Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 438.000 - Continuous Skilled Nursing Agency
Section 438.418 - Transfers and Discharge Planning
Universal Citation: 130 MA Code of Regs 130.438
Current through Register 1531, September 27, 2024
(A) Discharge Procedures.
(1) A member shall be discharged by the CSN
agency provider under the following conditions:
(a) upon the member's request;
(b) if the member no longer meets the
clinical eligibility for CSN agency services;
(c) if the member selects another service
that is duplicative of CSN agency services;
(d) if the member transitions to another CSN
provider; or
(e) if the CSN agency
ceases operations.
(2) A
member may be discharged by the CSN agency provider if the CSN agency cannot
safely serve the member in the home due to the member or other persons in
member's home being disruptive, abusive, or uncooperative to the extent that
delivery of care is seriously impaired. Prior to discharge the CSN agency must
(a) notify the member, representative,
ordering physician, and the MassHealth agency or its designee that a discharge
for cause is being considered;
(b)
notify the member, representative, ordering physician, and the MassHealth
agency or its designee that a discharge is planned within 14 days of the date
on the notice to ensure member or provider safety;
(c) make diligent efforts to solve the
problem(s) present and document these efforts in the member's clinical
records;
(d) provide the member
and/or caregiver contact information for alternative CSN agency providers;
and
(e) document the discharge and
CSN agency activity related to the discharge in the member's clinical
record.
(3) When a CSN
agency makes the determination that a member no longer meets the clinical
eligibility for CSN agency services and would like to proceed with discharge as
described at
130
CMR 438.418(A)(1)(b), the
CSN agency must consult with the MassHealth agency or its designee at minimum
14 days prior to discharge planning to allow the MassHealth agency or its
designee to perform a reassessment of the member's medical necessity for CSN
services as described at
130
CMR 438.414(A)(7).
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