Nonreimbursable Administrative Days

Administrative days are not reimbursable when (A) an appropriate placement is currently available, but the hospital has not transferred or discharged the member because of the hospital's administrative or operational delays; (B) the MassHealth agency or its agent determines that appropriate noninstitutional or institutional placement or services are available within a reasonable distance of the member's noninstitutional (customary) residence and the member, the member's family, or any person legally responsible for the member refuses the placement or services; or (C) the MassHealth agency or its agent determines that appropriate noninstitutional or institutional placement or services are available within a reasonable distance of the member's noninstitutional (customary) residence and advises the hospital of the determination, and the hospital or the physician refuses or neglects to discharge the member. (130 CMR 425.422 Reserved)