Submit the completed MassHealth Member Connection Form (MCF) to the appropriate entity based on the member's waiver status and eligibility. For members enrolled in an HCBS waiver, send the form to the entity managing the waiver services. For members not enrolled in a waiver, submit the form to the local Aging Services Access Point (ASAP). Use the following contact information for submission: - Massachusetts Rehabilitation Commission (MRC), Attn: ABI/MFP Waiver Unit, 600 Washington St., 2nd Floor, Boston, MA 02111, Fax: 617-204-3889, Email: Nadia.Dilibero@massmail.state.ma.us, Phone: 617-204-3656 - Department of Developmental Services (DDS), Attn: Operations Unit, 500 Harrison Avenue, Boston, MA 02118, Fax: 617-624-7885, Contact: Nancy Weston, Email: Nancy.weston@massmail.state.ma.us, Phone: 617-624-7820, Contact: Tim Fife, Email: Tim.Fife@massmail.state.ma.us, Phone: 617-624-7514 - For local ASAPs, follow the guidance on the 800AgeInfo website to identify the member's local ASAP and submit accordingly. Ensure that all required fields are completed, and attach the plan of care (POC) if applicable. Keep a copy of the submitted form for the member's home health record. Accurate and timely submission is crucial to avoid delays or denial of services.

There are no specific important dates for the MassHealth Member Connection Form in 2024 and 2025. The form should be submitted as required based on the member's situation and eligibility.

The MassHealth Member Connection Form (MCF) serves a critical role for home health agencies and certain MassHealth members. Its primary purpose is to facilitate the request for prior authorization of home health aide services, focusing particularly on activities of daily living (ADL) supports. Home health agencies must complete this form accurately to ensure that eligible members receive the care and assistance they need. Home health agencies are required to fill out and submit the MCF for members who are 21 years and older, as well as those enrolled in Home and Community-Based Services (HCBS) waiver programs. In addition, the form is necessary for members 60 years and older within 15 days of a planned discharge from home health services, or when it is determined that the member could benefit from services offered by local Aging Services Access Points (ASAPs). By providing comprehensive information about the member and the services required, the MCF ensures that the needs of the member are clearly communicated and addressed. This form is essential for maintaining continuity of care and ensuring that members receive timely and appropriate home health aide services in accordance with MassHealth's guidelines and regulations.

• 1. Date of Submission: The date on which the form is submitted by the home health agency.
• 2. Member Name: The full name of the MassHealth member for whom services are being requested.
• 3. Member ID: The unique identification number assigned to the MassHealth member.
• 4. Member Telephone: The contact telephone number of the MassHealth member.
• 5. Member's primary spoken language: The language primarily spoken by the MassHealth member.
• 6. DOB: The date of birth of the MassHealth member.
• 7. Assistance with activities of daily living (ADL): Indicates whether the member requires assistance with daily living activities.
• 8. Assistance with instrumental ADL: Indicates whether the member requires assistance with instrumental activities of daily living.
• 9. Other required services: Any additional services that the member may require.
• 10. Waiver program enrollment: Indicates if the member is enrolled in a waiver program and specifies the name of the program.
• 11. HHA Information: Details of the home health agency submitting the form, including name, telephone, and nurse/clinical supervisor.
• 12. Services provided by HHA: Current services provided to the member by the home health agency.
• 13. Expected Discharge Date: The anticipated date of discharge from home health services, if applicable.
• 14. HHA Contact Information: Contact details of the home health agency representative signing the form.

Failing to submit the MassHealth Member Connection Form (MCF) can result in delays or denial of home health aide services for the member. It is crucial to follow submission instructions carefully to ensure timely processing.

• Service Delays: Failure to submit the form may lead to delays in receiving necessary home health aide services.
• Denial of Services: Incomplete or missing forms can result in the denial of authorization for home health aide services.
• Non-compliance: Not submitting the form as required may result in non-compliance with MassHealth regulations.

• 1. Members aged 21 and older: The form is required for members 21 years and older who need assistance with activities of daily living.
• 2. HCBS Waiver Enrollees: Used for members enrolled in Home and Community-Based Services (HCBS) waiver programs.
• 3. Planned Discharge: For members 60 years and older within 15 days of a planned discharge from home health services.
• 4. Eligibility Check: To determine member eligibility for home health services and waiver enrollment.
• 5. Requesting ASAP Services: For members 60 years and older who may benefit from aging services access point (ASAP) services.