RESPITE CARE SERVICES PROVIDER IN MASSACHUSETTS
OFFERING TEMPORARY RELIEF FOR CAREGIVERS WHILE ENSURING SAFE, SUPPORTIVE CARE FOR INDIVIDUALS WITH DISABILITIES OR CHRONIC CONDITIONS

Respite Care Services in Massachusetts provide short-term relief to primary caregivers of individuals with physical, cognitive, or behavioral health challenges. Services are offered in the individual's home, a community setting, or an alternative licensed site. These supports are authorized and reimbursed through MassHealth waiver programs, including the DDS Waivers and the ABI/MFP Waivers.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)
Role: Funds respite care through waiver programs and ensures compliance with HCBS regulations

Agency: Department of Developmental Services (DDS)
Role: Oversees respite for individuals with intellectual/developmental disabilities (IDD)

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Oversees ABI and MFP Waiver respite supports for individuals with brain injuries

Agency: Department of Public Health (DPH)** (for facility-based respite)
Role: Licenses facilities that provide overnight or medical respite care

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Sets federal standards for waiver-funded respite under HCBS

2. RESPITE SERVICE OVERVIEW

Respite care is intermittent, time-limited care provided to individuals to give caregivers a break. Respite may be:

Planned or emergency

Hourly, daily, or overnight

Provided in-home, community settings, or licensed facilities

Delivered by trained direct care staff, nurses, or certified aides

Service goals:

Prevent caregiver burnout

Avoid unnecessary institutionalization

Support family stability and long-term caregiving

3. SERVICE TYPES & FUNDING PATHWAYS

Type of RespiteSettingFunding Waivers

In-home respiteParticipant’s residenceDDS, ABI, MFP, AFC, CFC

Out-of-home respiteStaffed residence or facilityDDS, MRC, MassHealth

Emergency respiteCrisis-approved settingsDDS or MRC approval

4. PROVIDER REQUIREMENTS

For In-Home or Community-Based Respite:

Register business entity (LLC or nonprofit)

Obtain EIN and Type 2 NPI

Enroll as a MassHealth waiver provider via ePREP

Apply with DDS or MRC (if serving individuals under those waivers)

Maintain liability insurance and background check policies

Train respite staff in person-centered care and safety

For Facility-Based Overnight Respite:

Obtain license from DPH as a group residence, if applicable

Meet COMAR / HCBS safety and staffing standards

Conduct fire safety and emergency preparedness planning

5. REQUIRED DOCUMENTATION

Articles of Incorporation or LLC certificate

EIN and NPI confirmation

Waiver provider enrollment confirmation

Respite care service model or program description

Policy & procedure manual including:

Intake forms and caregiver consent

Emergency contact and health information logs

Staff supervision and scheduling protocols

Incident reporting and participant rights

HIPAA compliance and data protection policies

Medication administration (if applicable)

Crisis support and behavioral response plans

6. STAFFING REQUIREMENTS

Role: Respite Worker / Direct Support Professional (DSP)
Requirements: Experience with the target population, CPR/First Aid, CORI check

Role: Program Supervisor / RN (if applicable)
Requirements: Oversees care plans and coordinates backup support

Training Requirements:

Person-centered care and HCBS rights

Abuse/neglect reporting (MANDATED)

Emergency and crisis procedures

Infection control and safety

Optional: MAP training (for med admin)

7. MEDICAID WAIVER PROGRAMS THAT COVER RESPITE

DDS Waivers (via Department of Developmental Services):

Community Living Waiver – For individuals living in the family home

Intensive Supports Waiver – For 24/7 care settings

Adult Supports Waiver – For part-time support needs

ABI & MFP Waivers (via MRC):

ABI Residential Habilitation Waiver

ABI Non-Residential Habilitation Waiver

MFP-Community Living and Residential Supports

Other Funding Sources:

Family Support Centers (state-funded short-term respite)

Children’s Behavioral Health Initiative (CBHI) (respite for youth with SED)

Autism Division (DESE/DDS) for school-age children

8. TIMELINE TO LAUNCH

Phase: Business Formation & Service Model Planning
Timeline: 1–2 weeks

Phase: Policy Manual and Staff Onboarding
Timeline: 2–4 weeks

Phase: Waiver Enrollment via DDS/MRC or ePREP
Timeline: 4–8 weeks

Phase: Referral Partnerships and Service Start
Timeline: Ongoing

9. CONTACT INFORMATION

MassHealth LTSS Provider Enrollment (ePREP)
Website: https://massfinance.ehs.state.ma.us

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Department of Developmental Services (DDS)
Website: https://www.mass.gov/orgs/department-of-developmental-services
Regional Contacts: https://www.mass.gov/dds-regional-offices

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Massachusetts Rehabilitation Commission (MRC)
Website: https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

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Department of Public Health (DPH)
Website: https://www.mass.gov/orgs/department-of-public-health

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WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS RESPITE CARE PROVIDER

We help individuals and agencies launch effective, family-centered respite care programs that relieve caregivers while ensuring compassionate, high-quality care for those they support.

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Scope of Work:

Business registration and Medicaid waiver enrollment

Program model and service setting design (in-home or facility-based)

Full policy & procedure manual for compliance

Staff training packets and emergency forms

Participant intake, consent, and incident documentation

Billing setup and LTSS tracking tools

Referral outreach to DDS, MRC, and family support centers

Templates for scheduling, backup care, and care plan updates

RESIDENTIAL CARE SERVICES PROVIDER IN MASSACHUSETTS

DELIVERING 24-HOUR SUPPORTIVE HOUSING IN SAFE, STABLE ENVIRONMENTS FOR INDIVIDUALS WITH DEVELOPMENTAL, PHYSICAL, OR BEHAVIORAL HEALTH NEEDS

Residential Care Services in Massachusetts offer structured, long-term housing and support for individuals who cannot live independently due to medical, behavioral, or functional needs. These services are funded through MassHealth Home and Community-Based Services (HCBS) waivers, and administered primarily by the Department of Developmental Services (DDS), Massachusetts Rehabilitation Commission (MRC), and Department of Mental Health (DMH).

1. GOVERNING AGENCIES

Agency: Department of Developmental Services (DDS)
Role: Oversees group homes, shared living, and residential habilitation services for individuals with intellectual or developmental disabilities

Agency: MassHealth (Medicaid)
Role: Authorizes residential services and reimburses under waiver programs

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees waiver compliance, funding, and provider eligibility

Agency: Department of Mental Health (DMH)
Role: Authorizes residential treatment for individuals with serious mental illness

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and funding through 1915(c) waivers

2. RESIDENTIAL CARE SERVICE OVERVIEW

Residential care supports individuals who need help with daily living tasks, supervision, or behavioral management in a structured home setting.

Service models include:

24-hour staffed group homes

Shared Living arrangements (host families)

Adult foster care

Supervised independent living

Behavioral residential treatment homes

Core supports provided:

ADL/IADL support (e.g., hygiene, meal prep, medication reminders)

Behavioral and mental health support (if applicable)

Life skills training and community integration

Transportation coordination

24/7 supervision and safety monitoring

Health services coordination with clinicians

Services must be outlined in an Individual Service Plan (ISP) or Plan of Care (POC) and follow person-centered planning practices.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Massachusetts Secretary of the Commonwealth

Obtain IRS EIN and Type 2 NPI

Secure general liability, property, and workers’ comp insurance

Apply for DDS or DMH residential program licensure

Comply with residential program standards (health, safety, and staffing)

Conduct CORI checks and fingerprinting for all staff

Develop emergency preparedness plans and staffing schedules

4. PROVIDER ENROLLMENT PROCESS

Step 1: Apply for DDS or DMH Residential Program Licensure
Submit policies, facility information, and operational plans for review

Step 2: Enroll with MassHealth as a Waiver Provider
Apply via Provider Online Service Center (POSC)

Step 3: Facility Readiness Inspection
Pass fire, health, and ADA compliance inspections before resident occupancy

Step 4: Finalize Contracts and Begin Service Delivery
Coordinate with DDS or DMH area offices for referrals and ongoing monitoring

5. REQUIRED DOCUMENTATION

Articles of Incorporation or DBA filings

IRS EIN and NPI confirmations

Proof of residential property insurance

DDS/DMH facility license and inspection reports

Residential Care Services Policy & Procedure Manual, including:

House rules and resident rights

Staff schedules and supervision logs

Emergency evacuation and response plans

Daily living skills support templates

Incident reports and medication administration records (MARs)

Behavioral support plans (if applicable)

Facility maintenance and safety checklists

Documentation for audits and ISP compliance

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP)
Requirements: High school diploma or GED; CPR/First Aid; experience with disabilities preferred; background checks required

Role: Program Manager / House Supervisor
Requirements: Experience in residential or habilitation services; staff supervision and scheduling; ISP implementation

Role: Nurse Consultant / Clinical Supervisor (optional but recommended)
Requirements: MA RN/LPN license for homes supporting complex medical needs

Required Training Topics:

Abuse, neglect, and mandatory reporting

Person-centered care and ISP goal tracking

Infection control and health protocols

Emergency procedures and fire safety

Human rights and behavioral management techniques

Medication administration (MAP certification)

7. MASSHEALTH & WAIVER PROGRAMS THAT COVER RESIDENTIAL SERVICES

Residential care is reimbursed under:

DDS HCBS Waivers (Community Living, Intensive Supports)

ABI Waivers (Acquired Brain Injury)

MFP Waivers (Money Follows the Person – Residential Supports)

DMH Adult Community Clinical Services (ACCS)

Adult Foster Care Program (administered by MassHealth)

Group Adult Foster Care (GAFC)

Providers must coordinate with:

Support coordinators and clinicians

ISP/POC teams

State licensing monitors and quality reviewers

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–4 weeks

Phase: Facility Preparation and Licensure Application
Timeline: 60–90 days

Phase: Staff Hiring and Policy Manual Completion
Timeline: 1 month

Phase: MassHealth Enrollment and Service Approval
Timeline: 1–2 months

Phase: Program Launch and Resident Intake
Timeline: Ongoing based on referrals and bed availability

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal
https://www.mass.gov/orgs/masshealth

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Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

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Department of Mental Health (DMH)
https://www.mass.gov/orgs/massachusetts-department-of-mental-health

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Executive Office of Health and Human Services (EOHHS)
https://www.mass.gov/orgs/executive-office-of-health-and-human-services

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS RESIDENTIAL CARE PROVIDER

WCG supports healthcare entrepreneurs, nonprofits, and behavioral health providers in launching licensed, Medicaid-approved residential programs across Massachusetts.

