Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 415.000 - Acute Inpatient Hospital Services
Section 415.415 - Reimbursable Administrative Days
Universal Citation: 130 MA Code of Regs 130.415
Current through Register 1531, September 27, 2024
(A) Administrative days as defined in 130 CMR 415.402 are reimbursable if the following conditions are met:
(1) the recipient requires an admission to a
hospital or a continued stay in a hospital for reasons other than the need for
services that can only be provided in an acute inpatient hospital as defined in
130 CMR 415.402
(see 130 CMR 415.415(B) for examples); and
(2) a hospital is making regular efforts to
discharge the recipient to the appropriate setting. These efforts must be
documented according to the procedures described in
130 CMR
450.205: Recordkeeping and
Disclosure. The regulations covering discharge-planning standards
described in
130 CMR
415.419 must be followed, but they do not
preclude additional, effective discharge-planning activities.
(B) Examples of situations that may require hospital stays at less than a hospital level of care include, but are not limited to, the following.
(1) A
recipient is awaiting transfer to a chronic disease hospital, rehabilitation
hospital, nursing facility, or any other institutional placement.
(2) A recipient is awaiting arrangement of
home services (nursing, home health aide, durable medical equipment, personal
care attendant, therapies, or other community-based services).
(3) A recipient is awaiting arrangement of
residential, social, psychiatric, or medical services by a public or private
agency.
(4) A recipient with lead
poisoning is awaiting deleading of his or her residence.
(5) A recipient is awaiting results of a
report of abuse or neglect made to any public agency charged with the
investigation of such reports.
(6)
recipient in the custody of the Department of Social Services is awaiting
foster care when other temporary living arrangements are unavailable or
inappropriate.
(7) A recipient
cannot be treated or maintained at home because the primary caregiver is absent
due to medical or psychiatric crisis, and a substitute caregiver is not
available.
(8) A recipient is
awaiting a discharge from the hospital and is receiving skilled nursing or
other skilled services. Skilled services include, but are not limited to:
(a) maintenance of tube feedings;
(b) ventilator management;
(c) dressings, irrigations, packing, and
other wound treatments;
(d) routine
administration of medications;
(e)
provision of therapies (respiratory, speech, physical, occupational,
etc.);
(f) insertion, irrigation,
and replacement of catheters; and
(g) intravenous, intramuscular, or
subcutaneous injections, or intravenous feedings (for example, total parenteral
nutrition.)
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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