Reimbursable Administrative Days

(A) Administrative days as defined in 130 CMR 415.402 are reimbursable if the following conditions are met: (1) the recipient requires an admission to a hospital or a continued stay in a hospital for reasons other than the need for services that can only be provided in an acute inpatient hospital as defined in 130 CMR 415.402 (see 130 CMR 415.415(B) for examples); and (2) a hospital is making regular efforts to discharge the recipient to the appropriate setting. These efforts must be documented according to the procedures described in 130 CMR 450.205. The regulations covering discharge-planning standards described in 130 CMR 415.419 must be followed, but they do not preclude additional, effective discharge-planning activities. (B) Examples of situations that may require hospital stays at less than a hospital level of care include, but are not limited to, the following. (1) A recipient is awaiting transfer to a chronic disease hospital, rehabilitation hospital, nursing facility, or any other institutional placement. (2) A recipient is awaiting arrangement of home services (nursing, home health aide, durable medical equipment, personal care attendant, therapies, or other community-based services). (3) A recipient is awaiting arrangement of residential, social, psychiatric, or medical services by a public or private agency. (4) A recipient with lead poisoning is awaiting deleading of his or her residence. (5) A recipient is awaiting results of a report of abuse or neglect made to any public agency charged with the investigation of such reports. (6)recipient in the custody of the Department of Social Services is awaiting foster care when other temporary living arrangements are unavailable or inappropriate. (7) A recipient cannot be treated or maintained at home because the primary caregiver is absent due to medical or psychiatric crisis, and a substitute caregiver is not available. (8) A recipient is awaiting a discharge from the hospital and is receiving skilled nursing or other skilled services. Skilled services include, but are not limited to: (a) maintenance of tube feedings; (b) ventilator management; (c) dressings, irrigations, packing, and other wound treatments; (d) routine administration of medications; (e) provision of therapies (respiratory, speech, physical, occupational, etc.); (f) insertion, irrigation, and replacement of catheters; and (g) intravenous, intramuscular, or subcutaneous injections, or intravenous feedings (for example, total parenteral nutrition.) Medical Assistance Program SUBCHAPTER NUMBER AND TITLE 4 PROGRAM REGULATIONS PAGE ACUTE INPATIENT HOSPITAL MANUAL TRANSMITTAL LETTER IH/AC-27 DATE