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Scope of Work:

Business setup and DDS/DMH licensure assistance

Facility readiness and health/safety inspection prep

Residential Care Policy & Procedure Manual creation

Staff training templates and supervision schedules

ISP tracking forms and incident documentation logs

MassHealth waiver credentialing and billing workflows

Referral networking with area offices and transition teams 

SUPPORTED EMPLOYMENT SERVICES PROVIDER IN MASSACHUSETTS

EMPOWERING INDIVIDUALS WITH DISABILITIES TO ACHIEVE MEANINGFUL, INCLUSIVE EMPLOYMENT THROUGH PERSON-CENTERED SUPPORT

Supported Employment Services in Massachusetts are designed to help individuals with intellectual, developmental, or physical disabilities enter, retain, and thrive in competitive, integrated employment settings. These services are available through MassHealth Home and Community-Based Services (HCBS) waivers, the Department of Developmental Services (DDS), and the Massachusetts Rehabilitation Commission (MRC).

1. GOVERNING AGENCIES

Agency: MassHealth (Medicaid)
Role: Funds Supported Employment through waiver programs such as DDS, ABI, and MFP

Agency: Department of Developmental Services (DDS)
Role: Manages and authorizes day and employment supports for individuals with developmental disabilities

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Offers Supported Employment and job placement services, particularly for individuals with physical disabilities or mental health conditions

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for waiver-funded employment supports

2. SUPPORTED EMPLOYMENT SERVICE OVERVIEW

Supported Employment helps individuals with disabilities secure and sustain meaningful employment in the community. Services may include:

Vocational assessment and job readiness

Resume development and interview preparation

Job matching and placement

On-site job coaching and workplace accommodations

Ongoing support to maintain employment

Soft skills training (communication, time management, etc.)

Benefits counseling and transportation coordination

Services are individualized and must be outlined in the participant’s Individual Service Plan (ISP) or Plan of Care (POC). They must promote competitive, integrated employment in accordance with Employment First principles.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth

Obtain IRS EIN and Type 2 NPI

Secure general liability insurance and workers’ compensation

Develop a Supported Employment Services Policy & Procedure Manual

Comply with HIPAA and ADA employment standards

Employ or contract qualified job coaches and employment specialists

Credentialing Agencies:

DDS (for individuals with intellectual/developmental disabilities)

MRC (for individuals with physical/multiple disabilities or post-rehab needs)

No special clinical license is required, but vocational rehabilitation experience is strongly recommended.

4. PROVIDER ENROLLMENT PROCESS

Step 1: MassHealth Provider Enrollment
Register via the Provider Online Service Center (POSC)

Step 2: Apply to Become a DDS or MRC Employment Provider
Submit organizational information, staff qualifications, and service descriptions

Step 3: Service Planning and Authorization
Develop individual support plans with ISP teams, including outcome goals and coaching strategies

Step 4: Execute Contracts and Begin Receiving Referrals
Coordinate with DDS area offices or MRC employment teams for case assignments

5. REQUIRED DOCUMENTATION

Business registration, EIN, and NPI confirmations

Proof of insurance

Supported Employment Policy & Procedure Manual, including:

Vocational assessment and intake forms

Individual employment plans and progress reports

Job development and placement logs

Coaching and contact notes

Employer engagement documentation

Staff training logs and credentials

Billing and audit-ready service records

6. STAFFING REQUIREMENTS

Role: Employment Specialist / Job Coach
Requirements: Bachelor’s degree or equivalent experience; knowledge of disability employment rights; background checks; CPR/First Aid preferred

Role: Program Manager / Employment Services Coordinator
Requirements: Experience in supported employment, vocational rehab, or workforce development; oversees staff and quality assurance

Mandatory Training Topics:

ADA and workplace accommodations

Person-centered planning and self-determination

Soft skills coaching and motivational interviewing

Employer engagement and partnership building

HIPAA and documentation standards

Safety in community-based settings

7. MASSHEALTH & STATE PROGRAMS FOR SUPPORTED EMPLOYMENT

Supported Employment is reimbursable under:

DDS Waivers (Community Living, Intensive Supports)

ABI Waivers (Acquired Brain Injury)

MFP Waivers (Residential and Community Living)

MRC Employment Supports (state-funded or post-rehab)

Providers may deliver:

Individualized placement and support (IPS)

Group-supported employment (in integrated settings)

Career exploration and pre-vocational training

Ongoing stabilization and employer communication

Billing units and service frequency are based on waiver authorizations and participant needs.

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–4 weeks

Phase: MassHealth and DDS/MRC Enrollment
Timeline: 1–2 months

Phase: Policy Manual Completion and Staff Onboarding
Timeline: 1 month

Phase: Referral Networking and Participant Enrollment
Timeline: Ongoing based on agency approvals and regional caseloads

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal
https://www.mass.gov/orgs/masshealth

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Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

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Massachusetts Rehabilitation Commission (MRC)
https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS SUPPORTED EMPLOYMENT PROVIDER

WCG supports disability-focused organizations and employment specialists in launching waiver-compliant Supported Employment services across Massachusetts.

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Scope of Work:

Business registration and Medicaid enrollment

DDS/MRC credentialing and application support

Supported Employment Policy & Procedure Manual creation

Staff onboarding tools and training curriculum

Job placement tracking templates and ISP alignment

Employer engagement scripts and documentation forms

Medicaid billing logs and compliance systems

PERSONAL CARE ASSISTANT (PCA) SERVICES PROVIDER IN MASSACHUSETTS
SUPPORTING INDEPENDENCE THROUGH CONSUMER-DIRECTED PERSONAL CARE FOR INDIVIDUALS WITH CHRONIC ILLNESS OR DISABILITIES

In Massachusetts, PCA Services are offered through a unique consumer-directed model managed by MassHealth (the state Medicaid program). Unlike other states where agencies employ aides directly, MassHealth PCA consumers act as the employer of their PCAs. However, provider agencies (called PCM agencies) play a key role in assessing eligibility and supporting access to PCA services.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)
Role: Administers and funds the PCA program under the Medicaid State Plan

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees regulation and contracts for PCA services and PCM agencies

Agency: Personal Care Management (PCM) Agencies
Role: Conduct evaluations, assist with PCA hiring and training, and help consumers with management

Agency: Fiscal Intermediary (FI) Providers
Role: Handle payroll, tax compliance, and timesheets for PCA workers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight of state Medicaid-funded PCA services

2. PERSONAL CARE ASSISTANT SERVICE OVERVIEW

Personal Care Assistants provide hands-on, non-medical support with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Typical tasks include:

Bathing, grooming, and dressing

Toileting and hygiene support

Eating and meal preparation

Transferring and ambulation assistance

Laundry, light housekeeping, and shopping

Cueing and supervision for memory support

All services are authorized via a PCA Evaluation and detailed in a Prior Authorization (PA) approved by MassHealth.

3. ELIGIBILITY & CONSUMER MODEL

Massachusetts uses a self-directed model:

The consumer is the employer: They hire, train, schedule, and terminate their own PCAs.

The PCM agency provides functional skills training and evaluation but does not directly employ the PCA.

The FI provider pays the PCA and handles tax reporting on behalf of the consumer.

To qualify for PCA services:

The individual must be MassHealth eligible (Standard or CommonHealth)

Require hands-on assistance with two or more ADLs

Be capable of managing their care independently or through a surrogate

4. BECOMING A PERSONAL CARE MANAGEMENT (PCM) AGENCY

To support the PCA program, your agency must be awarded a PCM contract by MassHealth.

Requirements:

Nonprofit or public agency status (typically required)

Experience in disability services, care planning, and ADL assessments

Staff RNs or qualified evaluators

Multilingual and culturally competent services

Capacity to assist with intake, skills training, and MassHealth documentation

PCM agencies do not employ PCAs. Instead, they act as administrative and clinical intermediaries between the consumer, MassHealth, and the FI.

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5. DOCUMENTATION REQUIREMENTS (FOR PCM AGENCIES)

Articles of Incorporation and 501(c)(3) status

Staff licenses (RN, OT) and resumes

Functional skills training curriculum

Policies on consumer rights, grievances, and language access

MassHealth contract compliance policies

Confidentiality and HIPAA documentation

Referral, evaluation, and prior authorization templates

6. STAFFING REQUIREMENTS

Role: PCA Evaluator (RN or Licensed Therapist)
Requirements: Must perform functional skills assessment and develop PCA plans

Role: PCA Skills Trainer
Requirements: Provides training and documentation support for consumers managing their own aides

Role: Program Coordinator
Requirements: Manages compliance, documentation, and referral relationships

Training Requirements:

MassHealth PCA training manual

ADA compliance and person-centered practices

Confidentiality, rights protection, and HIPAA

Cultural competence and language access standards

7. MASSHEALTH PAYMENT & FISCAL INTERMEDIARY SYSTEM

PCA workers are paid by a Fiscal Intermediary (FI) (e.g., Tempus Unlimited or Northeast Arc)

PCM agencies are reimbursed by MassHealth for evaluations, authorizations, and skills training

PCAs are typically paid hourly, and rates are determined by the PCA union agreement

Key systems:

EIM/EVV (Electronic Visit Verification) may apply

Timesheets and documentation are submitted by consumers and PCAs to the FI

8. TIMELINE TO LAUNCH (FOR PCM AGENCY)

Phase: Nonprofit Formation and Infrastructure Setup
Timeline: 2–4 weeks

Phase: Staffing, Training, and Policy Manual
Timeline: 3–5 weeks

Phase: Apply for MassHealth PCA Program Contract (RFR opens periodically)
Timeline: Varies based on open RFR

Phase: Referral Coordination and Service Launch
Timeline: Ongoing, once approved

9. CONTACT INFORMATION

MassHealth Customer Service
Website: https://www.mass.gov/topics/masshealth
Phone: 1-800-841-2900

MassHealth PCA Program Info
Website: https://www.mass.gov/personal-care-attendant-program

Fiscal Intermediary Providers (e.g., Tempus Unlimited)
Website: https://www.tempusunlimited.org

MassHealth Provider Enrollment (ePAY/eCredentialing)
Website: https://massfinance.ehs.state.ma.us/

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WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS PCA SERVICES

We support mission-aligned organizations and nonprofits in launching or partnering with PCM agencies to deliver high-quality, person-centered PCA support across Massachusetts.

