Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 435.000 - Chronic Disease And Rehabilitation Inpatient Hospital Services
Section 435.413 - Nonreimbursable Administrative Days

Universal Citation: 130 MA Code of Regs 130.435

Current through Register 1531, September 27, 2024

Administrative days after the 45-day period described in 130 CMR 435.407G) are not reimbursable when:

(A) a hospitalized member is awaiting services or an appropriate placement is currently available, but the hospital has not transferred or discharged the member because of the hospital's administrative or operational delays;

(B) the MassHealth agency or its agent determines that appropriate noninstitutional or institutional placement or services are available within a reasonable distance of the member's noninstitutional (customary) residence and the member, the member's family, or any person legally responsible for the member refuses the placement or services; or

(C) the MassHealth agency or its agent determines that appropriate noninstitutional or institutional placement or services are available within a reasonable distance of the member's noninstitutional (customary) residence and advises the hospital of the determination, and the hospital or the physician refuses or neglects to discharge the member.

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