Massachusetts - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Under 130 CMR 630.000, Massachusetts funds Skilled Respite through the Acquired Brain Injury (ABI), Moving Forward Plan (MFP), and Frail Elder (FEW) waivers to support members requiring intermittent nursing care while their primary caregiver is unavailable.

Approval requires an active Home Health Agency license from the Department of Public Health (DPH) or Medicare certification, followed by waiver-specific enrollment. Providers targeting the Frail Elder Waiver must secure a contract with one of the 24 regional Aging Services Access Points (ASAPs) before MassHealth will authorize service delivery, while ABI and MFP waiver applicants apply directly through the UMass HCBS Provider Network Administration Unit.

1. Service Definition and Scope

In Massachusetts, Skilled Respite provides short-term nursing care for waiver participants whose medical needs exceed what a standard non-skilled respite worker or companion can safely manage. It is designed to provide temporary relief to primary caregivers.

The service is delivered in the member's home or an approved community setting and must be explicitly authorized in the participant's Person-Centered Service Plan.

• Target Population: ABI, MFP, and FEW waiver participants with complex medical needs requiring clinical oversight.
• Staffing Level: Must be delivered directly by a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
• Setting: Typically the member's private residence, though facility-based respite exists under separate codes.
• Duration Limits: Authorized via the member's Plan of Care, subject to annual waiver caps and limits.
• Excluded Activities: Cannot be billed concurrently with continuous skilled nursing or standard home health visits for the same time period.

2. Regulatory and Oversight Agencies

Oversight of Skilled Respite is divided between the agency that licenses the clinical provider and the agencies that manage the specific Medicaid waivers.

The Department of Public Health ensures clinical standards are met, while MassHealth and its designees handle waiver enrollment and claims.

• Licensing Authority: Massachusetts Department of Public Health (DPH) [https://www.mass.gov/orgs/department-of-public-health]
• Medicaid Authority: MassHealth [https://www.mass.gov/masshealth]
• ABI/MFP Enrollment Designee: UMass HCBS Provider Network Administration Unit [https://www.mass.gov/info-details/home-and-community-based-services-waivers-acquired-brain-injury-and-moving-forward-plan-information-for-providers]
• FEW Oversight: Executive Office of Aging and Independence (AGE) [https://www.mass.gov/orgs/executive-office-of-aging-and-independence]
• FEW Contracting Entities: Aging Services Access Points (ASAPs) [https://www.mass.gov/aging-services-access-points-asaps-programs-and-agencies]

3. Gatekeeping Prerequisites: Who Can Even Apply

Massachusetts does not enroll independent nurses for agency-level skilled respite; applicants must be established entities. The pathway depends entirely on the target waiver.

Providers must clear specific structural hurdles, including licensure and regional contracting, before a waiver application is accepted.

• Licensure Prerequisite: Must hold a current Massachusetts Home Health Agency license from DPH or be a Medicare-certified Home Health Agency.
• FEW Contracting Gate: To serve Frail Elder Waiver participants, providers must successfully bid and contract with a regional ASAP via the Provider Contracting System.
• DDS Waiver Gate: Requires prior qualification through the Operational Services Division (OSD) COMMBUYS procurement system during open enrollment periods.
• ABI/MFP Pathway: Open enrollment through the UMass HCBS Provider Network Administration Unit, provided the agency meets DPH licensure standards.

4. Licensure and Certification Requirements

Because Skilled Respite requires nursing tasks, the provider must meet DPH standards for Home Health Agencies or equivalent clinical facility standards.

These regulations ensure that agencies have the proper clinical oversight, insurance, and administrative structures in place.

• Regulation Citation: 130 CMR 403.000 (Home Health Agency regulations).
• Medicare Certification: Often utilized as a proxy for state licensure for home health providers in Massachusetts.
• Administrator Qualifications: Must employ a qualified nursing director (RN with supervisory experience) to oversee clinical staff.
• Liability Insurance: Must maintain commercial general liability and professional liability insurance as dictated by ASAP or MassHealth contracts.

5. Medicaid Provider Enrollment

Enrollment requires submitting specific HCBS waiver forms. ABI/MFP providers submit to UMass, while FEW providers are enrolled via their ASAP contracts.

All providers must ultimately be registered in the state's MMIS system to submit claims.

