Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 27.00 - Interagency Review of Complex Cases
Section 27.07 - Interagency Review Process

Universal Citation: 101 MA Code of Regs 101.27

Current through Register 1531, September 27, 2024

(1) The IRT Review.

(a) The IRT review will include, without limit, review of the referral submission, input from the individual, parent(s) or guardian(s), review of materials relevant to the individual's case, including, as applicable, medical records, education records and evaluations, any other relevant assessments of the subject individual, and any report regarding the subject individual issued from the area or regional level of state agencies involved.

(b) During the review process, the IRT must provide the individual who is the subject of an IRT review, their legal custodian, and any attorney representing the individual or the individual's parent or guardian, as applicable, with regular updates and opportunities to provide input and make decisions as the IRT deems appropriate

(c) The IRT may also accept or request input from additional sources in its review of the individual's complex case, including from
1. the individual's custodian, in situations where the custodian is not the parent or guardian;

2. relevant service providers;

3. an attorney representing the individual or the individual's parent or guardian;

4. a representative from the individual's health plan; and

5. representatives of juvenile probation or juvenile courts, if relevant to the case.

(d) The IRT may order expedited eligibility determinations by a state agency or an extended evaluation at a special education residential school, if the IRT deems such updated information is necessary for the IRT to make determinations about the current service needs of an individual under IRT review.

(e) The secretary of EOHHS, in consultation with the commissioner of DESE, may authorize expenditures from the Interagency Services Reserve Fund in accordance with the procedures in 101 CMR 27.08, including paying the costs of an evaluation ordered by the IRT, as necessary to complete the IRT review.

(2) Initial IRT Meeting.

(a) Timing of Initial Meeting.
1. The co-chairs will convene the IRT no later than five business days after the referral date, except as provided in 101 CMR 27.07(2)(a)2.

2. If the individual who is the subject of the complex case is waiting in a hospital emergency department or medical bed, or at home, for not less than five days, to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services, the co-chairs must convene the initial IRT meeting no later than one business day after the referral date.

(b) IRT Meeting Participants. The co-chairs will invite the following IRT members to the IRT meeting:
1. the IRT representatives from the school district or districts responsible for any aspect of the individual's education, as determined by the commissioner of DESE;

2. the IRT representatives from agencies involved in or necessary for the complex case review, as determined by the co-chairs;

3. the individual who is the subject of the IRT meeting and/or their parent or guardian, if appropriate; and

4. a representative of the OCA.

(c) Notification of IRT Meeting(s). While maintaining confidentiality pursuant to 101 CMR 27.11, the co-chairs will notify all IRT meeting participants of
1. the date, time, and location of the IRT meeting;

2. the reason the referral source gave for referring the individual's case; and

3. the individual's name, address, date of birth, and the school district(s) involved in the individual's case.

(d) Meeting Protocol. The co-chairs will lead the IRT meeting and may impose guidelines for the meeting(s).

(3) Limits on IRT Authority.

(a) The IRT does not have the authority to plan or determine services the state agency would not be required to provide for an individual under its applicable statutes or regulations or to otherwise alter agency policy and practices relating to eligibility for and delivery of services, including activities related to the maintenance of waiting lists.

(b) The IRT does not have the authority to make medical necessity determinations for MassHealth-covered services, including hospital level of care for admission to a medical or inpatient psychiatric facility, the DMH Adolescent Continuing Care Unit, an Intensive Residential Treatment Program (IRTP), or at a psychiatric inpatient developmentally disabled unit.

(c) The IRT does not have the authority to plan or determine the special education services to which an individual may be entitled under IDEA, 20 U.S.C. §§ 1400 et seq., and M.G.L. c. 71B, or to supersede, amend, modify, or otherwise affect the authority of the IEP Team or the BSEA to mediate or adjudicate special education disputes as provided in § 1415 of the IDEA, M.G.L. c. 71B, § 3, and 603 CMR 28.08(3).

(d)101 CMR 27.00 does not affect DESE's established regulations, policies, or procedures for assigning to school districts programmatic and fiscal responsibility for individual students' special education programs. DESE issues such assignments of responsibility under federal and state special education laws and regulations including, but not limited to, 603 CMR 28.10: School District Responsibility. The IRT's determinations of fiscal or programmatic responsibility relate only to the responsibilities of state agencies.

(4) The IRT Determination.

(a) The IRT will issue a consensus determination after receiving and reviewing all necessary and updated information regarding the individual's service needs and eligibility decisions. The IRT's determination must include findings as to the following:
1. the services currently in place for the individual;

2. additional services that are needed to meet the current needs of the individual;

3. which agencies will provide said services, including location or placement where appropriate and ongoing case management services; and

4. which agencies have fiscal responsibilities to pay for such services.

(b) The IRT will record its determinations in a written report. The co-chairs will provide the IRT report to the parent(s), guardian(s), legal custodian or, if authorized by law, the individual, as well as to the representatives of the state agencies that participated in the review.

(c) Time Requirements to Complete the IRT Review.
1. The IRT must complete its review of the individual's case and make its determinations within 30 business days of the referral date, unless an expedited IRT review is required as set forth in 101 CMR 27.07(4)(c)2.

2. An expedited determination is required if the individual whose case is under IRT review is waiting to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services for not less than five days in a hospital emergency department medical bed, or, if at home, there is a need for urgent action as determined by the IRT. An expedited review must be completed within five business days of the referral date.

(5) Additional Processes When IRT Consensus Cannot Be Reached.

(a) If the IRT does not come to a consensus determination on a complex case, in whole or in part, the case will be referred to the co-chairs for determination. The co-chairs will issue a determination consistent with 101 CMR 27.07(4), which will be the final determination of the IRT.

(b) If the IRT cannot come to resolution regarding which state agency or agencies have fiscal responsibility for the services or placements determined necessary by the IRT, the co-chairs, EOHHS and DESE, may authorize the expenditure of funds pursuant to M.G.L. c. 29, § 2TTTTT for the costs of needed services or placements. EOHHS and DESE may seek reimbursement from any state agency, school district, or other entity that is subsequently found to have been responsible for the provision of services during the time period that EOHHS and DESE assumed fiscal responsibility.

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