Referrals and Admissions

Except for Agencies of the Commonwealth facilities accepting civil commitments pursuant to M.G.L. c. 123, § 35, the Licensed or Approved Provider must comply with the following: (A) Admission and Eligibility Criteria. (1) The Licensed or Approved Provider shall establish written admission eligibility criteria and procedures, provided such criteria and procedures do not impose any restrictions that would be reasonably conceived as a barrier to treatment access, including discrimination against patients and residents with public health insurance. (2) Such criteria and procedures shall describe the Licensed or Approved Provider's method of determining which service type and program are suitable for the prospective patient or resident. Such eligibility criteria shall not establish a category of automatic exclusion that is defined by a history of criminal conviction or type of primary substance used, or mental health diagnosis, or prescribed medication including FDA-approved medications for the treatment of addiction. (4) The Licensed or Approved Provider shall make the criteria and procedures available to prospective patients or residents upon the patient's or resident's application for admission. (5) Admission eligibility criteria shall be posted in a conspicuous public area. (B) The Licensed or Approved Provider shall comply with all applicable state and federal antidiscrimination laws such that the Provider evaluates all potential admissions regardless of the source of payment, and may not deny admission on the basis of race, color, ethnicity, religious creed, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, ancestry or status as a veteran, except that Licensed or Approved Providers providing a service designed for a specific population, e.g., civil commitments, women or adolescents, may limit admissions to members of that population. (C) Where consistent with the program of services, admission eligibility criteria shall specifically address priority populations defined by the Department including, but not limited to, Medicaid patients or residents. (D) Licensed and Approved Providers shall directly connect individuals who do not meet eligibility requirements or who are inappropriate for the Licensed or Approved Provider's services to the appropriate level of care. The Licensed or Approved Provider shall collaborate, as appropriate, with care managers, case managers, health plans, and any others necessary to obtain an appropriate placement for the patient. Additionally, the Licensed or Approved provider must maintain a log of applications denied, reasons for denial and direct referrals made, and shall make this documentation available to the Department for inspection. (E) The Licensed or Approved Provider may not deny admission to an individual solely because the individual uses medication prescribed by a practitioner outside the Licensed or Approved Provider's service or facility, including any FDA-approved medication for addiction treatment or medications used to treat mental health disorders. (1) Programs may not require a designated amount of medication for admission. (a) Programs must accept prospective patients or residents who arrive with medication(s) remaining on current prescription(s), and facilitate the ability to refill such prescription(s). (b) Programs cannot deny admission to prospective patients or residents who lack current prescription refills and must work with such patients or residents to coordinate medication refills. (c) Programs cannot deny admission based upon the types of medication a patient or resident is prescribed. (2) Programs may not deny admission to or exclude prospective patients or residents who lack an official state identification card. (F) Licensed or Approved Providers may deny admission to individuals who refuse to provide information necessary to complete an assessment and treatment plan, provided the Licensed or Approved Provider shall maintain a log of applications denied, reasons for denial and referrals made, and shall make this documentation available to the Department for inspection. (G) The Licensed or Approved Provider may not deny readmission to any person solely because that person (1) withdrew from treatment against clinical advice on a prior occasion; (2) relapsed from earlier treatment; or (3) filed a grievance regarding an action or decision of the Licensed or Approved Provider.