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Scope of Work:

Nonprofit registration and MassHealth credentialing guidance

Policy manual development for PCA assessments and consumer support

Templates for evaluations, service logs, and consumer training

Compliance tracking and contract readiness review

Fiscal Intermediary partnership facilitation

Website, intake forms, and multilingual outreach materials

ADAPTIVE EQUIPMENT SERVICES PROVIDER IN MASSACHUSETTS

DELIVERING SPECIALIZED TOOLS THAT SUPPORT MOBILITY, COMMUNICATION, AND DAILY LIVING FOR INDIVIDUALS WITH DISABILITIES

Adaptive Equipment Services in Massachusetts are designed to provide individuals with disabilities the tools they need to live as independently and safely as possible. These services cover the assessment, acquisition, customization, delivery, and maintenance of specialized equipment that enhances functional ability. They are reimbursable under MassHealth (Medicaid), Home and Community-Based Services (HCBS) waivers, and occasionally through the Massachusetts Rehabilitation Commission (MRC) or Department of Developmental Services (DDS).

1. GOVERNING AGENCIES

Agency: MassHealth (Medicaid)
Role: Authorizes and reimburses adaptive equipment under durable medical equipment (DME) and HCBS waiver policies

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees waiver services and Medicaid benefits

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Provides adaptive equipment supports and evaluations for eligible non-Medicaid participants

Agency: Department of Developmental Services (DDS)
Role: Coordinates funding and referrals for individuals with intellectual or developmental disabilities

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal approval and oversight for Medicaid-funded adaptive services

2. ADAPTIVE EQUIPMENT SERVICE OVERVIEW

Adaptive equipment includes tools and technologies that support an individual’s ability to perform everyday activities or ensure safety within the home and community.

Examples of adaptive equipment:

Manual or power wheelchairs and scooters

Communication devices (AAC, speech boards)

Hospital beds and bed rails

Adaptive utensils, dressing aids, and toileting equipment

Transfer boards, patient lifts, and fall prevention systems

Hearing or visual assistance devices

Mounting systems and positioning supports

Customized modifications to standard equipment

Services typically include assessment, procurement, delivery, fitting, training, and repairs. All equipment must be medically necessary and listed in the individual’s Plan of Care (POC) or Individual Support Plan (ISP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth

Obtain IRS EIN and Type 2 NPI

Secure general liability and product liability insurance

Hire or contract Assistive Technology Professionals (ATP), therapists, or certified DME fitters

Maintain HIPAA-compliant documentation and secure storage of health-related equipment

For Equipment Providers:

Enroll as a Durable Medical Equipment (DME) provider with MassHealth

Ensure staff have relevant certifications (ATP, RESNA, OT/PT)

Develop policies for delivery, servicing, warranties, and user training

4. PROVIDER ENROLLMENT PROCESS

Step 1: Enroll with MassHealth
Apply via the Provider Online Service Center (POSC)

Step 2: Apply for DME or HCBS Waiver Provider Status
Submit credentials, equipment lists, staff qualifications, and service areas

Step 3: Contract with DDS or MRC (if applicable)
Become an approved vendor for non-Medicaid or waiver-funded equipment support

Step 4: Finalize Contracts and Submit Purchase Authorization Requests
Coordinate with waiver support coordinators, therapists, and case managers

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business registration

IRS EIN and Type 2 NPI confirmations

Certificates of liability insurance

Adaptive Equipment Services Policy & Procedure Manual, including:

Equipment assessment and intake forms

Procurement and delivery logs

Installation and safety testing checklists

Warranty, repair, and replacement protocols

User training records and consent forms

Staff qualifications and ATP certifications

HIPAA and compliance audit logs

Billing documentation and invoice tracking

6. STAFFING REQUIREMENTS

Role: Assistive Technology Professional (ATP)
Requirements: RESNA-certified or equivalent experience with complex equipment evaluations

Role: Equipment Delivery Technician / Fitter
Requirements: Training in adaptive equipment setup, safety testing, and user education

Role: OT/PT Consultant (if offering assessments)
Requirements: Massachusetts licensure and experience in assistive device assessments

Required Trainings:

ADA and accessibility compliance

Infection control and sanitization of equipment

Safe handling and injury prevention

Medicaid documentation and audit readiness

Person-centered equipment customization

7. MASSHEALTH & WAIVER PROGRAMS COVERING ADAPTIVE EQUIPMENT

Adaptive equipment is covered under:

Durable Medical Equipment (DME) Benefits (MassHealth Standard and CommonHealth)

DDS Waivers (Community Living, Intensive Supports)

ABI Waivers (Acquired Brain Injury)

MFP Waivers (Community Living and Residential Supports)

MRC Statewide Programs (for non-Medicaid participants)

Services must be:

Pre-authorized based on medical need

Non-duplicative of insurance or other benefits

Justified in clinical assessments and POCs

Delivered and installed with documentation and user training

8. TIMELINE TO LAUNCH

Phase: Business and Insurance Registration
Timeline: 2–3 weeks

Phase: MassHealth/DME or Waiver Provider Enrollment
Timeline: 1–2 months

Phase: Policy Manual Completion and Staff Credentialing
Timeline: 4–6 weeks

Phase: Referral Networking and Equipment Fulfillment
Timeline: Ongoing based on POC authorizations and need-based referrals

9. CONTACT INFORMATION

MassHealth Provider Enrollment
https://www.mass.gov/orgs/masshealth

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Massachusetts Rehabilitation Commission (MRC)
https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

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Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

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National Registry of Rehabilitation Technology Suppliers (NRRTS)
https://nrrts.org

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Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)
https://www.resna.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS ADAPTIVE EQUIPMENT PROVIDER

WCG supports DME businesses, rehabilitation therapists, and equipment installers in launching adaptive equipment services for Medicaid-eligible individuals across Massachusetts.

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Scope of Work:

Business and Medicaid/DME provider setup

DDS/MRC waiver enrollment support

Adaptive Equipment Policy & Procedure Manual creation

Staff credentialing and training tools

Inventory and fulfillment tracking forms

Authorization workflow templates and billing logs

Audit readiness documentation and compliance systems

SKILLED NURSING SERVICES PROVIDER IN MASSACHUSETTS

DELIVERING LICENSED MEDICAL CARE IN THE HOME OR COMMUNITY FOR INDIVIDUALS WITH COMPLEX HEALTH NEEDS

Skilled Nursing Services in Massachusetts are provided by licensed nurses to individuals who require ongoing medical care due to chronic illnesses, disabilities, or post-hospitalization recovery. These services are a key component of MassHealth’s Medicaid benefits, and are also authorized under Home and Community-Based Services (HCBS) waivers, the Home Health Program, and the Money Follows the Person (MFP) initiative.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)
Role: Approves and reimburses skilled nursing services under state plan and HCBS waivers

Agency: Department of Public Health (DPH), Division of Health Care Facility Licensure and Certification
Role: Licenses home health agencies and ensures clinical compliance with state and federal standards

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees long-term services and supports (LTSS), including waiver-based nursing

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and funding for Medicaid-covered nursing services under 1915(c) waivers

2. SKILLED NURSING SERVICE OVERVIEW

Skilled nursing services involve medically necessary, clinical care provided in the individual’s home or community setting by licensed nurses (RN/LPN) under physician orders.

Services may include:

Medication administration and IV therapy

Wound care and post-surgical dressing changes

Catheter care, ostomy maintenance, and tube feeding

Monitoring of chronic conditions (e.g., diabetes, CHF, COPD)

Health assessments and vital signs monitoring

Client and caregiver training

Coordination with physicians and other care team members

All services must be ordered by a physician and documented in a Plan of Care (POC) or Individual Service Plan (ISP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth

Obtain IRS EIN and Type 2 NPI

Obtain a Home Health Agency license from DPH

Carry professional liability and malpractice insurance

Hire licensed RNs and LPNs with current Massachusetts Board of Registration in Nursing credentials

Develop clinical policies in compliance with CMS Conditions of Participation (CoPs)

If providing waiver-based skilled nursing:
You must be credentialed through DDS, MFP, or other waiver authorities and comply with additional program-specific requirements.

4. PROVIDER ENROLLMENT PROCESS

Step 1: Obtain DPH Home Health Agency License
Apply through the DPH Licensure Portal

Step 2: Enroll with MassHealth as a Skilled Nursing Provider
Apply via Provider Online Service Center (POSC)

Step 3: Apply to HCBS Waiver Programs (DDS, ABI, MFP)
Submit staffing plans, clinical protocols, and service descriptions

Step 4: Prepare for DPH Survey and CMS Conditions of Participation
Implement Quality Assurance Performance Improvement (QAPI) and clinical oversight systems

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business registration

IRS EIN and NPI confirmation

Proof of DPH home health agency licensure

Malpractice and general liability insurance

Skilled Nursing Services Policy & Procedure Manual, including:

Physician order templates and care plan forms

Clinical progress notes and medication administration records (MARs)

Infection control protocols and emergency procedures

Nurse supervision logs and training records

HIPAA and documentation compliance checklists

Quality assurance and client outcome tracking

Billing and time documentation forms

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements: Valid Massachusetts RN license; CPR certification; clinical experience; CORI background check

Role: Licensed Practical Nurse (LPN)
Requirements: MA LPN license; supervised by RN; experience with in-home care preferred

Role: Director of Nursing (for agencies)
Requirements: RN license with leadership experience; oversees clinical policies, QAPI, and supervision

Required Trainings:

HIPAA and infection control

Emergency preparedness

Abuse/neglect prevention and mandatory reporting

Electronic visit verification (EVV) systems (if required)

CMS Conditions of Participation and clinical documentation

7. MASSHEALTH PROGRAMS THAT COVER SKILLED NURSING

Skilled Nursing is reimbursed under:

MassHealth Home Health Program (State Plan Services)

ABI Waivers (Acquired Brain Injury)

MFP Waivers (Residential and Community Living)

DDS Waivers (for clients with developmental disabilities)

Children’s Behavioral Health Initiative (CBHI) — for eligible youth with complex needs

Providers may bill for:

Intermittent or hourly skilled nursing

RN supervisory visits

Complex case management and physician coordination

Shift nursing (for medically fragile individuals)

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–3 weeks

Phase: DPH Home Health License Application and Survey
Timeline: 2–4 months

Phase: MassHealth and Waiver Enrollment
Timeline: 1–2 months

Phase: Clinical Policy Manual and Staff Credentialing
Timeline: 1 month

Phase: Start of Services Upon Authorization
Timeline: Ongoing — based on physician referrals and waiver team approvals

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal
https://www.mass.gov/orgs/masshealth

​

Department of Public Health (DPH) — Home Health Licensure
https://www.mass.gov/guides/home-health-agency-licensure

​

Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

​

Massachusetts Board of Registration in Nursing
https://www.mass.gov/orgs/board-of-registration-in-nursing

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS SKILLED NURSING PROVIDER

WCG supports nurse entrepreneurs, medical professionals, and home health organizations in launching licensed, Medicaid-approved skilled nursing services across Massachusetts.

