Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Continuous Skilled Nursing Agency

Manual

CSN-7 08/30/24

4. Program Regulations

130 CMR 438.000: Continuous Skilled Nursing Agency

438.401: Introduction .............................................................................................................. 4-1 438.402: Definitions ................................................................................................................ 4-1 438.403: Eligible Members ..................................................................................................... 4-4 438.404: Provider Eligibility ................................................................................................... 4-5 (130 CMR 438.405 through 438.407 Reserved) 438.408: Services Provided under Contract ............................................................................ 4-7 438.409: Administrative Requirements ................................................................................... 4-7 438.410: Clinical Eligibility Criteria for CSN Agency Services ............................................. 4-8 438.411: Prior Authorization Requirements ............................................................................ 4-9 438.412: Notice of Prior Authorization and Clinical Eligibility Determination ................... 4-11 438.413: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services ........ 4-11 438.414: Administrative Care Management .......................................................................... 4-12 438.415: Provider Responsibilities ........................................................................................ 4-13 438.416: Plan of Care Requirements ..................................................................................... 4-20 438.417: Quality Management, Utilization Review, and Reporting Requirements .............. 4-23 438.418: Transfers and Discharge Planning .......................................................................... 4-23 438.419: Conditions of Payment ........................................................................................... 4-24 438.420: Maximum Allowable Fees ..................................................................................... 4-25 438.421: Denial of Services and Administrative Review ...................................................... 4-25 438.422: Prohibited Marketing Activities ............................................................................. 4-26 438.423: Providing Continuous Skilled Nursing Agency Services out of State…………… 4-26

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series (130 CMR 438.000)

Transmittal Letter Date

Continuous Skilled Nursing Agency

Manual

CSN-7 08/30/24