Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 164.000 - Licensure of Substance Abuse Treatment Programs
Part ONE - LICENSING AND APPROVAL PROCEDURES AND REQUIREMENTS
Substance Abuse Treatment Program Requirements: All Licensees
Section 164.070 - Referrals and Admissions

Universal Citation: 105 CMR 164.000 MA Code of Regs 164.070

Current through Register 1531, September 27, 2024

(A) Admission and Eligibility Criteria.

(1) The Licensed or Approved Provider shall establish written admission eligibility criteria and procedures, provided such criteria and procedures do not impose any restrictions that act as a barrier to treatment access including, but not limited to, discrimination against patients and residents with public health insurance.

(2) Such criteria and procedures shall describe the Licensed or Approved Provider's method of determining, for each prospective patient or resident, whether the Licensed or Approved Provider's services and program are suitable for the prospective patient or resident.

(3) Such eligibility criteria shall not establish a category of automatic exclusion that is defined by a history of criminal conviction or type of primary substance used, mental health diagnosis, or prescribed medication including FDA-approved medications for the treatment of addiction.

(4) The Licensed or Approved Provider shall make the criteria and procedures available to prospective patients or residents upon the patient's or resident's application for admission.

(5) Admission eligibility criteria shall be posted in a conspicuous, public area.

(B) The Licensed or Approved Provider shall comply with all applicable state and federal antidiscrimination laws such that the Provider equally evaluates all potential admissions regardless of the source of payment, and may not deny admission on the basis of disability, race, color, ethnicity, religious creed, national origin, sex, sexual orientation, gender identity, age, genetic information, ancestry, or status as a veteran, except that Licensed or Approved Providers providing a service designed for a specific population, e.g., women or adolescents, may limit admissions to members of that population.

(C) Where consistent with the program of services, admission eligibility criteria shall specifically address priority populations defined by the Department including, but not limited to, Medicaid patients or residents.

(D) The Licensed or Approved Provider shall gather and record all pertinent information needed to evaluate eligibility and service need, and to complete the Department's information system form(s).

(E) Licensed and Approved Providers shall directly connect individuals who do not meet eligibility requirements or who are inappropriate for the Licensed or Approved Provider's services to the appropriate level of care. The Licensed or Approved Provider shall collaborate, as appropriate, with care managers, case managers, health plans, and any others necessary to obtain an appropriate placement for the patient. Additionally, the Licensed or Approved provider must maintain a log of applications denied, reasons for denial and direct referrals made, and shall make this documentation available to the Department for inspection.

(F) Upon admission into treatment, or as soon as the patient or resident is medically cleared, the Licensed or Approved Provider shall obtain and make a part of the patient or resident record:

(1) a consent to treatment form signed by the patient or resident;

(2) name and contact information of a person to contact on patient's or resident's behalf in an emergency, including patient's or resident's consent to such contact. Refusal to provide an emergency contact shall be documented in the patient's or resident's record;

(3) name of patient's or resident's health insurance carrier;

(4) documentation of information provided to the patient or resident in accordance with 105 CMR 164.070(D), including patient's or resident's signed receipt of such information; and

(5) Documentation of patient or resident consent to provide treatment information to the patient or resident's primary care provider or release information to the receiving provider prior to or upon patient transfer. In the event the patient or resident refuses such consent, the Licensed or Approved Provider shall document such refusal in the patient's or resident's record.

(G) The Licensed or Approved Provider may not deny admission to an individual solely because the individual uses medication prescribed by a practitioner outside the Licensed or Approved Provider's service or facility, including any FDA-approved medication for addiction treatment and any FDA-approved medications used to treat mental health conditions.

(1) Programs may not require a designated amount of medication for admission.

(a) Programs must accept prospective patients or residents who arrive with medication(s) remaining on current prescription(s), and facilitate the ability to refill such prescription(s).

(b) Programs cannot deny admission to prospective patients or residents who lack current prescription refills and must work with such patients or residents to coordinate medication refills.

(2) Programs may not deny admission to or exclude prospective patients or residents who lack an official state identification card.

(H) Licensed or Approved Providers may deny admission to individuals who refuse to provide information necessary to complete an assessment and treatment plan, provided the Licensed or Approved Provider shall maintain a log of applications denied, reasons for denial and referrals made, and shall make this documentation available to the Department for inspection.

(I) The Licensed or Approved Provider may not deny readmission to any person solely because that person

(1) withdrew from treatment against clinical advice on a prior occasion;

(2) relapsed from earlier treatment; or

(3) filed a grievance regarding an action or decision of the Licensed or Approved Provider.

(J) The Licensed or Approved Provider shall not admit patients or residents in excess of the number of beds approved by the Department and listed on the License or Certificate of Approval document.

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