​

Scope of Work:

Business setup and DPH licensure support

MassHealth and waiver credentialing (DDS, ABI, MFP)

Skilled Nursing Policy & Procedure Manual creation

Clinical staffing models and supervisory templates

Nurse scheduling and electronic documentation tools

Physician referral coordination and billing setup

Audit compliance and EVV system integration

INDEPENDENT LIVING SKILLS SERVICES PROVIDER IN MASSACHUSETTS

SUPPORTING SELF-SUFFICIENCY AND DAILY FUNCTIONING FOR INDIVIDUALS WITH DISABILITIES THROUGH PERSON-CENTERED COACHING AND SKILL-BUILDING

Independent Living Skills (ILS) Services in Massachusetts are designed to help individuals with disabilities or chronic conditions gain, improve, or retain the skills needed to live as independently as possible. These services are delivered in homes and communities through Medicaid HCBS waivers, MassHealth programs, or through partnerships with agencies like the Massachusetts Rehabilitation Commission (MRC) and the Department of Developmental Services (DDS).

1. GOVERNING AGENCIES

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees MassHealth, waivers, and long-term support programs

Agency: MassHealth (Medicaid)
Role: Funds and authorizes ILS services under waiver programs and long-term supports

Agency: Department of Developmental Services (DDS)
Role: Oversees services for individuals with intellectual and developmental disabilities

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Coordinates ILS services for adults with disabilities seeking independence and employment

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal guidance and 1915(c) waiver oversight

2. INDEPENDENT LIVING SKILLS SERVICE OVERVIEW

ILS services support individuals by building competencies in areas that promote self-determination, community integration, and daily functioning.

Examples of ILS supports include:

Budgeting and money management

Cooking, grocery shopping, and meal prep

Personal hygiene and grooming routines

Medication reminders (non-clinical)

Scheduling and attending appointments

Communication skills and relationship building

Navigating public transportation and safety awareness

Maintaining a clean and organized home

Services are tailored to each individual’s needs and are outlined in their Individual Service Plan (ISP) or Plan of Care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Massachusetts Secretary of the Commonwealth

Obtain an IRS EIN and Type 2 NPI

Secure liability and worker’s compensation insurance

Develop HIPAA-compliant documentation practices

No clinical licensure is typically required (unless offering overlapping clinical supports)

Meet staff training and supervision requirements

Special Note: ILS is considered a habilitative, non-medical service. However, coordination with case managers and clinicians may be necessary to align goals and prevent overlap with clinical care.

4. PROVIDER ENROLLMENT PROCESS

Step 1: MassHealth Provider Enrollment
Apply through the Provider Online Service Center (POSC):
https://massgov.account.gov

Step 2: DDS or MRC Program Credentialing
Submit documentation to enroll under DDS Adult Services or MRC’s Independent Living Program

Step 3: Develop and Submit Service Plans
Include skill-building curricula, supervision structure, and safety protocols

Step 4: Execute Medicaid Provider Agreements and Secure Referrals
Complete onboarding, submit ISP-aligned goals, and coordinate with support coordinators

5. REQUIRED DOCUMENTATION

Articles of Incorporation or DBA filings

IRS EIN and NPI confirmations

Insurance certificates

Independent Living Skills Service Policy & Procedure Manual, including:

Client intake and goal-setting templates

Daily skills tracking logs and progress notes

Emergency response protocols

Staff training and supervision records

Consent and participant rights forms

Documentation for billing and audits

6. STAFFING REQUIREMENTS

Role: Independent Living Skills Trainer / Coach
Requirements: High school diploma (minimum), experience supporting individuals with disabilities, background checks, CPR/First Aid

Role: Program Supervisor (for agencies)
Requirements: Experience in social services or habilitation, responsible for supervision and quality assurance

Required Trainings:

Person-centered planning and documentation

HIPAA and confidentiality

Safety in home and community settings

Abuse, neglect, and exploitation prevention

Effective communication and motivational coaching

7. MEDICAID WAIVER & STATE PROGRAMS

ILS services are reimbursable under the following:

DDS Adult Waiver Programs (Community Living, Intensive Supports)

ABI Waivers (Acquired Brain Injury)

MFP Community Living Waiver (Money Follows the Person)

MassHealth PCA Program (non-duplicative support)

MRC Independent Living Programs (non-Medicaid funding)

Providers may bill for:

Hourly coaching sessions

Group or 1:1 skill-building

Community integration support

Remote or hybrid sessions (if approved)

All services must be authorized through an ISP or waiver plan.

8. TIMELINE TO LAUNCH

Phase: Business Setup and MassHealth Enrollment
Timeline: 1–2 months

Phase: Waiver Program Credentialing (DDS or MRC)
Timeline: 30–60 days

Phase: Policy Manual Development and Staff Onboarding
Timeline: 4–6 weeks

Phase: Referral Coordination and Program Launch
Timeline: Ongoing based on support coordinator networks and waitlist priorities

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal
https://www.mass.gov/orgs/masshealth

​

Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

​

Massachusetts Rehabilitation Commission (MRC)
https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS ILS PROVIDER

WCG equips individuals and community organizations to launch ILS programs that support real-world skills and Medicaid-approved billing.

​

Scope of Work:

Business registration and Medicaid credentialing

DDS/MRC application and provider setup

Independent Living Skills manual development

Daily documentation forms and client tracking logs

Staff training resources and supervision protocols

Referral networking support with case managers

Audit-ready documentation templates and billing logs

ADULT DAY HEALTH (ADH) SERVICES PROVIDER IN MASSACHUSETTS
PROVIDING CLINICALLY-SUPERVISED DAYTIME CARE FOR ADULTS WITH MEDICAL OR FUNCTIONAL NEEDS TO SUPPORT HEALTH, WELLNESS, AND COMMUNITY LIVING

Adult Day Health (ADH) services in Massachusetts provide nursing oversight, personal care, case management, therapeutic activities, and meals in a structured community setting. These services are regulated by the Massachusetts Department of Public Health (DPH) and reimbursed by MassHealth (Medicaid) for eligible adults through a medical model of day care.

1. GOVERNING AGENCIES

Agency: Massachusetts Department of Public Health (DPH)
Role: Licenses and inspects Adult Day Health programs per 105 CMR 158.000

Agency: MassHealth (Massachusetts Medicaid)
Role: Reimburses ADH services and defines clinical eligibility and operational standards

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Establishes programmatic and rate-setting guidance for ADH providers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures compliance with Medicaid and HCBS waiver regulations

2. ADULT DAY HEALTH SERVICE OVERVIEW

Adult Day Health programs provide structured services for adults with chronic illness, physical/cognitive impairments, or behavioral health needs, and who are at risk of institutionalization.

Core services include:

Skilled nursing services (e.g., vitals, medication administration, wound care)

Assistance with ADLs (e.g., bathing, dressing, toileting)

Case management and care coordination

Meals and dietary support

Therapeutic and recreational activities

Transportation (optional/additional service)

ADH centers typically operate 5–6 hours per day, Monday through Friday, and participants attend regularly based on need and authorization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

To operate an ADH program in Massachusetts, you must:

Obtain licensure through the DPH Bureau of Health Care Safety and Quality under 105 CMR 158

Meet facility requirements for square footage, accessibility, and infection control

Employ licensed staff including an RN, activity director, case manager, and aides

Maintain participant records, care plans, and clinical documentation

Enroll with MassHealth for reimbursement

4. DPH LICENSURE PROCESS

Step 1: Business Formation

Register entity via https://www.mass.gov/orgs/secretary-of-the-commonwealth

Obtain EIN and NPI

Step 2: Site Acquisition and Buildout

Identify location that meets fire safety, ADA, and health codes

Design rooms for clinical services, activities, dining, and rest areas

Step 3: DPH Application and Policies Submission

Submit licensure application with required attachments:

Staffing plan, org chart, policies/procedures, sample forms

Lease/deed, floor plans, food service documentation

Infection control plan and emergency preparedness plan

Step 4: DPH Survey and Approval

Pass on-site inspection

Receive licensure to operate as an Adult Day Health center

5. MASSHEALTH ENROLLMENT & SERVICE AUTHORIZATION

Step 1: Enroll as a MassHealth Adult Day Health Provider
Step 2: Submit provider contract and rate documentation
Step 3: Accept referrals through MassHealth LTSS programs, SCO (Senior Care Options), or ACOs
Step 4: Provide services per care plans and submit billing through the LTSS Provider Portal

6. REQUIRED DOCUMENTATION

Articles of Organization or LLC registration

IRS EIN and Type 2 NPI

DPH ADH license

MassHealth provider contract

Comprehensive policy and procedure manual including:

Nursing protocols and MAR logs

Service and care plan templates

ADL documentation and attendance logs

Participant intake and consent forms

Emergency and disaster plans

Infection control and cleaning logs

Staffing supervision records

Client rights, privacy, and grievance procedures

7. STAFFING REQUIREMENTS (PER DPH 105 CMR 158)

Required Roles:

Registered Nurse (RN): Full-time during operating hours; oversees clinical services

Case Manager (e.g., LSW): Coordinates participant services and PCP communication

Activity Director: Plans and delivers therapeutic programs

Personal Care Staff (CNA/HHA): Assists with ADLs

Program Director (Admin): Ensures operational compliance and supervision

Recommended:

On-call medical director (physician)

Social worker, dietitian, behavioral health consultant

Training Requirements:

CPR, first aid, and medication administration

Infection control and universal precautions

Person-centered planning and cultural competence

Abuse, neglect, and elder protection reporting

HIPAA and documentation standards

8. MASSHEALTH ELIGIBILITY & REIMBURSEMENT

Participants must:

Be MassHealth-eligible (Standard or CommonHealth)

Have medical necessity for nursing supervision or ADL assistance

Be at risk for institutionalization without ADH support

MassHealth reimburses per level of care:

Basic Level – For participants needing basic nursing and ADL support

Complex Level – For those requiring more intensive clinical interventions

Transitional Level – For participants being discharged from a facility

Rates are set by EOHHS and billed through MassHealth LTSS or contracted MCOs.

