1. (A) Discharge Procedures.

   1. (1) A member shall be discharged by the CSN agency provider under the following conditions:

      1. (a) upon the member’s request;
      2. (b) if the member no longer meets the clinical eligibility for CSN agency services;

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-24

Provider Manual Series (130 CMR 438.000)

Transmittal Letter Date

Continuous Skilled Nursing Agency

Manual

CSN-7 08/30/24

1. (c) if the member selects another service that is duplicative of CSN agency services;
2. (d) if the member transitions to another CSN provider; or
3. (e) if the CSN agency ceases operations.

4. (2) A member may be discharged by the CSN agency provider if the CSN agency cannot safely serve the member in the home due to the member or other persons in member’s home being disruptive, abusive, or uncooperative to the extent that delivery of care is seriously impaired. Prior to discharge the CSN agency must

   1. (a) notify the member, representative, ordering physician, and the MassHealth agency or its designee that a discharge for cause is being considered;
   2. (b) notify the member, representative, ordering physician, and the MassHealth agency or its designee that a discharge is planned within 14 days of the date on the notice to ensure member or provider safety;
   3. (c) make diligent efforts to solve the problem(s) present and document these efforts in the member’s clinical records;
   4. (d) provide the member and/or caregiver contact information for alternative CSN agency providers; and
   5. (e) document the discharge and CSN agency activity related to the discharge in the member’s clinical record.
5. (3) When a CSN agency makes the determination that a member no longer meets the clinical eligibility for CSN agency services and would like to proceed with discharge as described at 130 CMR 438.418(A)(1)(b), the CSN agency must consult with the MassHealth agency or its designee at minimum 14 days prior to discharge planning to allow the MassHealth agency or its designee to perform a reassessment of the member’s medical necessity for CSN services as described at 130 CMR 438.414(A)(7).