• Primary Application: MassHealth Home and Community-Based Services (HCBS) Waiver Provider Application (Rev. 4/25).
• Agreement Form: Massachusetts Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for HCBS Waivers (GEN-HCBS).
• Data Collection: Provider Enrollment Data Collection Form and Registration Instructions (POSC-HCBS).
• Financial Form: Electronic Funds Transfer (EFT) Enrollment/Modification Form (EFT-1-WU).
• System Access: Provider Online Service Center (POSC) [https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/]

6. Staffing, Training and Background Checks

Staff delivering skilled respite must hold active Massachusetts nursing licenses. Agencies must conduct rigorous background screening.

Providers are responsible for ensuring all clinical staff maintain their credentials and complete required health screenings.

• Clinical Licensure: Direct care staff must hold an active, unencumbered RN or LPN license from the Massachusetts Board of Registration in Nursing.
• Background Check (CORI): Mandatory Criminal Offender Record Information (CORI) checks for all staff prior to patient contact.
• OIG Screening: Monthly checks against the LEIE and MassHealth exclusion lists.
• Tuberculosis Screening: Staff must comply with DPH tuberculosis screening requirements for health care professionals.
• CPR Certification: All nursing staff must maintain active CPR/Basic Life Support (BLS) certification.

7. Documentation, Policies and Records

Providers must maintain clinical records that justify the skilled nature of the respite visit.

Documentation must clearly link the services provided to the member's approved Plan of Care.

• Care Plan Alignment: Services must strictly follow the waiver participant's approved Plan of Care (POC).
• Visit Notes: Clinical notes must document the specific nursing tasks performed during the respite period.
• Medication Administration: Detailed Medication Administration Records (MAR) if medications are dispensed during the shift.
• Record Retention: MassHealth requires providers to retain all clinical and billing records for a minimum of six years.

8. Billing, Rates and Claims

Rates are established by the Executive Office of Health and Human Services (EOHHS). Claims are submitted via the POSC or an approved clearinghouse.

Providers must ensure all billed hours are prior-authorized by the appropriate waiver case manager.

• Rate Regulation: 101 CMR 359.00 (Rates for Home and Community Based Services Waivers).
• Billing System: MassHealth Provider Online Service Center (POSC) or via 837P electronic transactions.
• Prior Authorization: All skilled respite hours must be prior-authorized by the waiver case manager or ASAP before delivery.
• Unit Measurement: Typically billed in 15-minute increments, depending on the specific waiver's service code.

9. Approval Sequence and Timeline

The timeline varies based on whether the provider needs initial DPH licensure or is an existing Home Health Agency adding waiver services.

Existing licensed agencies can complete the waiver enrollment process much faster than new entities.

• Step 1: Obtain DPH Home Health Agency licensure or Medicare certification (6-12 months if new).
• Step 2: For FEW, respond to ASAP procurement and execute contract (3-6 months).
• Step 3: Submit HCBS Waiver Provider Application to UMass or MassHealth (30-60 days for review).
• Step 4: Receive MassHealth Provider ID and POSC welcome letter.
• Step 5: Complete POSC registration and begin accepting authorizations.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed by incomplete forms or failure to secure the necessary prerequisite contracts.

During audits, missing clinical documentation is a primary reason for recoupment.

• Missing ASAP Contract: Applying for Frail Elder Waiver enrollment without an active ASAP contract.
• Incomplete POSC-HCBS: Failure to properly complete the Provider Enrollment Data Collection Form.
• Lapsed Nursing Licenses: Utilizing LPNs or RNs whose Massachusetts licenses have expired or have disciplinary actions.
• Unapproved Settings: Billing for respite delivered in an unlicensed facility rather than the member's home.

11. Key Contacts and Resources

Primary contacts depend on the specific waiver program the provider intends to serve.

Providers should utilize the official MassHealth and UMass portals for the most current forms and rate information.

• ABI/MFP Enrollment: UMass HCBS Provider Network Administration Unit, (855) 300-7058, [email protected].
• MassHealth Provider Portal: Provider Online Service Center (POSC) [https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/]
• FEW Contracting: Provider Contracting System [https://noi.800ageinfo.com/]
• Regulations: MassHealth Provider Regulations (130 CMR 630.000) [https://www.mass.gov/regulations/130-CMR-630000-home-and-community-based-services-waiver-services]

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