFC services provided to a member upon significant change of the member or more often as the member's condition warrants, but not less frequently than every six months. The MDT may determine when AFC community support specialist visits are appropriate in place of a registered nurse, licensed practical nurse, or AFC care manager visit based on member needs and as specified in 130 CMR 408.415(B)(6), 408.415(C)(5), and 408.415(D).(C)The Multidisciplinary Professional Team Staff Qualifications and Responsibilities(1)Program Director. The AFC provider must employ a program director who is a health-care professional.(a)Qualifications. The program director must have a bachelor's degree and a minimum of five years of recent professional health-care experience working with elders or adults. A master's degree in a relevant health-care discipline may be substituted for two of the required five years of work experience. At least one of those years must have been spent in an administrative role.(b)Responsibilities. The responsibilities of the program director include1. development and implementation of the AFC provider's policies and procedures in 130 CMR 408.430(A);2. direction and supervision of all aspects of the AFC program;3. oversight of the hiring, training, supervision, firing, and evaluation, of all AFC employees and independent contractors;4. payment of a stipend to all AFC caregivers for their services, and in accordance with any minimum amount established by the MassHealth agency pursuant to 130 CMR 408.404(A)(9);5. the fiscal administration of the AFC program, including billing, budget preparation, and required program statistical and financial reports; and6. ensuring that the AFC provider meets all of the requirements in 130 CMR 408.000 and 130 CMR 450.000: Administrative and Billing Regulations.(2)Registered Nurse. The AFC provider must employ or independently contract with a registered nurse. The registered nurse may function as the program director. (a)Qualifications. The registered nurse must be fully licensed by the Massachusetts Board of Registration in Nursing. The registered nurse must have at least two years of recent experience in the direct care of elders or adults with disabilities.(b)Responsibilities. The responsibilities of the registered nurse include1. completing and coordinating all applicable clinical assessments and clinical evaluations;2. developing and reviewing on an ongoing basis each member's AFC plan of care;3. provide oversight to AFC caregivers in conjunction with the care manager;4. reviewing the PCP Summary Form;5. monitoring the health status of all members to ensure that all needed AFC is properly delivered;6. reporting changes in the health status of any member to the member's PCP;7. reviewing AFC caregiver logs at a minimum of every 30 days;8. conducting on-site visits with each member at the qualified setting in accordance with 130 CMR 408.415(B)(6);9. completing a nursing progress note corresponding with each on-site visit or encounter, or more often as the member's condition warrants;10. submitting semiannual health-status reports to the member's PCP;11. planning for and implementing discharges and transition from the AFC program;12. conducting an orientation for each AFC caregiver before the AFC caregiver begins personal care; and13. providing ongoing training to AFC caregivers on health and aging.(3)Care Manager. The AFC provider must employ or independently contract with a care manager. The AFC care manager may function as the program director. (a)Qualifications. The care manager must have1. a bachelor's degree, a social worker license from the Massachusetts Board of Registration in Social Work, and at least two years of recent experience working with elders or adults with disabilities; or2. a bachelor's degree and two years of clinical experience in the care of elders or people with disabilities.(b)Responsibilities. The responsibilities of the care manager include1. conducting the initial and ongoing evaluations of the AFC qualified setting;2. obtaining a social history and conducting a psychosocial evaluation;3. provide oversight to AFC caregivers in conjunction with the registered nurse;4. participating in the development, implementation, and ongoing review of the AFC plan of care;5. conducting on-site visits with each member at the qualified setting in accordance with 130 CMR 408.415(C)(5);6. completing a care-management progress note corresponding with each on-site visit or encounter and upon significant change;7. reviewing AFC caregiver logs at a minimum of every 30 days;8. assisting with obtaining information and accessing other health-care and community services;9. reviewing and documenting the fire and safety procedures for the qualified setting;10. participating in discharge and transition planning and implementation; and11. reviewing, as needed and at least annually the suitability of the qualified setting.