1. (A) The facility must establish and maintain a system of recordkeeping that ensures a complete and separate accounting of the PNA funds according to generally accepted accounting principles. The system must prevent any commingling of a member’s PNA funds with facility funds or with the funds of any other person other than another resident of the facility. If the facility does not manage the PNA funds for any member, it is not required to maintain such records.

2. (B) Specific Requirements.

   1. (1) The facility must ensure a separate accounting of each member’s PNA funds, maintain a written record of all financial transactions involving the PNA funds, and allow the member or the member’s authorized or legal representative access to the accounting record.
   2. (2) The bank account statements and the general ledger must be in agreement and reconcilable at all times. All bank statements, canceled checks, and supporting documentation relating to the PNA account must be kept in the facility for no less than required by the recordkeeping requirements at 130 CMR 450.205: Recordkeeping and Disclosure.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-22

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

1. (3) All checks or cash received by the nursing facility on behalf of the member must be deposited into the PNA account no later than 30 days after the receipt of the money by the facility.
2. (4) The facility must maintain for each member with a PNA account a record of receipts and disbursements separate from other members’ records. The facility must clearly label all PNA receipts and disbursements in the general ledger.

3. (5) At a minimum, all receipts and disbursements must be recorded in the ledger as follows:

   Receipts Disbursements

   1. 1. Date of entry 1. Date of entry
   2. 2. Amount 2. Specific description (Avoid
   3. 3. Source “misc.,” “personal needs,” etc.)

   4. 4. Balance 3. Amount

      1. 4. Signature of member or person receiving disbursement
      2. 5. Invoice number or date
4. (6) General ledger records must be updated at least once a month.
5. (7) The facility must ensure that funds are available to members in the form of actual cash or check for no less than ten hours a week and on no less than three days a week. The facility must inform the members and their authorized or legal representatives of the times when they may receive their money.
6. (8) All money disbursed to or on behalf of a member must be at the request of the member or the member’s authorized or legal representative. The nursing facility must not make any disbursements on behalf of a member for a service that is covered by either Medicare or MassHealth.
7. (9) If a facility disburses money to a member by means of a check, or if the member signs petty cash vouchers, the facility does not need to obtain a signature in the ledger.
8. (10) The facility does not need to itemize cash disbursements to members.
9. (11) The facility must provide the member or the member’s authorized or legal representative every three months and upon the member’s request or the member’s authorized or legal representative’s request with an accounting of all financial transactions made on the member’s behalf.

456.605: Petty Cash in the Facility

The facility may, if it chooses, maintain a petty cash fund in order to make direct cash distributions to residents. The total of this petty cash fund must not exceed an amount equal to $5 per member for whom the facility manages a PNA account; however, a maximum of $250 is allowable regardless of the number of residents.

456.606: Assurance of Financial Security

The facility must purchase a surety bond to assure the security of all personal funds of members deposited with the facility. The facility must keep this bond at the facility.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-23

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

456.607: Availability of PNA Records to MassHealth or it’s Designee’s Personnel

All PNA records must be kept in the facility at all times and must be available to MassHealth or its designee’s personnel upon request.

456.608: Member Signature

If the member cannot sign their own name, a staff member or business employee of the facility may sign as witness that the member has received cash from the member’s PNA account.

456.609: Notification of Account Balance

1. (A) The facility must notify each member for whom it has established a PNA account, and their authorized or legal representatives, when the balance reaches a total of $1800, which is $200 less than the maximum countable assets allowed per member. The notification must state that, if the member’s countable assets exceed the maximum allowable amount of $2000, the member may lose MassHealth eligibility.
2. (B) If the member’s balance exceeds the maximum allowable amount, the member may apply the excess to the cost of care in the facility.

456.610: Availability of PNA Records to Members

The facility must, within one working day of a request, allow the member or the member’s authorized or legal representative to examine the PNA records of the member.

456.611: PNA Funds of a Member Transferred to Another Facility

If a member is transferred to another nursing facility, all of the member's funds held in trust by the facility must be sent to the new facility within ten days of the transfer date.

456.612: PNA Funds of a Member Discharged to the Community

If a member has been discharged from the facility to the community, the member must receive their personal ledger or bank book back from the facility and must receive a check for the balance of the member’s PNA account. The amount of the check must reflect both the cash held on behalf of the member by the facility and the bank balance.

456.613: Member is Transferred to a Hospital and Does Not Return to the Facility

If a member is transferred to a hospital and does not return to the facility, the balance of the PNA account must be sent to the member at their new address within ten days after the member leaves the hospital.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-24

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

456.614: Death of a Member

1. (A) Upon the death of a MassHealth member, the nursing facility must

   1. (1) render an accounting of the member’s PNA funds. The funds must remain at the facility for 30 days after the death of a member to allow for the appointment of an administrator or executor of the estate and for the payment of burial expenses; and

   2. (2) notify the next of kin or the member’s authorized or legal representative of any remaining funds, determine whether an executor or administrator has been or will be appointed, and explain to the next of kin or the member’s authorized or legal representative how to obtain the funds from the facility.

