CCA supervision and 60-day onsite visit requirements

Allow LPNs and RNs employed by the CSN agency to supervise CCA services and conduct supervisory visits. Make an onsite supervisory visit to the member's home at least every 60 days to assess the quality and safety of CCA services; the CCA need not be present. Document each visit in the member's medical record and clearly identify notes as CCA supervisory visit notes. 60-day visits may coincide with plan-of-care recertification.

• Supervisors permitted: LPNs and RNs employed by the CSN agency.
• Minimum frequency: onsite visit no less frequently than every 60 days.
• CCA presence: CCA does not need to be present during 60-day supervisory visits.
• Documentation: visits must be documented in the member's medical record and clearly identified using CCA supervisory visit notes.
• Timing: visits may be concurrent with CSN agency plan-of-care recertification.

Deficiency observation, remediation, and 12-month evaluation requirements

If a supervisor observes concerns during a supervisory visit, the supervisor must perform an additional onsite observation while the CCA is providing services. If a deficiency is verified during that onsite visit, the CSN agency must provide reeducation and training and document satisfactory completion in the CCA's employment file in accordance with 130 CMR 438.415(D). Also conduct and document a 12-month enhanced care evaluation by an RN or LPN and any additional training to demonstrate continued proficiency.

• If area of concern noted: make another onsite visit to observe the CCA while providing services.
• If deficiency verified: conduct reeducation and training specific to the deficiency and maintain documentation of satisfactory completion in the CCA's employment file per 130 CMR 438.415(D).
• Annual evaluation: conduct a 12-month enhanced care evaluation by an RN or LPN that reviews member-specific enhanced care tasks, assesses CCA proficiency, and documents any additional training.