Code of Massachusetts Regulations
940 CMR - OFFICE OF THE ATTORNEY GENERAL
Title 940 CMR 4.00 - Long Term Care Facilities
Section 4.05 - Charges

Universal Citation: 940 MA Code of Regs 940.4

Current through Register 1531, September 27, 2024

It shall be an unfair or deceptive act or practice, in violation of M.G.L. c. 93A, § 2, for a licensee or administrator:

(1) to fail or refuse to inform a resident, both orally and in writing, in clear and conspicuous type, in a language the resident understands, and to fail or refuse to inform his/her legal representative or next of kin at the time of admission to the facility, and at least every year thereafter during the resident's stay, of any of the following:

(a) services available in the facility and charges for those services, including any charges for services not covered under Medicare and Medicaid or by the facility's per diem rate;

(b) the existing basic per diem rate, applicable to the resident, charged by the licensee and all the services included in that rate;

(c) except in the case of private residents, the services available to the resident that are covered by the Social Security Act, but that are not included in the basic per diem rate (e.g., telephone, television, personal clothing, etc.); however, such disclosures shall be made to each private resident at the time when he/she ceases to be a private resident;

(2) to fail or refuse to inform each resident, both orally and in writing, in clear and conspicuous type, in a language the resident understands, and to fail or refuse to inform his/her legal representative or next of kin when changes are made to the items and services specified in 940 CMR 4.05(1);

(3) to impose, seek to impose, or collect a charge in addition to the basic per diem rate for services included in the basic per diem rate;

(4) to charge, or collect payment from, a resident, his/her legal representative or next of kin for services covered by the Social Security Act for that resident;

(5) to fail or refuse to provide all the services included in the basic per diem rate, except those services not medically required by the resident which are included in the basic per diem rate;

(6) to charge for services not actually rendered to a resident, except that a licensee or administrator may charge for medical services included in the basic per diem rate that are not medically required by the resident during a particular billing period; or to fail to return to the resident, his/her legal representative, or, when appropriate, the resident's estate, any advance payments made for services not rendered as a result of the resident's death or transfer from the facility; however, the facility may require a private resident or a third party acting on his/her behalf to give two days advance notice of a voluntary transfer;

(7) to provide and charge for additional services, except for medical services required in an emergency, which are not included in the per diem rate, without prior written request for those services by the resident or his/her legal representative or next of kin;

(8) to fail or refuse to permit a resident, his/her legal representative or next of kin to receive, upon request, a reasonable explanation of the charge[s] or bill[s] for the resident's care in the facility, regardless of the source of payment;

(9) in the case of a private resident, to increase the basic per diem rate without written notification to the resident and his/her legal representative of the higher rate; such notification shall be given not less than 60 days prior to the effective date of the higher rate so as to insure an orderly transfer of the resident if the resident cannot afford the higher rate.

(10) to demand that any private resident pay, at or prior to his/her admission to the facility, any security deposit that is greater than the total of one month's per diem charges or to fail or refuse:

(a) to give the resident, his/her legal representative or next of kin a signed receipt indicating the amount of the security deposit, the date received, and the employee or agent of the facility who received it;

(b) to place said deposit in an interest-bearing escrow account in a bank located within the Commonwealth under such terms that place such deposit beyond the claim of creditors of the facility;

(c) to provide the resident, his/her legal representative or next of kin with the name of the bank and the account number where the security deposit is located;

(d) to preserve the security deposit intact unless the resident fails to pay for services which he/she requested, which were provided by the facility, and which remained unpaid after having been invoiced in accordance with the facility's regular procedure for two successive months; however, a licensee or administrator may apply the security deposit to outstanding charges for a resident who has spent down his/her assets and is otherwise eligible for Medicaid without invoicing for two successive months;

(e) to return said deposit, plus accrued interest, to the resident, or his/her legal representative or estate within 30 days of said resident's discharge, transfer or death, unless deductions, duly accounted for, have been made in accordance with 940 CMR 4.05(10)(e);

(f) to return said deposit, plus accrued interest, to the resident, or his/her legal representative or estate, within 30 days of receipt of notice of the resident's eligibility for Medicaid, provided that the resident is eligible for Medicaid coverage of long-term care services.

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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