Authority

The authority for 130 CMR 610.000 is set out in 42 CFR 431.200 et seq., M.G.L. c. 30A, c. 118E, §§ 12, 20, 47, and 48, and 801 CMR 1.03(4). Pursuant to M.G.L. c. 118E, § 48, the Board of Hearings (BOH) has exclusive jurisdiction to hear appeals relating to the programs administered by the MassHealth agency; provided, however, that for certain appeals by an integrated care organization (ICO) or senior care organization (SCO) enrollee concerning covered benefits, the Centers for Medicare & Medicaid Services (CMS) Independent Review Entity (IRE) also has jurisdiction. Pursuant to 42 U.S.C. 1396r(e)(7) and 42 CFR 483.204, the BOH has authority to hear appeals of PASRR determinations. BOH has authority to hear financial eligibility appeals, clinical eligibility appeals, and service plan appeals for the following 1915(c) home- and community-based services waivers: Traumatic Brain Injury (TBI), Acquired Brain Injury – Nonresidential Habilitation (ABI-N), Acquired Brain Injury – Residential Habilitation (ABI-RH), Moving Forward Plan – Community Living (MFP-CL), and Moving Forward Plan – Residential Supports (MFP-RS). BOH has authority to hear financial eligibility appeals and clinical eligibility appeals of the following 1915(c) home- and community-based services waiver: Frail Elder. BOH has authority to hear the financial eligibility appeals of the following 1915(c) home- and community-based services waivers: Young Children with Autism, Persons with an Intellectual Disability – Intensive Supports, Persons with an Intellectual Disability – Community Living, and Persons with an Intellectual Disability – Adult Supports.