Revision to Complex Care Assistant (CCA) Service Supervision Requirements
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Amends supervision requirements for CCA services provided by Continuous Skilled Nursing (CSN) agencies: changes visit frequency, allows LPN supervisors, clarifies documentation and follow-up actions; affects CSN agencies and CCAs serving MassHealth members.
Biweekly supervisory visits for CCA services are no longer required; supervision frequency and format have been amended.
CCA supervisors may conduct the 60-day supervisory visit with or without the CCA present.
Licensed practical nurses (LPNs) may serve as CCA supervisors and conduct supervisory visits in addition to registered nurses (RNs).
If a supervisor notes concern during a visit, an additional onsite observation while the CCA provides services is required; documented deficiencies trigger reeducation and training.
A 12-month enhanced care evaluation must be conducted by an RN or LPN and documented, with additional training as needed.
60-day supervisory visits must be documented in the member's medical record and clearly identified as CCA supervisory visit notes.
CCA Supervision Requirements
CCA supervision requirements
Requirements CSN agencies must follow for supervising CCA services:
ALL of the following
ONE OF
- LPN or RN employed by the CSN agency conducts CCA supervision and supervisory visits.
ALL of the following
- Onsite supervisory visits must occur no less frequently than every 60 days to assess quality and safety of CCA services.
- The CCA does not need to be present during the 60-day onsite supervisory visit.
- 60-day supervisory visits must be documented in the member’s medical record and clearly identified as CCA supervisory visit notes; visits may be concurrent with the CSN agency’s recertification of the plan of care.
ALL of the following
- If the supervisor notes an area of concern during a supervisory visit, the supervisor must make another onsite visit to observe and assess the CCA while they are providing CCA services to the member.
- If a deficiency is verified during an onsite visit with the CCA, the CSN agency must provide reeducation and training specific to the deficiency and document satisfactory completion in the CCA’s employment file in accordance with 130 CMR 438.415(D).
ALL of the following
- A 12-month enhanced care evaluation must be conducted by an RN or LPN employed by the CSN agency.
- The evaluation must review member-specific enhanced care tasks, assess the CCA’s proficiency, and any additional training required must be provided and documented to demonstrate continued proficiency in performing the enhanced care tasks.
Coding and Frequency
| No codes listed |
Required Supervisor Actions and Follow-up
Perform follow-up observation, reeducation, and 12-month enhanced care evaluation
If a supervisor observes a concern during a supervisory visit, perform a follow-up onsite observation while the CCA is providing services; if a deficiency is verified, require the CCA to complete reeducation and training and keep documentation of satisfactory completion in the CCA’s employment file per 130 CMR 438.415(D). Also, conduct a 12-month enhanced care evaluation by an RN or LPN and document the evaluation and any additional training demonstrating continued proficiency.
- Follow-up observation: another onsite visit to observe the CCA while providing services is required when concerns are noted.
- Deficiency response: CSN agency must conduct reeducation/training; CCA must complete it.
- Recordkeeping: document satisfactory completion of reeducation/training in the CCA’s employment file in accordance with 130 CMR 438.415(D).
- 12-month evaluation: RN or LPN must perform an enhanced care evaluation of member-specific tasks, evaluate proficiency, provide additional training as needed, and document the evaluation and training.
Use LPNs or RNs as authorized CCA supervisors
Ensure that authorized supervisors for CCA services and supervisory visits may be either licensed practical nurses (LPNs) or registered nurses (RNs) employed by the CSN agency.
- Both LPNs and RNs employed by CSN agencies are authorized to supervise CCA services and conduct CCA supervisory visits.
Key Terms
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