Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Psychiatric Inpatient Hospital Manual

PIH-23 06/16/17

4. PROGRAM REGULATIONS

425.401: Introduction ....................................................................................................................... 4-1 425.402: Definitions ........................................................................................................................ 4-1 425.403: Eligible Members .............................................................................................................. 4-3 425.404: Exclusion of MassHealth Managed Care Members ........................................................... 4-3 425.405: Provider Eligibility ............................................................................................................ 4-3 425.406: Admission Criteria for Members Younger than 21 Years of Age ..................................... 4-4 425.407: Admission Criteria for Members 21 Years of Age or Older ............................................. 4-4 425.408: Payment Methodology ...................................................................................................... 4-5 425.409: Nonreimbursable Services ................................................................................................ 4-5 425.410: Service Limitations ........................................................................................................... 4-6 425.411: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services ..................... 4-6 425.412: Child and Adolescent Needs and Strengths (CANS) Certification .................................... 4-6 425.413: Child and Adolescent Needs and Strengths (CANS) Data Reporting ................................ 4-6 (130 CMR 425.414 Reserved) 425.415: Notification and Right of Appeal ..................................................................................... 4-7 425.416: Treatment Plan ................................................................................................................. 4-7 425.417: Conditions for Continuing Care ....................................................................................... 4-8 425.418: Discharge Planning .......................................................................................................... 4-8 (130 CMR 425.419 Reserved) 425.420 Reimbursable Administrative Days ................................................................................. 4-10 425.421 Nonreimbursable Administrative Days ............................................................................ 4-10 (130 CMR 425.422 Reserved) 425.423: Recordkeeping Requirements .......................................................................................... 4-12 425.424: Confidentiality ................................................................................................................. 4-13

456.601: Personal Needs Allowance Account ................................................................................. 4-15 456.602: Management of the PNA Account .................................................................................... 4-15 456.603: Autonomy of PNA Accounts ............................................................................................ 4-15 456.604: PNA Recordkeeping Requirements .................................................................................. 4-15 456.605: Petty Cash in the Facility .................................................................................................. 4-16 456.606: Assurance of Financial Security........................................................................................ 4-16 456.607: Availability of the PNA Records to Division Personnel ................................................... 4-17 456.608: Member Signature ............................................................................................................ 4-17 456.609: Notification of Account Balance ....................................................................................... 4-17 456.610: Availability of the PNA Records to Members .................................................................. 4-17 456.611: PNA Funds of a Member Transferred to Another Facility ................................................ 4-17 456.612: PNA Funds of a Member Discharged to the Community ................................................. 4-17 456.613: Member Is Transferred to a Hospital and Does Not Return to the Facility ....................... 4-18 456.614: Death of a Member ........................................................................................................... 4-18 456.615: Annual Accounting to the Division of the PNA Balance .................................................. 4-19

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents vi

Provider Manual Series

Transmittal Letter Date

Psychiatric Inpatient Hospital Manual

PIH-23 06/16/17

Appendix A. Directory ................................................................................................................. A-1

Appendix C. Third-Party-Liability Codes ..................................................................................... C-1

Appendix D. Supplemental Instructions for Claims with Other Insurance .................................... D-1

Appendix T. CMSP-Covered Codes ............................................................................................. T-1

Appendix U. DPH-Designated Serious Reportable Events That Are Not Provider

Preventable Conditions ........................................................................................... U-1

Appendix V. MassHealth Billing Instructions for Provider Preventable Conditions .................... V-1

Appendix W. EPSDT Services Medical and Dental Protocols and Periodicity Schedules ............ W-1

Appendix X. Family Assistance Copayments and Deductibles .................................................... X-1

Appendix Y. EVS Codes and Messages ....................................................................................... Y-1

Appendix Z. EPSDT/PPHSD Screening Services Codes .............................................................. Z-1

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series (130 CMR 425.000)

Transmittal Letter Date

Psychiatric Inpatient Hospital Manual

PIH-23 06/16/17