9. TIMELINE TO LAUNCH

Phase: Business and Facility Setup
Timeline: 2–4 weeks

Phase: Policy Manual and Staffing Plan
Timeline: 3–5 weeks

Phase: DPH Application and Site Readiness
Timeline: 8–12 weeks

Phase: MassHealth Enrollment and Referral Activation
Timeline: 4–6 weeks (can overlap)

10. CONTACT INFORMATION

Massachusetts Department of Public Health (DPH)
Website: https://www.mass.gov/orgs/department-of-public-health
Licensing Unit: https://www.mass.gov/guides/apply-for-a-health-care-facility-license

​

MassHealth Provider Enrollment
Website: https://massfinance.ehs.state.ma.us

​

MassHealth Adult Day Health Program
Program Manual: https://www.mass.gov/doc/adult-day-health-provider-manual

​

LTSS Provider Portal
Billing and documentation: https://ltss.mass.gov

​

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS ADULT DAY HEALTH PROVIDER

We help healthcare entrepreneurs and community leaders launch compliant and impactful Adult Day Health centers that meet the needs of Massachusetts residents with complex medical or support needs.

Scope of Work:

Business registration (LLC, EIN, NPI)

Facility design consultation and DPH compliance prep

Policy & procedure manual development (per 105 CMR 158)

Staffing plan, job descriptions, and training logs

MAR, ADL, and nursing documentation templates

Medicaid enrollment support and LTSS billing tools

Client intake packets, family consent forms, and grievance procedures

Audit readiness and referral networking templates

BEHAVIORAL HEALTH SERVICES PROVIDER IN MASSACHUSETTS

DELIVERING INDIVIDUALIZED MENTAL HEALTH AND SUBSTANCE USE SUPPORT ACROSS HOME, COMMUNITY, AND OUTPATIENT SETTINGS

Behavioral Health Services in Massachusetts are essential to promoting mental wellness, recovery, and independence for individuals with mental illness, emotional disturbances, or substance use disorders. These services may be delivered through Medicaid’s MassHealth Behavioral Health Initiative, managed care plans, or Home and Community-Based Services (HCBS) programs under specific waivers.

1. GOVERNING AGENCIES

Agency: Massachusetts Executive Office of Health and Human Services (EOHHS)
Role: Oversees MassHealth and behavioral health policy across the state

Agency: Massachusetts Behavioral Health Partnership (MBHP) and other MCOs like Tufts Health Together, BMC HealthNet Plan, etc.
Role: Administer behavioral health services for Medicaid-eligible members

Agency: Department of Mental Health (DMH)
Role: Provides licensing, oversight, and service coordination for individuals with serious mental illness

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Approves and oversees 1915(c) waiver programs and Medicaid funding

2. BEHAVIORAL HEALTH SERVICE OVERVIEW

Behavioral Health Services support individuals across a spectrum of needs, from short-term counseling to long-term clinical and community-based interventions.

Common service types include:

Outpatient therapy (individual, group, or family counseling)

In-home therapy and therapeutic mentoring (especially for youth)

Peer support and recovery coaching

Mobile crisis intervention

Intensive Care Coordination (ICC)

Psychiatric consultation and medication management

Community Support Programs (CSP) for complex needs

Services must be authorized through a member’s treatment plan and must align with MassHealth or waiver eligibility criteria.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Massachusetts Secretary of the Commonwealth

Obtain an IRS EIN and Type 2 NPI

Secure professional liability insurance

Obtain DMH, DCF, or Department of Public Health (DPH) licensure for clinical services, depending on scope

Comply with local zoning and safety codes (if operating a facility)

Develop HIPAA-compliant Policies & Procedures

Clinical Practice Requirements:

Supervising clinician must hold an active MA license (e.g., LICSW, LMHC, LMFT, Psychologist, or Psychiatrist)

Maintain active clinical documentation and treatment plans

Adhere to DMH guidelines and MassHealth billing protocols

4. PROVIDER ENROLLMENT PROCESS

Step 1: Register with MassHealth
Apply via the Provider Online Service Center (POSC):
https://massgov.account.gov

Step 2: Complete Credentialing with Managed Care Plans
Submit documentation and clinician rosters to MBHP or participating MCOs for network participation

Step 3: Obtain Licensing (If Applicable)
If providing outpatient clinic services, apply for a DMH site license or DPH clinic license (Substance Use)

Step 4: Execute Provider Agreements & Prepare Documentation
Ensure contracts, compliance manuals, and supervisory structures are in place

​

5. REQUIRED DOCUMENTATION

Articles of Incorporation or DBA filings

IRS EIN and NPI confirmation letters

Proof of insurance and licensure

Behavioral Health Policy & Procedure Manual, including:

Treatment plan templates

Intake, screening, and referral forms

Progress notes and discharge summaries

Medication administration (if applicable)

Incident reporting protocols

Staff training logs and supervision schedules

Client rights and consent documentation

Billing and compliance audit forms

6. STAFFING REQUIREMENTS

Role: Licensed Clinician (LICSW, LMHC, etc.)
Requirements: Valid Massachusetts license, clinical experience, liability coverage

Role: Unlicensed Mental Health Counselor / Behavioral Health Worker
Requirements: Bachelor’s degree in related field, supervision from licensed clinician, background checks

Role: Peer Support or Recovery Coach
Requirements: Peer certification or relevant lived experience, training in harm reduction and motivational interviewing

Mandatory Trainings:

HIPAA & confidentiality

Trauma-informed care

Emergency protocols & crisis response

Cultural competency & language access

Ethics and professional boundaries

7. MASSHEALTH & HCBS BEHAVIORAL HEALTH PROGRAMS

Behavioral health services may be delivered and reimbursed through:

MassHealth Standard and CommonHealth (general Medicaid plans)

Children’s Behavioral Health Initiative (CBHI) — ICC, Family Support, In-Home Therapy

Community Support Program (CSP) — adults with complex needs

Program of Assertive Community Treatment (PACT) — intensive, multidisciplinary outreach

Behavioral Health for Dually Eligible (One Care & SCO)

Money Follows the Person (MFP) Waiver — transition support with BH wraparound services

Providers must coordinate with case managers, service teams, and health homes to ensure continuity and compliance.

8. TIMELINE TO LAUNCH

Phase: Business Registration and Credentialing
Timeline: 30–60 days

Phase: MassHealth Enrollment and MCO Paneling
Timeline: 1–2 months

Phase: Licensing and Policy Development (if clinical site-based)
Timeline: 60–90 days

Phase: Hiring, Training, and Client Onboarding
Timeline: Ongoing

​

9. CONTACT INFORMATION

MassHealth Provider Enrollment and POSC Portal
https://massgov.account.gov

​

Massachusetts Behavioral Health Partnership (MBHP)
https://www.masspartnership.com

​

Executive Office of Health and Human Services (EOHHS)
https://www.mass.gov/orgs/executive-office-of-health-and-human-services

​

Department of Mental Health (DMH)
https://www.mass.gov/orgs/massachusetts-department-of-mental-health

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS BEHAVIORAL HEALTH PROVIDER

WCG helps licensed professionals, community clinics, and non-profits launch Medicaid-approved Behavioral Health practices across Massachusetts.

​

Scope of Work:

Business and MassHealth registration

Licensing support (DMH, DPH, or outpatient site)

Behavioral Health Policy & Procedure Manual development

MCO credentialing and panel applications

Staff onboarding and supervision logs

Service documentation and billing tools

Compliance checklists and audit preparation systems

Referral network support with CBHI, CSP, and DMH teams

HOME AND VEHICLE MODIFICATION SERVICES PROVIDER IN MASSACHUSETTS

ENHANCING ACCESSIBILITY AND SAFETY THROUGH MEDICAID-FUNDED ENVIRONMENTAL ADAPTATIONS FOR INDIVIDUALS WITH DISABILITIES

Home and Vehicle Modification Services in Massachusetts are essential supports that enable individuals with disabilities to live more independently and safely in their homes or access their communities through adapted vehicles. These services are covered under MassHealth Home and Community-Based Services (HCBS) waivers and the Money Follows the Person (MFP) program. Providers play a vital role in customizing physical spaces and vehicles to align with each individual’s functional needs.