      1. (a) If there is an outstanding balance due on a funeral bill, the funeral home may submit an itemized funeral bill to the nursing facility and the nursing facility may pay the bill from the PNA funds.
      2. (b) If an executor or administrator is appointed within 30 days after the death of a member, the facility must send the balance of the PNA account and a final accounting of the member’s account to the administrator or executor of the member's estate. If any payment has been made to the funeral home under 130 CMR 456.614(A)(2)(a), the final accounting must reflect that payment.

2. (B) If any funds remain in the PNA account after 30 days after the death of the member, the facility must

   1. (1) send a check for the balance and a final accounting of the member’s account to MassHealth or its designee;
   2. (2) notify the next of kin or the member’s authorized or legal representative of the amount of the funds, and the address to which they are being sent; and
   3. (3) notify the next of kin or the member’s authorized or legal representative that they may apply for the funds if they are appointed executor or administrator of the member’s estate.
3. (C) A final accounting of the PNA funds must include any transactions that occurred during the three months prior to and the 30 days following the member’s death. If there are no PNA funds, the nursing facility is not required to submit the final accounting; however, the facility must maintain all member records according to 130 CMR 456.604 and 130 CMR 450.205: Recordkeeping and Disclosure.

4. (D) The facility must include with the returned PNA balance and the accounting the following information:

   1. (1) the member's name and MassHealth ID number;
   2. (2) the member’s date of birth and date of death;
   3. (3) the name, address, and relationship of the next of kin or the member’s authorized or legal representative;
   4. (4) the name, address, and MassHealth provider number of the facility; and
   5. (5) the name and address of the funeral director.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-25

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 9/8/25

456.615: Annual Accounting to MassHealth of the PNA Balance

1. (A) An accounting must be made to MassHealth of the balance of each PNA account annually by the deadline specified by EOHHS. If the facility is not a trustee for any member’s money, it must report this fact annually to MassHealth by the deadline specified by EOHHS. The accounting to MassHealth must be submitted in accordance with the requirements established by EOHHS in an administrative bulletin or other written issuance.

2. (B) The accounting must at a minimum consist of the following, as well as any additional information requested by MassHealth:

   1. (1) the member's name;
   2. (2) the member's MassHealth ID number;
   3. (3) the amount of petty cash held in the facility for the member;
   4. (4) the balance held in any individual bank account for the member;
   5. (5) the balance held in the trustee account for the member;
   6. (6) any other money being held by the facility for the member; and
   7. (7) if funds are held in an aggregate trustee bank account, then a copy of the bank statement for that account must be submitted with the accounting.

(130 CMR 456.616 through 456.700 Reserved)

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-26

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

456.701: Notice Requirements for Transfers and Discharges Initiated by a Nursing Facility

1. (A) A resident may be transferred or discharged from a nursing facility only when

   1. (1) the transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the nursing facility;
   2. (2) the transfer or discharge is appropriate because the resident's health has improved sufficiently so that the resident no longer needs the services provided by the nursing facility;
   3. (3) the safety of individuals in the nursing facility is endangered;
   4. (4) the health of individuals in the nursing facility would otherwise be endangered;
   5. (5) the resident has failed, after reasonable and appropriate notice, to pay for (or failed to have MassHealth or Medicare pay for) a stay at the nursing facility; or
   6. (6) the nursing facility ceases to operate.

2. (B) When the facility transfers or discharges a resident under any of the circumstances specified in 130 CMR 456.701(A)(1) through (4), the resident's clinical record must contain documentation to explain the transfer or discharge. The documentation must be made by

   1. (1) the resident's physician or PCP when a transfer or discharge is necessary under 130 CMR 456.701(A)(1) or (2); and
   2. (2) a physician or PCP when the transfer or discharge is necessary under 130 CMR 456.701(A)(3) or (4).

3. (C) Before a nursing facility discharges or transfers any resident, the nursing facility must hand deliver to the resident and mail to the authorized or legal representative a notice written in 12- point or larger type that contains, in a language the member understands, the following:

   1. (1) the action to be taken by the nursing facility;
   2. (2) the specific reason or reasons for the discharge or transfer;
   3. (3) the effective date of the discharge or transfer;
   4. (4) the location to which the resident is to be discharged or transferred;

   5. (5) a statement informing the resident of their right to request a hearing before MassHealth’s Board of Hearings, including

      1. (a) the address to send a request for a hearing;
      2. (b) the time frame for requesting a hearing as provided for under 130 CMR 456.702; and
      3. (c) the effect of requesting a hearing as provided for under 130 CMR 456.704;
   6. (6) the name, address, and telephone number of the local long-term-care ombudsman office;
   7. (7) for nursing facility residents with developmental disabilities, the address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. s. 6041 et seq.);
   8. (8) for nursing facility residents who are mentally ill, the mailing address, and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the Protection and Advocacy for Mentally Ill Individuals Act (42 U.S.C. s. 10801 et seq.);

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-27

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

1. (9) a statement that all residents may seek legal assistance and that free legal assistance may be available through their local legal services office. The notice should contain the address of the nearest legal services office; and
2. (10) the name of a person at the nursing facility who can answer any questions the resident has about the notice and who will be available to assist the resident in filing an appeal.
3. (D) A nursing facility’s failure to readmit a resident following a medical leave of absence will be deemed a transfer or discharge (depending on the resident’s circumstances). The nursing facility must issue notice to the resident and an authorized or legal representative in accordance with 130 CMR 456.701(A) through (C), 456.702(C), 130 CMR 610.028: Notice Requirements Regarding Actions Initiated by a Nursing Facility, and 610.029: Time Frames for Notices Issued by Nursing Facilities.

