Instructions for Use

This register defines the rules that set the qualifications a client's care team must hold beyond what their role requires. Each rule carries a stable identifier (RULE-NNN), matches one fact about the client, and names the qualifications it requires by their codes in the qualification type register (REG-006). It serves the qualified match: a person may be placed with a client only when they hold every qualification their role requires and every qualification the client's rules require (POL-010).

The three client facts. A rule matches one of three facts, each recorded where it arises:

• Payer. The client's coverage, recorded at authorization intake: the organization whose program covers the client, named by its identifier in REG-002. Where a program's authorizations and claims are handled by a managing organization, the managing organization is recorded as a separate fact and never changes the client's rules.
• Site. The kind of setting where the client receives services, recorded on the client's record.
• Plan. A requirement the supervising BCBA documents in the client's treatment plan, such as a risk of serious harm documented in the behavior intervention plan or crisis management plan, which requires restraint training of everyone placed with the client.

How the required set is read. A client's required set is every qualification required by every rule that matches the client's payer, site, and plan, together with any qualification added by hand on the client's record. A qualification added by hand never removes one a rule requires.

What the register holds. A rule prints here only where a written source supplies the requirement: a payer's specification, a regulation, or a Company policy. A payer or setting that has supplied no requirement has no row. The rule register names qualifications only; a condition that is not a qualification, such as the bar on placing a person who has a personal relationship with the client outside the services, is applied in scheduling under its governing document.

How to use this register:

1. When a payer, a setting, or a policy changes what a client's care team must hold, revise the rule in the same cycle, citing the source.
2. When a program moves to a new managing organization, no rule changes: the rule follows the client's coverage.
3. Retired rules keep their identifier with a Retired status. Identifiers are never reused.
4. The school setting rule applies only where the Company supplies staff to a district or host-program school setting. It is not a condition of employment with the Company.

Rules

Maintained by: Compliance Officer

One row per rule, grouped by the client fact it matches. The population names the roles the requirement applies to; a rule with no population applies to everyone placed with the client.

Payer

Site

Plan

RULE-001 matches every client whose coverage is a MassHealth program (ORG-001), whichever organization manages the program's authorizations and claims. The school setting is a district or host-program school premises where the Company supplies staff. RULE-003 matches a client whose behavior intervention plan or crisis management plan, written by the supervising BCBA, documents a risk of serious harm to the client or to others.

Form Realization and Fallback

This is the canonical, authoritative version of Form REG-007, maintained in the compliance documentation. It defines the columns and vocabulary that any realization of the client qualification rule register must capture.

Field contract. Each row defines: the identifier (RULE-NNN, stable for the life of the rule, never reused); the client fact it matches, given by its heading (payer, site, or plan); the value it matches (an organization identifier from REG-002 for a payer rule, a setting kind for a site rule, a key naming a requirement documented in the client's treatment plan for a plan rule, such as safety for a risk of serious harm documented in the behavior intervention plan or crisis management plan); the roles it applies to; the qualification codes it requires from REG-006; the basis; the governing source; and the profile row it derives from, where one exists.

Basis. Law, Payer, Program, or Policy, with the same meaning as in the compliance obligations register (REG-005). The basis is provenance and never changes how a rule applies.

Derived from. Empty in this version. Where the row is later derived from a shared base register, the column names the base row.

Division of labor with the compliance management system. This register defines the rules. The compliance management system holds each client's payer, site, and plan facts and any qualification added by hand, derives the client's required set from the rules at each read, and shows a derived qualification with the rule that requires it. It ingests this register at each approved revision, matching rows by identifier. A rule retired here stops applying there. Conflicts resolve in favor of this register.

The documented register here is always available as a fallback. It can be printed and used on paper whenever the electronic system is unavailable.

Retention

The register itself is a controlled document. Its revision history is its record. Scheduling records that show a placement was checked against a client's required set retain with the client's record under the Company's records practices.