1. GOVERNING AGENCIES

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees waiver and MFP environmental adaptation policy and funding

Agency: MassHealth (Massachusetts Medicaid)
Role: Authorizes and reimburses for environmental modifications under waiver plans

Agency: Department of Developmental Services (DDS)
Role: Coordinates waiver services for individuals with intellectual and developmental disabilities

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Manages home and vehicle modification programs for individuals with physical disabilities

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal funding and oversight for HCBS waiver-based modifications

2. SERVICE OVERVIEW

Home and vehicle modifications are non-medical, structural adaptations to the home or personal vehicle that enhance safety, mobility, and independence. Services may include:

Home Modifications:

Ramps and stair lifts

Widened doorways and hallways

Roll-in showers, grab bars, and accessible sinks

Kitchen reconfiguration for wheelchair access

Hard-wired emergency alert systems

Non-slip flooring or threshold modifications

Vehicle Modifications:

Wheelchair lifts and securement systems

Transfer seating and hand controls

Door automation and lowered floors

Driving equipment for adaptive use

Modifications must be medically necessary, cost-effective, and part of the individual’s Plan of Care (POC) or Individual Support Plan (ISP). Services are one-time, pre-authorized, and require cost estimates and contractor bids.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Massachusetts Secretary of the Commonwealth

Obtain IRS EIN and Type 2 NPI

Secure general liability and workers’ compensation insurance

Hold relevant contractor licenses (for structural home work)

Obtain automotive modification certifications (for vehicle work)

Submit proof of compliance with ADA, HUD, and state building codes

Develop written policies for project planning, safety, and documentation

4. PROVIDER ENROLLMENT PROCESS

Step 1: MassHealth Provider Registration
Enroll via the Provider Online Service Center (POSC)

Step 2: Apply with Waiver Program(s)

DDS: For home modifications under developmental disability waivers

MRC: For vehicle mods and home access (MFP or state-funded)

ABI or MFP Waivers: For institutional transition supports

Step 3: Submit Service and Project Documentation
Provide sample cost estimates, contractor credentials, safety certifications, and timelines

Step 4: Sign Provider Agreements and Start Receiving Referrals
Coordinate with support coordinators and transition teams for project assignments

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business filings

IRS EIN and Type 2 NPI confirmation

Contractor license (Massachusetts CSL or HIC, if applicable)

Automotive modifier credentials (QAP/ASE/NMEDA, if applicable)

Proof of insurance

Environmental Modification Policy & Procedure Manual, including:

Cost proposal forms and bidding templates

Project approval and modification checklists

Home safety assessment templates

Completion certification forms

Warranties, service logs, and photos of finished work

Client consent and satisfaction surveys

Billing documentation and audit records

6. STAFFING REQUIREMENTS

Role: Project Manager / Modification Coordinator
Requirements: Construction or OT background; oversees project scope, budget, and documentation

Role: Licensed Contractor / Installer
Requirements: Valid Massachusetts Construction Supervisor License (CSL) or Home Improvement Contractor (HIC) license; ADA experience preferred

Role: Vehicle Modification Technician
Requirements: Automotive technician license and QAP/NMEDA certifications

Required Trainings:

ADA accessibility standards

Home safety and structural integrity

Infection control during home entry (especially post-discharge)

Documentation and Medicaid billing compliance

7. MASSHEALTH & WAIVER PROGRAMS THAT COVER MODIFICATIONS

These services are reimbursed under:

ABI Waiver (Acquired Brain Injury)

MFP-Residential and Community Living Waivers

DDS Waivers (Community Living, Intensive Supports)

Frail Elder and Community Living Waivers (with mobility needs)

State-funded MRC Home Modifications (for individuals not eligible under Medicaid)

Modifications must:

Be cost-effective and medically justified

Not duplicate coverage under housing programs (e.g., Section 8 renovations)

Comply with building codes and maintain safety standards

Be documented with photos, contractor invoices, and sign-offs

8. TIMELINE TO LAUNCH

Phase: Business and License Registration
Timeline: 2–4 weeks

Phase: Medicaid and Waiver Enrollment
Timeline: 1–2 months

Phase: Staff Hiring and Compliance Manual Completion
Timeline: 1 month

Phase: Referral Coordination and Service Start-Up
Timeline: Ongoing — based on discharge planning and home safety assessments

9. CONTACT INFORMATION

MassHealth Provider Enrollment
https://www.mass.gov/orgs/masshealth

​

Massachusetts Rehabilitation Commission (MRC)
https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

​

Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

​

Department of Public Safety – Contractor Licensing
https://www.mass.gov/orgs/office-of-public-safety-and-inspections

​

National Mobility Equipment Dealers Association (NMEDA)
https://www.nmeda.org

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS HOME & VEHICLE MODIFICATION PROVIDER

WCG supports contractors, adaptive technicians, and agencies in launching Medicaid-approved environmental modification services across Massachusetts.

​

Scope of Work:

Contractor licensing and Medicaid enrollment support

DDS and MRC application assistance

Environmental modification policy & procedure manuals

Procurement and warranty tracking templates

Staff onboarding and safety training resources

Referral coordination with case managers and discharge teams

Audit-ready project documentation and compliance systems

ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN MASSACHUSETTS

ENABLING GREATER INDEPENDENCE THROUGH PERSONALIZED DEVICES AND TECHNOLOGICAL SUPPORT FOR INDIVIDUALS WITH DISABILITIES

Assistive Technology (AT) Services in Massachusetts provide critical tools and supports to help individuals with disabilities live more independently, communicate effectively, and perform everyday tasks. These services are available under Medicaid Home and Community-Based Services (HCBS) waivers, MassHealth programs, and through state-funded initiatives aimed at expanding access to adaptive technologies.

1. GOVERNING AGENCIES

Agency: Massachusetts Executive Office of Health and Human Services (EOHHS)
Role: Oversees Medicaid policy and HCBS waiver administration

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Administers state-funded AT programs and facilitates service referrals for eligible individuals

Agency: MassHealth (Massachusetts Medicaid)
Role: Authorizes AT under waiver services, including Durable Medical Equipment (DME) and environmental adaptations

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal funding and oversight for AT services through 1915(c) waivers and MFP programs

2. ASSISTIVE TECHNOLOGY SERVICE OVERVIEW

Assistive Technology services support individuals with disabilities by providing equipment or services that maintain or improve functional capabilities. These may include:

Evaluation of assistive technology needs

Purchase, leasing, or customization of devices

Training for the individual, caregivers, and providers

Device maintenance and repair

Environmental control units or augmentative communication systems

Specialized software or mobility aids

Home modifications for accessibility (as allowed under waiver programs)

Services must be outlined in the individual’s care plan and justified through a clinical or functional assessment.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth

Obtain an IRS EIN and Type 2 NPI

Secure general liability and professional insurance

Maintain HIPAA-compliant client records and device logs

Employ or contract qualified professionals (e.g., Assistive Technology Professional (ATP), occupational/physical therapists)

For Home Modification or Installation Services:

Obtain applicable contractor licensure

Comply with Massachusetts building codes and ADA guidelines

Follow waiver-specific safety and quality standards

4. PROVIDER ENROLLMENT PROCESS

Step 1: Register with MassHealth
Enroll as a Medicaid provider through the Provider Online Service Center (POSC):
https://massgov.account.gov

Step 2: Apply as a Waiver Provider (if relevant)
Submit documents to become a provider under specific waiver programs such as the ABI, MFP, or DDS waivers

Step 3: Submit Service Descriptions and Pricing
Outline device types, installation process, maintenance support, and staff qualifications for authorization approval

Step 4: Execute Provider Agreements
Complete MassHealth contracts and MRC partnership forms (if applicable)

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business filings

IRS EIN and Type 2 NPI confirmation

Proof of liability and worker’s comp insurance

AT Policy & Procedure Manual, including:

Client assessment forms

Equipment recommendation templates

Installation, repair, and tracking logs

User training documentation

Emergency device support procedures

Consent and rights acknowledgement forms

Staff credentials and technical certifications

Billing and audit preparation documents

6. STAFFING REQUIREMENTS

Role: Assistive Technology Professional (ATP)
Requirements: Certification from RESNA or equivalent experience in evaluating and implementing AT solutions

Role: Occupational/Physical Therapist (if providing assessments)
Requirements: Valid Massachusetts licensure, experience in adaptive equipment planning

Role: Installation Technician / Home Modification Specialist
Requirements: Contractor license (if modifying structures), training in accessibility and device mounting

Mandatory Trainings:

HIPAA and client privacy

Device safety and troubleshooting

Client-centered service delivery

Waiver documentation and billing protocols

7. MASSHEALTH & HCBS PROGRAMS

Assistive Technology services are reimbursed under:

ABI Waiver (Acquired Brain Injury)

MFP-Residential Supports Waiver

MFP-Community Living Waiver

DDS Waivers (Department of Developmental Services)

Community Living Waiver for Adults with Disabilities

Massachusetts Rehabilitation Commission (non-Medicaid funding)

Services may also be coordinated with:

Durable Medical Equipment (DME) benefits

Home Accessibility Modifications

Environmental Adaptation Waiver Services

School-based AT (for minors, via IEP)

8. TIMELINE TO LAUNCH

Phase: Business Registration and Professional Credentialing
Timeline: 1 month

Phase: Medicaid Enrollment and Waiver Program Applications
Timeline: 1–2 months

Phase: Service Manual Development and Staff Onboarding
Timeline: 4–6 weeks

Phase: MRC/MassHealth Contract Execution and Service Rollout
Timeline: Ongoing based on service authorizations and referrals

9. CONTACT INFORMATION

MassHealth Provider Enrollment
Website: https://www.mass.gov/orgs/masshealth

​

Massachusetts Rehabilitation Commission (MRC)
Website: https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

​

MassHealth Provider Online Service Center (POSC)
Portal: https://massgov.account.gov

​

Department of Developmental Services (DDS)
Website: https://www.mass.gov/orgs/department-of-developmental-services

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS AT PROVIDER

WCG empowers entrepreneurs, clinicians, and adaptive tech installers to launch licensed, Medicaid-approved Assistive Technology services across Massachusetts.

​

Scope of Work:

Business and Medicaid enrollment

Assistive Technology policy & procedure manual development

Waiver credentialing and documentation tools

Device installation tracking and maintenance forms

Staff onboarding, ATP sourcing, and clinical partnerships

Coordination with MRC and DDS referral teams

Billing systems and compliance checklist setup

HOME CARE TECHNOLOGY SERVICES PROVIDER IN MASSACHUSETTS

LEVERAGING INNOVATIVE TECHNOLOGIES TO MONITOR, SUPPORT, AND ENHANCE IN-HOME CARE FOR INDIVIDUALS WITH DISABILITIES OR CHRONIC CONDITIONS

Home Care Technology Services in Massachusetts enable individuals receiving care at home to maintain safety, independence, and better health outcomes through the use of digital tools, remote monitoring, and assistive systems. These services are increasingly supported by MassHealth Home and Community-Based Services (HCBS) waivers, the Money Follows the Person (MFP) program, and other Medicaid-funded long-term care initiatives.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)
Role: Approves and reimburses home care technologies when deemed medically necessary and listed in the individual’s care plan

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees waiver programs and Medicaid-funded innovations in home-based care

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: May coordinate home-based technology services, especially under the MFP program

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and funding approval for Medicaid-covered technologies through 1915(c) waivers

2. HOME CARE TECHNOLOGY SERVICE OVERVIEW

Home care technology services include the selection, setup, training, and ongoing support of devices designed to ensure safety, communication, health monitoring, and environmental control for individuals receiving home-based services.

