Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 456.000 - Long Term Care Services › Section 456.402 - Definitions

Current through Register 1525, July 5, 2024
Board of Hearings (BOH)
. The unit
				within MassHealth that is responsible for administering the fair-hearing
				process under
				130 CMR
				610.000:
MassHealth: Fair Hearing
				Rules
and claims for adjudication hearings under
				130
				CMR 450.241:
Hearings: Claim for an
				Adjudicatory Hearing
, including hearings about transfers and
				discharges of residents by nursing facilities.
Department of Developmental Services
				(DDS)
. An agency of the Commonwealth of Massachusetts, established
				under M.G.L. c. 19B. DDS also serves as the Preadmission and Resident Review
				(PASRR) authority for intellectual disabilities and developmental
				disabilities.
Department of Mental Health (DMH)
. An
				agency of the Commonwealth of Massachusetts, established under M.G.L. c. 19.
				DMH also serves as the PASRR authority for serious mental illness.
Department of Public Health (DPH)
. An
				agency of the Commonwealth of Massachusetts, established under M.G.L. c.
				17.
Discharge
. Movement of a resident from
				a nursing facility to a noninstitutional setting resulting in the cessation of
				the discharging nursing facility's legal responsibility for the care of that
				individual. A nursing facility's failure to resume care of or to readmit an
				individual following hospitalization or other medical leave of absence is
				considered a discharge.
DPH Multi-disciplinary Medical Review Team
				(MRT)
. A multi-disciplinary interagency team, established pursuant
				to M.G.L. c. 111 § 4J, and authorized to make determinations about nursing
				facility eligibility for individuals younger than 22 years old.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Fair Hearing
. An administrative,
				adjudicatory proceeding conducted pursuant to
				130 CMR
				610.000:
MassHealth: Fair Hearing
				Rules
to determine the legal rights, duties, benefits, or privileges
				of applicants, members, or residents.
Hospital
. A facility that is licensed
				or operated as a hospital by DPH or DMH, and provides diagnosis and treatment
				on an inpatient basis for patients who have any variety of medical
				conditions.
Length of Stay
. The duration of a
				member's inpatient hospital stay at a Medicare hospital level of care during a
				medical leave of absence.
MassHealth
. The medical assistance and
				benefit programs administered by EOHHS pursuant to Title XIX of the Social
				Security Act (42 U.S.C.
				1396a
et seq
.), Title XXI of
				the Social Security Act (42
				U.S.C. 1397aa
et seq
.),
				M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for
				medical services to eligible members.
MassHealth Agency
. The Executive
				Office of Health and Human Services, which is the state that is designated
				under the state plan as the Single State Agency responsible for the
				administration of MassHealth, in accordance with the provisions of M.G.L. c.
				118E.
Medical Leave of Absence (MLOA)
. An
				inpatient hospital stay for an individual who is a resident of a nursing
				facility. Medical leave of absence also includes an observation stay.
Medicare Hospital Level of Care
. a
				level of care that meets all criteria, as determined by the Centers for
				Medicare & Medicaid Services or its designee, for Medicare payment for
				hospital care.
Member
. A person determined by
				MassHealth to be eligible for MassHealth.
Mobility System
. A manual or power
				wheelchair or other wheeled device, such as a scooter, including a base, a
				seating system, its components, accessories, and modifications.
Non-medical Leave of Absence (NMLOA)
.
				A temporary absence from the nursing facility for non-medical reasons subject
				to the requirements in
				130
				CMR 456.431 and
				456.432
Nursing Facility (NF)
. An institution
				or a distinct part of an institution that meets the provider eligibility and
				certification requirements of
				130
				CMR 456.404 or
				456.405.
Observation Stay
. Outpatient hospital
				services provided anywhere in an acute inpatient hospital to evaluate a
				member's condition and determine the need for admission to an acute inpatient
				hospital. Observation services are provided under order of a physician or PCP,
				consistent with the use of a bed and intermittent monitoring by professional
				licensed clinical staff, and may be provided for more than 24 hours.
Patient-paid Amount (PPA)
. The portion
				of monthly income that a member in a nursing facility must contribute to the
				cost of care.
Personal Needs Allowance (PNA)
. The
				designated portion of monthly income that a member in a facility is allowed to
				keep for personal expenses.
Personal Needs Allowance Account
. An
				account or accounts administered by a nursing facility on behalf of a member.
				The account may be used to deposit the PNA and any other money, such as a gift,
				belonging to the member.
Primary Care Provider (PCP)
. Any of
				the following: a physician, a physician assistant, or a nurse practitioner
				operating within the scope of their licensure and supervision requirements, as
				applicable.
Resident
. An individual receiving care
				in a nursing facility regardless of whether the individual is a MassHealth
				member.
Transfer
. Movement of a resident
				from:
(1) a Medicaid- or
			 Medicare-certified bed to a noncertified bed;
(2) a Medicaid-certified bed to a
			 Medicare-certified bed;
(3) a
			 Medicare-certified bed to a MassHealth-certified bed;
(4) one nursing facility to another nursing
			 facility; or
(5) a nursing facility
			 to a hospital, or any other institutional setting.
A nursing facility's failure to readmit a resident following
				hospitalization or other medical leave of absence, resulting in the resident
				being moved to another institutional setting, is also a transfer. Movement of a
				resident within the same facility from one certified bed to another bed with
				the same certification is not a transfer.
Working Days
. Monday through Friday
				except for legal holidays.