Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Acute Inpatient Hospital Bulletin 115
August 1999

TO:      Acute Inpatient Hospitals Participating in MassHealth

FROM:      Mark E. Reynolds, Acting Commissioner

RE:      Revisions to the Notification of Clinical Eligibility for Nursing Facility Services

Introduction                      This bulletin provides you with a copy of the newly revised acute hospital nursing facility notification form.  There are two changes to the notification, the length of short-term approval and the PAS/OBRA section.

Background                       All Massachusetts acute inpatient hospitals are responsible for determining the clinical eligibility of MassHealth members or applicants for nursing facility services according to the Division’s acute inpatient hospital regulations (130 CMR 415.000.)  The hospital determines if the applicant or member meets the Division’s clinical criteria for payment of nursing facility services and completes the nursing facility notification.

The approval process has been simplified.  Approvals will be for either up to 90 days or for more than 90 days.  The signed notification form and the assessment form are sent to the local aging services access point
(ASAP) for processing.

Duration                            All MassHealth applicants or members who meet the Division’s standards
of Approvals                      for payment of nursing facility services will receive a 90-day approval, unless one or more of the following conditions are present:
1.  mid-late stage Alzheimer’s disease or dementia;
2.  end-stage terminal illness;
3.  comatose, unresponsive state; and
4.  complex multisystem failure resulting in permanent dependence in all activities of daily living.
For members or applicants with such diagnoses the clinical approval is for over 90 days.

MassHealth
Acute Inpatient Hospital
Bulletin 115
August 1999
Page 2

Federal                              Although the forms have been revised, the PAS/OBRA process for mental
Requirements                    illness, mental retardation, and developmental disability has not changed. A PAS/OBRA referral is not required if the member is being admitted to the nursing facility to receive care for the same condition for which he or she received hospital care and the member’s attending physician certifies before admission to the facility that the individual is expected to require less than 30 days of nursing facility services.

Effective Date                    These procedural changes are effective September 1, 1999.

Supplies                            You may create your own supply of this form by photocopying it or you may send or fax a written request to the following address or fax number.

Unisys
ATTN: Forms Distribution
P.O. Box 9101
Somerville, MA  02145
Fax:  (617) 576-4087

Questions                         If you have any questions about the information in this bulletin, please contact the Unisys Provider Services Department at (617) 628-4141 or 1-800-325-5231.