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Digitized by the Internet Archive 2014 in https://archive.org/details/medicalassistanc03mass MASS. DEPARTMENT OF PUBLIC WELFARE Trans, by MA Letter 2jj MEDICAL ASSISTANCE PROGRAM CHRONIC DISEASE AND REHABILITATION Chapter 435 7/1/82 HOSPITAL SERVICES Page 435.000 CMR 435.000 MEDICAL ASSISTANCE PROGRAM: CHRONIC DISEASE AND REHABILITATION HOSPITAL SERVICES 106 CMR 453.000 is superseded by a new chapter 106 CMR 435.000: Section (106 CMR 435.001 through 435.400 Reserved) 435.401 Introduction 435.402 Definitions 435.403 Eligible Recipients 435.404 Provider Eligibility 435.405 Per Diem Rates 435.406 Billing Exceptions to the Per Diem Rate 435.407 Payment 435.408 Nonreimbursable Services 435.409 Level-of-Care Criteria for Chronic Disease Hospitals 435.410 Level-of-Care Criteria for Rehabilitation Hospitals 435.411 Utilization Review 435.412 Reimbursable Administrative Days 435.413 Nonreimbursable Administrative Days 435.414 Notification of Denial 435.415 Appeals 435.416 Discharge-Planning Standards ) I 106 CMR: DEPARTMENT OF PUBLIC WELFARE Trans, by MA Letter 235 MEDICAL ASSISTANCE PROGRAM CHRONIC DISEASE AND REHABILITATION Chapter 435 Rev. 7/1/82 HOSPITAL SERVICES Page 435.401 (106 CMR 435.001 through 435.400 Reserved) 435.401: Introduction This Chapter 435.000 contains regulations governing par- ticipation in the Massachusetts Medical Assistance Program by chronic disease and rehabilitation hospitals or units within hospitals performing these services. The word "hospital" in these regulations refers specifically to a chronic disease and rehabilitation hospital or unit only, unless the context clearly indicates otherwise. 435.402: Definitions The following terms used in these regulations shall have the meanings given in this section unless the context clearly requires a different meaning. — (A) Administrative Day a day of inpatient hospitalization on which a lower-than-hospital level of care is determined appropriate by the Department or its agent, but on which an appropriate placement is not available. — (B) Agent the Professional Standards Review Organization (PSRO) coordinator, the hospital's utilization review coordinator, or other party designated by the Department to act on its behalf in instances when the Department itself does not perform the required function. — (C) Child Abuse a nonaccidental physical injury to a child inflicted by another person that causes or creates a substan- tial risk of death or protracted impairment of any bodily organ or function; or the commission of sex offenses against a child, as defined in the criminal laws of Massachusetts. — (D) Child Neglect failure by a financially able caretaker responsible for a child to provide adequate food, clothing, shelter, education, medical care, proper supervision, or guardianship that results in the child's present avoidable suffering. The caretaker shall be considered capable of pro- viding adequate food, clothing, shelter, education, medical care, proper supervision, and guardianship if he is financially able to do so or is offered other reasonable means to do so. — (E) Chronic Disease Hospital a facility or a unit within a facility devoted to the care and treatment of patients whose condition is expected to continue for an extended period and requires at least weekly physician visits in addition to ( . 106 CMR: DEPARTMENT OF PUBLIC WELFARE Trans, by MA Letter 230 MEDICAL ASSISTANCE PROGRAM CHRONIC DISEASE AND REHABILITATION Chapter 435 Rev. 2/1/82 HOSPITAL SERVICES Page 435.401 (106 CMR 435.001 through 435.400 Reserved) 435.401: Introduction This Chapter 435.000 contains regulations governing par- ticipation in the Massachusetts Medical Assistance Program by chronic disease and rehabilitation hospitals or units within hospitals performing these services. The word "hospital" in these regulations refers specifically to a chronic disease and rehabilitation hospital or unit only, unless the context clearly indicates otherwise. 435.402: Definitions The following terms used in these regulations shall have the meanings given in this section unless the context clearly requires a different meaning. — (A) Administrative Day a day of inpatient hospitalization on which a lower-than-hospital level of care is determined appropriate by the Department or its agent, but on which an appropriate placement is not available. — (B) Agent the Professional Standards Review Organization (PSRO) coordinator, the hospital's utilization review coordinator, or other party designated by the Department to act on its behalf in instances when the Department itself does not perform the required function. — (C) Child Abuse a nonaccidental physical injury to a child inflicted by another person that causes or creates a substan- tial risk of death or protracted impairment of any bodily organ or function; or the commission of sex offenses against a child, as defined in the criminal laws of Massachusetts. — (D) Child Neglect failure by a financially able caretaker responsible for a child to provide adequate food, clothing, shelter, education, medical care, proper supervision, or guardianship that results in the child's present avoidable suffering. The caretaker shall be considered capable of pro- viding adequate food, clothing, shelter, education, medical care, proper supervision, and guardianship if he is financially able to do so or is offered other reasonable means to do so — (E) Chronic Disease Hospital a facility or a unit within a facility devoted to the care and treatment of patients whose condition is expected to continue for an extended period and requires at least weekly physician visits in addition to