Common technologies include:

Emergency alert and fall detection systems

Smart medication dispensers and reminders

Remote patient monitoring (e.g., blood pressure, glucose)

Motion sensors and door alarms for elopement prevention

Voice-activated assistants integrated with care plans

Home automation systems (lighting, thermostat, blinds)

Two-way video communication for caregiver check-ins

Mobile apps for daily routines and care documentation

All devices must align with the individual’s Plan of Care (POC) or Individual Support Plan (ISP) and must not duplicate other covered services.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth

Obtain an IRS EIN and Type 2 NPI

Carry general liability insurance and cybersecurity protection

Enroll with MassHealth as a waiver provider

Hire or contract trained technology installers and support staff

Implement HIPAA-compliant software systems and data storage practices

Note: No special state license is required for non-clinical technology providers, but some services (e.g., remote health monitoring) may require coordination with clinicians.

4. PROVIDER ENROLLMENT PROCESS

Step 1: MassHealth Provider Enrollment
Register through the Provider Online Service Center (POSC)

Step 2: Waiver Program Application (MFP, ABI, DDS, etc.)
Submit documents detailing your technology types, use cases, procurement process, and staff roles

Step 3: Technology Demonstration and Approval
Prepare sample workflows showing how each device addresses POC goals and enhances home care

Step 4: Provider Agreement Execution and Referrals
Collaborate with care coordinators, case managers, and therapists for referrals and authorizations

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business filings

IRS EIN and NPI confirmations

Proof of liability insurance and cybersecurity plan

Home Care Technology Services Policy & Procedure Manual, including:

Device assessment and recommendation forms

Installation logs and service contracts

User training and tech literacy checklists

Emergency override protocols and response plans

HIPAA-compliant data handling procedures

Documentation for equipment warranty and replacement

Billing logs and audit preparation documents

6. STAFFING REQUIREMENTS

Role: Technology Specialist / Installer
Requirements: Experience with smart home and medical technology installation; background checks; technical certifications preferred

Role: Client Support Representative / Educator
Requirements: Knowledge of assistive tech and remote health devices; training in client communication and accessibility

Role: Program Supervisor / Service Coordinator
Requirements: Manages referrals, tracks device deployment, supervises staff

Required Trainings:

HIPAA and data privacy

Universal design and accessibility

Device troubleshooting and remote support

Emergency procedures and client safety

Cultural competence and disability sensitivity

7. MASSHEALTH & HCBS WAIVER PROGRAMS THAT COVER HOME CARE TECH

Technology services may be reimbursed under:

ABI Waivers (Acquired Brain Injury)

MFP Waivers (Residential and Community Living)

DDS Waivers (Community Living and Intensive Supports)

Community Living Waiver (for aging adults and those with physical disabilities)

State-funded home care or technology innovation grants

Examples of covered services:

Installation and training for home-based alert systems

Integration of technology into daily support routines

Monthly tech support and maintenance

Data tracking/reporting as part of care monitoring

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–3 weeks

Phase: MassHealth and Waiver Enrollment
Timeline: 1–2 months

Phase: Technology Policy Manual and Staff Training
Timeline: 4–6 weeks

Phase: Referral Network Integration and Device Rollout
Timeline: Ongoing

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal
https://www.mass.gov/orgs/masshealth

​

Massachusetts Rehabilitation Commission (MRC)
https://www.mass.gov/orgs/massachusetts-rehabilitation-commission

​

Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

​

Executive Office of Elder Affairs (EOEA) – Aging & technology support
https://www.mass.gov/orgs/executive-office-of-elder-affairs

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS HOME CARE TECHNOLOGY PROVIDER

WCG supports tech startups, DME providers, and in-home care companies in launching Medicaid-approved home care technology programs across Massachusetts.

​

Scope of Work:

Business and MassHealth enrollment

Waiver program application support (DDS, ABI, MFP)

Technology policy & procedure manual creation

Staff onboarding materials and technical training resources

Installation logs, emergency protocols, and support scripts

Billing documentation systems and HIPAA compliance setup

Referral coordination with discharge planners and case managers

TRANSITION ASSISTANCE SERVICES PROVIDER IN MASSACHUSETTS

FACILITATING SAFE, SUPPORTED MOVES FROM INSTITUTIONAL SETTINGS TO INDEPENDENT COMMUNITY LIVING

Transition Assistance Services (TAS) in Massachusetts help individuals with disabilities or chronic conditions move out of institutional settings—such as nursing facilities or hospitals—and successfully reintegrate into the community. These services are covered under the Money Follows the Person (MFP) initiative and certain 1915(c) HCBS waiver programs, offering time-limited, person-centered support during the move and initial adjustment period.

1. GOVERNING AGENCIES

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees MFP programs and Medicaid-funded transition initiatives

Agency: MassHealth (Medicaid)
Role: Authorizes and reimburses transition services through MFP and waivers

Agency: Massachusetts Rehabilitation Commission (MRC)
Role: Manages the Money Follows the Person program and Transition Coordinators

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and funding for the MFP demonstration program

2. TRANSITION ASSISTANCE SERVICE OVERVIEW

Transition Assistance Services help individuals move from institutional settings to home or community-based living with appropriate supports.

Eligible services include:

Security deposits for leases

Essential household furnishings (beds, linens, cookware)

Utility setup fees (gas, electricity, water)

Initial groceries and basic cleaning supplies

Moving expenses (hiring movers or transport of belongings)

Home setup assistance (assembly, minor organization)

Coordination with housing, benefits, and waiver services

Services must be non-recurring and directly related to the transition process. All purchases must be pre-approved and documented in the individual's Transition Plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register with the Massachusetts Secretary of the Commonwealth

Obtain IRS EIN and Type 2 NPI

Apply to become an MFP-approved or waiver provider

Secure general liability insurance

Develop policies for procurement, documentation, and HIPAA compliance

Partner with housing coordinators and support teams

Note: No specific clinical licensure is required, but experience with case management or service coordination is strongly recommended.

4. PROVIDER ENROLLMENT PROCESS

Step 1: MassHealth and MFP Enrollment
Register via the Provider Online Service Center (POSC):
https://massgov.account.gov

Step 2: Apply with MRC or DDS (Depending on Population)
Submit credentials to become an authorized Transition Services vendor

Step 3: Submit Service Descriptions and Protocols
Outline your approach to purchasing, documentation, and safeguarding client funds

Step 4: Contract Execution and Network Integration
Sign provider agreements and begin receiving referrals from MFP Transition Coordinators or waiver case managers

5. REQUIRED DOCUMENTATION

Articles of Incorporation or DBA filings

IRS EIN and NPI confirmations

Proof of insurance coverage

Transition Assistance Policy & Procedure Manual, including:

Transition budgeting and planning forms

Procurement and reimbursement tracking

Inventory checklists for essential household items

Receipts submission templates and audit logs

Staff training and supervision protocols

Emergency contacts and contingency procedures

HIPAA compliance and confidentiality policies

6. STAFFING REQUIREMENTS

Role: Transition Services Coordinator / Support Worker
Requirements: High school diploma (minimum); experience with service coordination, housing navigation, or social work; background checks

Role: Program Manager / Fiscal Coordinator
Requirements: Oversight of purchasing, inventory, and Medicaid documentation; strong budgeting and compliance skills

Required Training:

Person-centered planning

Housing safety and tenant rights

HIPAA and privacy regulations

Budget management and receipt tracking

Abuse and neglect prevention

7. MEDICAID WAIVER & MFP PROGRAMS

TAS is authorized under:

MFP-Community Living Waiver

MFP-Residential Supports Waiver

ABI Waivers (Acquired Brain Injury)

DDS Waivers (for individuals with developmental disabilities)

Community Living Waiver (for older adults or those with physical disabilities)

Services are typically capped per transition (e.g., $5,000 max) and must be non-duplicative of other benefits (e.g., SNAP, Section 8, or PCA).

Providers must coordinate with:

MRC Transition Coordinators

Housing agencies and property managers

Waiver service providers and case managers

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–4 weeks

Phase: MassHealth and MFP Vendor Enrollment
Timeline: 1–2 months

Phase: Staff Hiring and Policy Manual Completion
Timeline: 4–6 weeks

Phase: Provider Network Integration and Referrals
Timeline: Ongoing, based on institutional discharge plans and housing availability

9. CONTACT INFORMATION

MassHealth Provider Enrollment
https://www.mass.gov/orgs/masshealth

​

Massachusetts Rehabilitation Commission (MRC) — MFP Program
https://www.mass.gov/service-details/money-follows-the-person

​

Department of Developmental Services (DDS)
https://www.mass.gov/orgs/department-of-developmental-services

​

Massachusetts Housing Consumer Education Centers (HCECs)
https://www.masshousinginfo.org

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS TRANSITION SERVICES PROVIDER

WCG helps housing nonprofits, peer support teams, and small service agencies become certified Transition Assistance Service providers under MFP and waiver programs.