456.702: Time Frames for Notices Issued by Nursing Facilities

1. (A) The notice of discharge or transfer required under 130 CMR 456.701(C) must be made by the nursing facility at least 30 days prior to the date the resident is to be discharged or transferred, except as provided for under 130 CMR 456.702(B).

2. (B) In lieu of the 30-day notice requirement set forth in 130 CMR 456.702(A), the notice of discharge or transfer required under 130 CMR 456.701(C) must be made as soon as practicable before the discharge or transfer in any of the following circumstances.

   1. (1) The health or safety of individuals in the nursing facility would be endangered and this is documented in the resident's record by a physician or PCP.
   2. (2) The resident's health improves sufficiently to allow a more immediate transfer or discharge and the resident's attending physician or PCP documents this in the resident's record.
   3. (3) An immediate transfer or discharge is required by the resident's urgent medical needs and this is documented in the medical record by the resident's attending physician or PCP.
   4. (4) The resident has not resided in the nursing facility for 30 days immediately prior to receipt of the notice.
3. (C) When the transfer or discharge is the result of a nursing facility’s failure to readmit a resident following hospitalization or other medical leave of absence, the notice of transfer or discharge, including that which is required under 130 CMR 456.429, must comply with the requirements set forth in 130 CMR 456.701 and must be provided to the resident and an authorized or legal representative at the time the nursing facility determines that it will not readmit the resident.

456.703: Time Frames for Submission of Requests for Fair Hearings

1. (A) Appeals of discharges and transfers will be handled by MassHealth’s Board of Hearings
2. (BOH) pursuant to 130 CMR 610.000: MassHealth: Fair Hearing Rules.
3. (B) Time Limitation on the Right of Appeal. The date of request for a fair hearing is the date on which BOH receives such a request in writing. BOH must receive the request for a fair hearing within the following time limits:

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-28

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

1. (1) 30 days after a resident receives written notice of a discharge or transfer pursuant to 130 CMR 456.702(A); or (2) 30 days after a nursing facility initiates a transfer or discharge or fails to readmit and fails to give the resident notice; or
2. (3) 14 days after a resident receives written notice of an emergency discharge or emergency transfer pursuant to 130 CMR 456.702(B); or
3. (4) 14 days after a resident receives written notice of a transfer or discharge that is the result of a nursing facility’s failure to readmit a resident following hospitalization or other medical leave of absence.

456.704: Stay of a Transfer or Discharge from a Nursing Facility Pending Appeal

1. (A) If a request for a hearing regarding a discharge or transfer from a nursing facility is received by the Board of Hearings during the notice period described in 130 CMR 456.703(B)(1), the nursing facility must stay the planned discharge or transfer until 30 days after the decision is rendered. While this stay is in effect, the resident must not be transferred or discharged from the nursing facility.
2. (B) If a hearing is requested, in accordance with 130 CMR 456.703(B)(2), and the request is received prior to the discharge or transfer, then the nursing facility must stay the planned transfer or discharge until five days after the hearing decision.
3. (C) If the request for a hearing, in accordance with 130 CMR 456.703(B)(2), is received within the applicable time frame but after the transfer, the nursing facility must, upon receipt of an appeal decision favorable to the resident, promptly readmit the resident to the next available bed in the facility.
4. (D) In the case of a transfer or discharge that is the result of a nursing facility’s failure to readmit a resident following hospitalization or other medical leave of absence, if the request for a hearing is received within the applicable time period as described in 130 CMR 456.703(B)(3), the nursing facility must, upon receipt of an appeal decision favorable to the resident, promptly readmit the resident to the next available bed in the facility.

456.705: Scheduling by the Board of Hearings

1. (A) Upon receipt of a request for a fair hearing, BOH will register the appeal, set a date for a hearing, and so notify the appellant and the nursing facility.
2. (B) In accordance with 130 CMR 610.015(F): Expedited Appeals for Discharges and Transfers from a Nursing Facility Under 130 CMR 610.029(B) or (C), a resident may request an expedited appeal when a nursing facility notifies a resident of a discharge or transfer under the time frames in 130 CMR 456.702(B) or (C).
3. (C) BOH will designate a site for the hearing accessible to the appellant. If the appellant has a handicap or disability that reasonably prevents their appearance at the designated site, they may request that the hearing be held by telephone or video conferencing, or at an accessible location.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Program Regulations

4-29

Provider Manual Series (130 CMR 456.000)

Transmittal Letter Date

Nursing Facility Manual

NF-64 09/08/25

REGULATORY AUTHORITY

130 CMR 456.000: M.G.L. c. 118E, §§ 7 and 12.