Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 425.000 - Psychiatric Inpatient Hospital Services
Section 425.406 - Admission Criteria for Members Younger than 21 Years Old
Universal Citation: 130 MA Code of Regs 130.425
Current through Register 1531, September 27, 2024
(A) A screening team must screen a member younger than 21 years old prior to admission to a psychiatric inpatient hospital or prior to conversion to MassHealth, as defined in 130 CMR 425.402. The screening team will determine and certify whether the admission is medically necessary.
(B) To demonstrate the necessity of a psychiatric inpatient hospital admission for a member younger than 21 years old, the following conditions must be met:
(1) the member must have mental
illness;
(2) the member must meet
one or more of the following criteria:
(a) be
dangerous to himself or herself;
(b) be dangerous to others; or
(c) be unable to care for himself or herself;
and
(3) the
moment-to-moment medical observation or clinical management required cannot be
provided in a less restrictive setting.
(C) Court-ordered admissions are exempt from the admission criteria stated in 130 CMR 425.406(A) and (B).
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