Current through Register 1531, September 27, 2024
(A)
Discharge Procedures.
(1) A member shall be discharged by the home
health agency provider under the following conditions:
(a) upon the member's request;
(b) if the member ceases to benefit from home
health services;
(c) if the member
no longer meets the clinical eligibility for home health services;
(d) if the member selects another MassHealth
service that is duplicative of the home health the member is receiving,
including MassHealth services that provide assistance with personal
care;
(e) if the member transitions
completely to another home health provider or CSN provider or combination of
providers; or
(f) if the home
health agency ceases operations.
(2) A member may be discharged by the home
health agency provider if the home health agency cannot safely serve the member
in the home in accordance with
42 CFR
484.50(d)(5).
(B)
Safe Discharge
Planning When Other Community Services Needed. Home health
agencies must
(1) begin to develop a discharge
and transition plan for members during the admission process/start of
care;
(2) coordinate community
long-term services that are most appropriate for the member's needs at
discharge and refer to other community services accordingly;
(3) provide assistance to the member in
identifying and locating other community long-term services;
(4) document coordination with community
resources and keep documentation of referrals to other community resources in
the member's record;
(5) coordinate
the discharge and transition with the member, member's family/caregiver, and
the staff of the provider, program or agency to which the member is to be
transferred; and
(6) make best
efforts to ensure the continuity of care until the new service has
commenced.
(C)
Discharge Planning Requirements for Members over 21 Years of Age
Utilizing Home Health Aide Services for ADL Supports Only. In
addition to complying with the discharge requirements established in 130 CMR
403.422(A) and 130 CMR 403.422(B), home health agencies providing home health
aide services for ADL supports only must also
(1) complete a Member Connection Form as
designated by the MassHealth agency, and send to the member's waiver program
(as applicable) or to the member's local ASAP for evaluation or options
counseling;
(2) establish an
individualized discharge plan at the start of services. The member's discharge
plan must be reviewed and updated as the member's discharge from home health
services approaches; and
(3) assist
the member in locating and securing long-term personal care services, if
needed.
(D)
Members 60 Years of Age or Older. Home health agencies
must complete a Member Connection Form for those MassHealth members 60 years of
age or older within 15 days of a planned discharge from home health services or
whenever the agency determines that the MassHealth member could benefit from
ASAP services. See651 CMR 14.00: Aging Services Access
Points, for a description and definition of ASAP. Home health agencies
shall forward the completed referral form to the ASAP serving the area in which
the member resides and must keep a copy of the completed ASAP referral form in
the member's record.
(E)
Transfers of Members to Alternate Home Health
Agencies.
(1) When a member
transfers from one home health agency to an alternate home health agency, the
transferring home health agency must inform MassHealth within ten days of the
transfer. When informing the MassHealth agency of the transfer, the
transferring home health agency must include the following information in the
form and format required by the MassHealth agency and maintain this information
in the member's record:
(a) Member
Name;
(b) Member ID;
(c) Member care plan;
(d) Receiving home health agency;
(e) Date of transfer; and
(f) Reason for transfer.
(2) The receiving home health agency must
complete an initial member assessment and must obtain prior authorization. The
new agency must collaborate with the transferring agency in regards to the
prior authorization timeline, number of visits completed, and must ensure that
there are no overlapping dates of service.
