Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 456.000 - Long Term Care Services
Section 456.423 - Patient-paid Amount
Universal Citation: 130 MA Code of Regs 130.456
Current through Register 1531, September 27, 2024
(A) If the MassHealth agency determines that a member is financially eligible for nursing facility services, the MassHealth agency will issue a notice that contains the effective date of coverage and the patient-paid amount.
(B) The patient-paid amount is applied to the nursing facility's per diem rate for the member. If the member is discharged from the facility or transferred to another nursing facility, the patient-paid amount is applied up to the last full day of the member's stay and the nursing facility must do the following.
(1) If the member is transferred from one
facility to another, the first facility must notify the second facility of the
disposition of the patient-paid amount. If the first facility receives a
patient-paid amount in excess of the per diem rate for the
number of days the member was in the facility, then the first facility must
issue a check to the second facility for the amount of the balance. The first
facility must submit a claim for the member's stay up to, but not including,
the day of transfer, even if the claim will not result in any payment by
MassHealth to the facility. Submission of this claim is necessary to ensure
that the second facility is correctly paid.
(2) If the member is discharged to the
community and the facility received a patient-paid amount in excess of the
per diem rate for the number of days the member was in the
facility, then the facility must return the balance of the patient-paid amount
to the member.
(3) If the patient
dies and the facility has received a patient-paid amount in excess of the
per diem rate for the number of days the member was in the
facility, then the facility must deposit the balance into the member's personal
needs account or return the balance to the party who paid the patient-paid
amount. See
130
CMR 456.614 for the disposition of the
personal needs allowance account when a member dies.
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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