Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth

MassHealth
Acute Inpatient Hospital Bulletin 132
October 2006

	TO:	Acute Inpatient Hospitals Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director  

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


Background	This bulletin is to inform you of the change in the duration 
		of short-term nursing facility stays that acute inpatient 
		hospitals are allowed to authorize for MassHealth members or 
		applicants, effective November 1, 2006.

		Massachusetts acute inpatient hospitals are responsible for 
		reviewing clinical eligibility of certain MassHealth members or 
		applicants as specified in MassHealth Acute Inpatient Hospital 
		Bulletin 128 (May 2004) for nursing facility services.  The hospital 
		determines if the individual meets the MassHealth clinical criteria 
		for nursing facility coverage and completes the Nursing Facility 
		Clinical Eligibility notification.  Copies of the form are available 
		on the MassHealth Web site at www.mass.gov/masshealth.  Click on the 
		Information for MassHealth Providers link, and then on the link for 
		MassHealth Provider Forms.  Scroll down to the section containing forms 
		for Long Term Care–Nursing Facility and click on the Acute Inpatient 
		Hospital Admission form.
	
Short-Term	Acute inpatient hospitals may issue a 30-day short-term nursing facility 
Approvals	approvalMassHealth members who meet MassHealth standards of clinical 
		eligibility fornursing facility coverage.  This replaces the previous
		45-day approval.
	
Long-Term	The acute inpatient hospital may approve a long-term nursing facility coverage
Approvals	only for MassHealth members or applicants as specified in Acute Inpatient 
		Hospital Bulletin 128 who have one or more of the following conditions:
		1.	mid-to-late-stage Alzheimer’s disease or dementia;
		2.	end-stage terminal illness;
		3.	comatose, unresponsive state; or
		4.	complex, multisystem failure resulting in permanent dependence in all 
		activities of daily living.
		For all other members, only a short-term approval may be issued.  This process 
		has not been changed.  The OBRA/PAS requirements for mental illness, mental 
		retardation, and developmental disability are not affected by this change.
 	
(continued on next page)
MassHealth
Acute Inpatient Hospital Bulletin 132
October 2006
Page 2


Questions	If you have any questions about the information in this bulletin, 
		please contact MassHealth Customer Service at 1-800-841-2900, 
		e-mail your inquiry to providersupport@mahealth.net, or fax your 
		inquiry to 617-988-8974.