130 C.M.R. 414.401 – Introduction

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

Provider Manual Series (130 CMR 414.000)

Transmittal Letter Date

Independent Nurse Manual

IN-30 08/30/24

4. Program Regulations

130 CMR 414.000: Independent Nurse

414.401: Introduction ................................................................................................................ 4-1 414.402: Definitions .................................................................................................................. 4-1 414.403: Eligible Members ....................................................................................................... 4-3 414.404: Provider Eligibility ..................................................................................................... 4-3 414.405: Provider Responsibilities ............................................................................................ 4-4 (130 CMR 414.406 through 414.407 Reserved 414.408: Continuous Skilled Nursing Services ......................................................................... 4-5 414.409: Conditions of Payment ............................................................................................... 4-5 414.410: Multiple-patient Care ................................................................................................. 4-7 414.411: Administrative Care Management .............................................................................. 4-7 414.412: Plan of Care ................................................................................................................ 4-9 414.413: Prior Authorization Requirements ........................................................................... 4-10 414.414: Notice of Approval or Denial of Prior Authorization ............................................... 4-12 414.415: Early and Periodic Screening, Diagnostic and Treatment Services .......................... 4-13 414.416: Overtime ................................................................................................................... 4-13 414.417: Recordkeeping Requirement and Utilization Review .............................................. 4-13 414.418: Maximum Allowable Fees ....................................................................................... 4-15 414.419: Denial of Services and Administrative Review ....................................................... 4-15 414.420: Prohibited Marketing Activities ................................................................................ 4-16 414.421: Providing Continuous Skilled Nursing Services out of State .................................... 4-16