Review of Need for Continuing Care in a Nursing Facility

(A) When a nursing facility determines during any of the quarterly reviews required by the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) and implemented by regulations at 42 CFR 483.20 that the member has discharge potential, then the facility must notify MassHealth or its agent. (B) When the nursing facility is notified by MassHealth or its agent that the member no longer meets the conditions for payment criteria under 130 CMR 456.408(A), the nursing facility must initiate the nursing facility’s discharge plan for the member in collaboration with MassHealth or its agent. All discharges must be in accordance with the federal requirements found at 42 CFR 483.15(c) and with 130 CMR 456.701 through 456.704.