(4)Staff Qualification Substitution. For any staff member on the MDT that does not meet the qualifications as stated in 130 CMR 408.433, the AFC provider must receive a written approval from the MassHealth agency for substitution of the qualification prior to hiring.(D)AFC Community Support Specialist. The AFC provider may employ or independently contract with community support specialists.(1)Qualifications. A community support specialist must have at least one year of experience working with elders or adults with disabilities.(2)Responsibilities. The responsibilities of a community support specialist include(a) conducting on-site visits with the member at the qualified setting in accordance with 130 CMR 408.415(B)(6), 408.415(C)(5) and 408.415(D);(b) participating in the development, implementation, and ongoing review of the AFC plan of care;(c) completing a community support specialist progress note corresponding with each on-site visit and encounter with members; and(d) providing to the member and caregiver culturally appropriate health education, information, support, and counseling.(E)Licensed Practical Nurse. The AFC provider may employ or independently contract with a licensed practical nurse. (1)Qualifications. The licensed practical nurse must be licensed by the Massachusetts Board of Registration in Nursing and in good standing with the Board.(2)Responsibilities. Under the direction and supervision of the AFC provider RN, licensed practical nurses may: (a) complete and coordinate all applicable clinical assessments and clinical evaluations;(b) develop and review on an ongoing basis each member's AFC plan of care;(c) provide oversight to AFC caregivers in conjunction with the care manager;(d) review the PCP Summary Form;(e) monitor the health status of all members to ensure that all needed AFC is properly delivered;(f) report changes in the health status of any member to the member's PCP;(g) review AFC caregiver logs at a minimum of every 30 days;(h) conduct on-site visits with each member at the qualified setting in accordance with 130 CMR 408.415(B)(6);(i) complete a progress note corresponding with each on-site visit or encounter, or more often as the member's condition warrants;(j) submit semiannual health-status reports to the member's PCP;(k) plan for and implementing discharges and transition from the AFC program;(l) conduct an orientation for each AFC caregiver before the AFC caregiver begins personal care; and(m) provide ongoing training to AFC caregivers on health and aging.(F)AFC Staff Training Requirements.(1) The AFC provider must provide initial and periodic training to all staff members who are responsible for the care of a member. Records of completed training must be kept on file and updated regularly by the AFC provider.(2) The AFC provider must hold an orientation for new staff within one month of hire. This orientation must include the following topics:(a) delivery of AFC by the AFC provider;(b) AFC provider written policies and procedures;(c) the requirements of 130 CMR 408.000;(d) AFC provider staff roles and responsibilities;(e) caring for people with disabilities, elders, individuals with Alzheimer's disease and related disorders, behavioral health issues and cognitive impairments, including behavioral interventions, behavior acceptance, and accommodations;(f) observation, reporting, and documentation of the member's status and the care provided, including AFC caregiver log entries;(g) basic first aid, cardiopulmonary resuscitation (CPR) and emergency procedures including the Heimlich maneuver;(h) universal precautions and infection control practices;(i) information about local health, fire, safety, and building codes;(j) privacy and confidentiality;(k) multidisciplinary team approach;(l) medication management;(m) communication and interpersonal skills;(o) prevention of and reporting of, abuse, neglect, mistreatment/and misappropriation/financial exploitation;(p) completing and filing critical incident reports;(q) techniques of providing safe personal care assistance: good body mechanics;(r) human rights, nondiscrimination and cultural sensitivity;(s) recognizing the physical, emotional and developmental needs of the individuals in their care and working in a manner that respects them, their privacy and their property;(t) recognizing, responding to and reporting change in condition, emergencies and knowledge of emergency procedures, including the AFC provider's fire, safety, and disaster plans; and(u) relevant provisions of the Health Insurance Portability and Accountability Act of 1996.(G)AFC Backup Staff Coverage. The AFC provider must ensure the availability of professional and direct care backup staff if coverage is required due to illness, vacation, or other reasons. All staff providing backup coverage must possess an equal or greater level of licensure and certification required for each position, and must meet all other requirements of regular staff members.Amended by Mass Register Issue 1338, eff. 5/5/2017.Amended by Mass Register Issue 1472, eff. 7/1/2022.Amended by Mass Register Issue 1520, eff. 4/26/2024.