Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 435.000 - Chronic Disease And Rehabilitation Inpatient Hospital Services
Section 435.411 - Utilization Review
Universal Citation: 130 MA Code of Regs 130.435
Current through Register 1531, September 27, 2024
(A) The hospital must determine the medical or administrative necessity of each continued inpatient hospital stay of a member in accordance with the level-of-care criteria in 130 CMR 435.409 and 435.410. For those members requiring a less-than-hospital level of care, the hospital must determine the appropriate care in accordance with the MassHealth agency's medical eligibility criteria in 130 CMR 456.000: Long Term Care Services.
(B) The MassHealth agency may designate an agent to determine the medical or administrative necessity of each inpatient hospital stay.
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