​

Scope of Work:

Business setup and Medicaid/MFP enrollment

Transition Services policy & procedure manual creation

Procurement tracking forms and receipt logs

Staff training materials and supervision tools

Housing coordination and referral scripts

Compliance tools and audit-ready documentation systems

TRANSPORTATION ASSISTANCE SERVICES PROVIDER IN MASSACHUSETTS

OFFERING RELIABLE, NON-EMERGENCY TRANSPORTATION TO SUPPORT ACCESS TO HEALTHCARE, EMPLOYMENT, AND COMMUNITY LIFE FOR INDIVIDUALS WITH DISABILITIES

Transportation Assistance Services (TAS) in Massachusetts ensure that Medicaid beneficiaries and individuals with disabilities have access to safe, timely, and appropriate rides for medical appointments, adult day programs, work, and other waiver-authorized activities. These services are typically offered under MassHealth’s Non-Emergency Medical Transportation (NEMT) program and through HCBS waiver programs such as ABI, MFP, and DDS Waivers.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)
Role: Funds and authorizes transportation services for eligible Medicaid members

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Oversees Medicaid transportation operations and waiver compliance

Agency: Human Service Transportation (HST) Office
Role: Contracts with regional brokers to coordinate and schedule NEMT services

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides oversight for transportation services funded through 1915(c) waivers

Agency: Massachusetts Department of Public Utilities (DPU)
Role: Regulates commercial and livery vehicles, including licensing and safety standards

2. TRANSPORTATION ASSISTANCE SERVICE OVERVIEW

Transportation services help individuals who are unable to drive or access public transit get to:

Medical, dental, or mental health appointments

Adult day health programs

Community-based day support and employment

Waiver-authorized habilitation or therapy

Housing or benefits-related appointments

Pharmacy or medical supply pickups (if approved)

Services can include:

Ambulatory rides

Wheelchair-accessible transportation

Door-to-door and curb-to-curb options

Escort assistance (if authorized)

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth

Obtain an IRS EIN and Type 2 NPI

Obtain DPU operating authority for livery or paratransit services

Acquire commercial auto liability insurance and workers’ compensation

Maintain clean driving records for all drivers

Pass vehicle safety inspections (per DPU and HST standards)

Create HIPAA-compliant trip logs and documentation

If providing Medicaid NEMT services:
You must work under contract with an HST Broker or receive direct referrals under waiver programs.

4. PROVIDER ENROLLMENT PROCESS

Option A: HST Broker Network Participation (NEMT)

Register through MassHealth Provider Online Service Center

Apply with your regional HST Broker (e.g., MART or GATRA)

Submit vehicle, insurance, and driver documentation

Complete orientation and secure service authorization referrals

Option B: Waiver Transportation Provider (MFP, DDS, ABI)

Apply to be a waiver provider through DDS or MRC

Provide transportation descriptions aligned with ISP/POC goals

Get approved to bill under authorized transportation codes

Maintain logs for trip validation and audit readiness

5. REQUIRED DOCUMENTATION

Articles of Incorporation or sole proprietor filing

IRS EIN and NPI confirmation

Commercial vehicle insurance and DPU certification

Transportation Services Policy & Procedure Manual, including:

Daily trip logs and rider rosters

Vehicle safety inspection checklists

Incident reporting and emergency protocols

Consent forms and rider rights documentation

Billing records and schedule logs

Staff onboarding forms (driver background checks, licenses, training records)

6. STAFFING REQUIREMENTS

Role: Driver / Transportation Specialist
Requirements:

Valid Massachusetts driver’s license

Clean driving record (CORI and RMV check)

CPR/First Aid certification

Defensive driving and passenger assistance training

DPU operating authority (company-wide)

Role: Transportation Manager / Dispatcher (for agencies)
Requirements:

Coordination of schedules, staff, and vehicle maintenance

Experience in NEMT or paratransit logistics

Mandatory Trainings:

HIPAA and confidentiality

Passenger safety and lift operations

Abuse, neglect, and emergency response

Cultural competency and disability awareness

7. MASSHEALTH & WAIVER PROGRAMS COVERING TRANSPORTATION

Transportation services are billable under:

MassHealth Standard and CommonHealth NEMT

ABI Waiver (Acquired Brain Injury)

MFP Waivers (Community Living and Residential Supports)

DDS Adult Waivers

Community Living Waiver (for seniors and individuals with physical disabilities)

Services must be coordinated with:

HST Brokers (e.g., MART, GATRA) for standard NEMT

Waiver support coordinators or transition teams for ISP-based rides

Case managers and program providers for billing and service alignment

8. TIMELINE TO LAUNCH

Phase: Business Registration and Licensing
Timeline: 1 month

Phase: DPU Certification and Insurance Setup
Timeline: 2–3 weeks

Phase: Medicaid/HST Broker Enrollment or Waiver Program Application
Timeline: 30–60 days

Phase: Staff Training and Service Readiness
Timeline: 2–4 weeks

Phase: Start of Operations (based on referrals or contracts)
Timeline: Ongoing

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal
https://www.mass.gov/orgs/masshealth

​

HST Office – Human Service Transportation
https://www.mass.gov/human-service-transportation

​

Department of Public Utilities – Transportation Oversight
https://www.mass.gov/orgs/department-of-public-utilities

​

Montachusett Regional Transit Authority (MART)
https://www.mrta.us

​

Greater Attleboro Taunton Regional Transit Authority (GATRA)
https://www.gatra.org

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MASSACHUSETTS TRANSPORTATION PROVIDER

WCG helps local entrepreneurs and agencies launch Medicaid-approved transportation services that connect people to the care and independence they need.

​

Scope of Work:

Business and DPU licensing guidance

NEMT/HST broker applications and compliance setup

Waiver transportation provider enrollment

Vehicle safety checklists and inspection templates

Driver onboarding and training materials

Trip log and billing documentation systems

Audit readiness and Medicaid billing workflows

HOME HEALTH SERVICES PROVIDER IN MASSACHUSETTS
DELIVERING SKILLED NURSING, THERAPY, AND PERSONAL CARE TO INDIVIDUALS IN THE COMFORT OF THEIR HOMES

Home Health Services in Massachusetts offer medical, therapeutic, and personal care to individuals with disabilities, chronic illnesses, or recovering from hospital stays. These services are regulated by the Massachusetts Department of Public Health (DPH) and reimbursed by MassHealth and Medicare, depending on eligibility and service type.

1. GOVERNING AGENCIES

Agency: Massachusetts Department of Public Health (DPH)
Role: Licenses home health agencies under 105 CMR 140.000 regulations

Agency: MassHealth (Massachusetts Medicaid)
Role: Pays for home health services under Medicaid State Plan and community-based waivers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Oversees Medicare-certified home health agencies and HCBS compliance

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Provides policy guidance, provider bulletins, and LTSS systems

2. HOME HEALTH SERVICE OVERVIEW

Home Health Care includes:

Skilled Nursing (e.g., wound care, injections, chronic disease monitoring)

Home Health Aide Services (e.g., bathing, grooming, mobility assistance)

Physical, Occupational, or Speech Therapy

Medical Social Work

Patient and caregiver education

Medication management and care plan oversight

These services are delivered based on a physician’s order and documented in a plan of care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

To become a licensed home health agency (HHA) in Massachusetts, providers must:

Register a business entity with the MA Secretary of State

Obtain an EIN, NPI, and Medicaid ID

Apply for a Home Health Agency license through the DPH Determination of Need (DoN) Program

Submit a comprehensive application package and policy & procedure manual

Pass a DPH survey inspection

Employ qualified nursing and therapy professionals

Maintain malpractice insurance and secure EMR systems

4. MASSACHUSETTS HOME HEALTH LICENSURE PROCESS

Step 1: Business Formation & Planning

Establish legal entity and secure office location

Develop staffing and service model (e.g., skilled, aide-only, full-service)

Step 2: Apply to DPH for Licensure

Submit application under 105 CMR 140.000

Include org chart, medical director, policies, emergency plan, etc.

Step 3: Site Visit and Licensing Survey

DPH will inspect the office and review staff files, procedures, and compliance

Step 4: Enroll with MassHealth via ePREP

Select appropriate home health categories: RN, LPN, PT, HHA, MSW, etc.

Step 5 (Optional): Apply for Medicare Certification

For dual revenue streams and to serve Medicare-eligible patients

5. REQUIRED DOCUMENTATION

Articles of Organization or LLC registration

IRS EIN and Type 2 NPI

DPH Home Health License

MassHealth Provider ID and contract

Policy & procedure manual covering:

Admission, discharge, and eligibility criteria

Care planning, RN supervision, and therapy protocols

Home Health Aide logs and time sheets

HIPAA, infection control, and medication safety

Quality assurance, grievances, and risk management

Emergency and disaster preparedness

Client rights, informed consent, and training documentation

6. STAFFING REQUIREMENTS

Role: Director of Nursing (RN)
Requirements: Active MA license, supervisory experience, responsible for clinical operations

Role: Licensed Practical Nurse (LPN)
Requirements: Works under RN delegation for skilled tasks

Role: Home Health Aide (HHA)
Requirements: Must complete state-approved training (75 hours), CPR certified

Role: Therapists (PT, OT, ST)
Requirements: State-licensed, responsible for evaluations and POC updates

Role: Medical Social Worker (if offering full-service model)

Training Requirements:

HIPAA and infection control

Delegation and nursing documentation

Abuse/neglect reporting (MANDATED)

ADL support, body mechanics, and safety

Annual skills review and continuing education

7. MASSHEALTH SERVICE TYPES & BILLING

MassHealth reimburses licensed HHAs for:

Skilled nursing visits

Home health aide visits

Physical therapy, occupational therapy, speech therapy

Social work (MSW) assessments

Telehealth services (in some cases, per bulletins)

Billing is done through:

MassHealth LTSS Provider Portal

Claims must follow POC requirements and be properly documented

8. TIMELINE TO LAUNCH

Phase: Business Registration and Planning
Timeline: 1–2 weeks

Phase: Policy Manual, Hiring, and DPH Application
Timeline: 4–6 weeks

Phase: DPH Survey and Licensure
Timeline: 6–10 weeks

Phase: Medicaid Enrollment and Service Start
Timeline: 4–6 weeks (can overlap)

9. CONTACT INFORMATION

Massachusetts Department of Public Health (DPH)
Website: https://www.mass.gov/guides/apply-for-a-health-care-facility-license

​

Home Health Licensure Regulations (105 CMR 140)
https://www.mass.gov/doc/105-cmr-140-the-licensure-of-clinics/download

​

MassHealth Provider Enrollment (ePREP)
Website: https://massfinance.ehs.state.ma.us

​

LTSS Provider Portal
Website: https://ltss.mass.gov

​

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS HOME HEALTH AGENCY

We help clinicians and mission-driven organizations navigate licensing, Medicaid enrollment, and operational setup for Home Health Agencies across Massachusetts.

​

Scope of Work:

Business registration (LLC, EIN, NPI)

DPH licensure application and inspection prep

Policy & procedure manual tailored to MA Home Health standards

Staff credentialing trackers and onboarding documents

RN delegation forms, POC templates, and MAR logs

MassHealth billing guidance and LTSS portal setup

HIPAA-compliant communication tools and care coordination templates

Referral development for discharge planners, SCOs, and ACOs