Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 27.00 - Interagency Review of Complex Cases
Section 27.06 - Eligibility for Review

Universal Citation: 101 MA Code of Regs 101.27

Current through Register 1531, September 27, 2024

(1) An individual's case is eligible for review by the IRT if

(a) the individual presents a complex case as defined in 101 CMR 27.03, as determined by the co-chairs;

(b) the case was referred by a party who may refer such cases, consistent with 101 CMR 27.05(1);

(c) the documents and information required in 101 CMR 27.05(2) have been submitted to the co-chairs; and

(d) the individual is domiciled in the Commonwealth of Massachusetts.

(2) An individual's case is ineligible for review by the IRT if

(a) the individual has an appeal pending with an EOHHS state agency, a mediation or hearing pending with the BSEA (see 603 CMR 28.08(3)), or a court case, and the subject of such appeal, mediation, hearing, or court case is substantially related to the reason that the individual's case is being referred for review by an IRT, as determined by the co-chairs at their discretion. Once such appeal, mediation, hearing, or court case is completed, the individual's case may again be referred for review; or

(b) the individual's case is not eligible, under 101 CMR 27.06(1), including if the case is not determined to be a complex case as defined in 101 CMR 27.03. Consistent with the definition in 101 CMR 27.03, an individual's case is not a complex case and therefore ineligible for IRT review if
1. the individual is deemed to meet hospital level of care requiring admission to an acute care hospital or inpatient psychiatric facility inclusive of the DMH Adolescent Continuing Care Unit, an Intensive Residential Treatment Program (IRTP), or at a psychiatric inpatient developmentally disabled unit; or

2. there is agreement as to the services or placement necessary for the individual, including agreement as to which entity is responsible for payment, and the individual has been on the waiting list for such services or placement for less than 60 days.

(3) If the co-chairs determine based upon the referral submission that consensus or resolution may be possible at the regional level or that regional representatives have not yet been engaged, the co-chairs may refer the individual's case to the regional representatives of an interagency team currently involved in the individual's case, or which represents the region responsible or likely responsible for the individual, for investigation and resolution. If that regional team is unable to resolve the case within 20 business days, the regional team will submit the case back to the IRT co-chairs to determine eligibility for IRT review, unless the parties involved including the individual or the person legally authorized to consent on behalf of the individual, agree otherwise.

(4) The co-chairs will notify the legal custodian, or the individual if 18 years of age or older or otherwise authorized by law, in writing whether such individual's case is eligible for review by the IRT and, if applicable, will include any reasons for ineligibility. Such notification will also be provided to the referral source, if different, and if there is a valid consent for the referral source.

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