Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Acute Inpatient Hospital Manual

AIH-52 01/02/15

4. Program Regulations

415.401: Introduction ........................................................................................................... 4-1 415.402: Definitions ............................................................................................................ 4-1 415.403: Eligible Members ................................................................................................. 4-4 415.404: Provider Eligibility ................................................................................................ 4-4 415.405: Utilization Management Program ........................................................................ 4-4 415.406: Payment Methodology .......................................................................................... 4-4a 415.407: Covered Administrative Days: Payment Methodology ....................................... 4-4a 415.408: Nonpayable Services ............................................................................................ 4-4a 415.409: Sterilization Services: Introduction ..................................................................... 4-4a 415.410: Sterilization Services: Informed Consent ............................................................. 4-4b 415.411: Sterilization Services: Consent Form Requirements ............................................ 4-5 415.412: Early and Periodic Screening, Diagnosis and Treatment (EDPST) Services ........ 4-6 415.413: Hysterectomy Services .......................................................................................... 4-6 415.414: Utilization Review ................................................................................................. 4-6a 415.415: Reimbursable Administrative Days ....................................................................... 4-7 415.416: Nonreimbursable Administrative Days ................................................................ 4-8 415.417: Notification of Denial, Reconsideration, and Appeals ......................................... 4-8 415.418: Accident Victims .................................................................................................. 4-9 415.419: Discharge-Planning Standards ............................................................................. 4-9 415.420: Child and Adolescent Needs and Strengths (CANS) Certification ....................... 4-12 415.421: Child and Adolescent Needs and Strengths (CANS) Data Reporting ................... 4-12 (130 CMR 415.422 through 415.424 Reserved) 415.425: Medical Leave of Absence: Responsibilities of the Hospital for the Transfer

of a Recipient Who Is a Resident of a Nursing Facility ................................... 4-13

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series (130 CMR 415.000)

Transmittal Letter Date

Acute Inpatient Hospital Manual

AIH-52 01/02/15