Massachusetts Skilled Nursing Services Policy Manual

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The Massachusetts Skilled Nursing Services Policy Manual provides a comprehensive framework for operating state-compliant agencies delivering skilled nursing services to individuals in Massachusetts. This manual aligns with the Massachusetts Code of Regulations (105 CMR 150.000 and 130 CMR 630.433), the State Nurse Practice Act (M.G.L. c. 112), Department of Public Health (DPH) standards, and MassHealth requirements to ensure full regulatory compliance and high-quality care delivery.
Key Features of the Manual:
Regulatory Compliance: The manual adheres to state-specific regulations, including 105 CMR (Standards for Long-Term Care Facilities) and 130 CMR (Home- and Community-Based Services Waiver). It ensures providers meet all licensing, certification, and operational standards required for skilled nursing services.
Service Scope: Skilled nursing services include medically necessary care provided by registered nurses (RNs) or licensed practical nurses (LPNs). Services will involve wound care, medication administration, monitoring of chronic conditions, rehabilitation support, and coordination of care plans.
Eligibility Criteria: Skilled nursing services are available to individuals requiring medical care that cannot be provided by non-skilled personnel. 
Conditions of Payment: Payment for skilled nursing services is contingent upon prior authorization by MassHealth or its designee. Services must be included in the participant's individualized service plan (ISP) and adhere to established billing procedures. Temporary exceptions may be authorized to facilitate transitions or stabilize medical conditions.
Operational Standards: Policies include staffing requirements, such as maintaining sufficient numbers of trained nursing personnel to meet resident needs based on acuity and care plans. Providers must ensure compliance with minimum staffing ratios, documentation protocols, and adherence to safety standards.
Nonpayable Services: The manual specifies exclusions such as duplicative nursing services or care provided outside the scope of the State Nurse Practice Act. Only one skilled nursing visit per week is typically covered unless authorized for specific circumstances.
Quality Assurance: Includes robust quality assurance programs, including performance improvement initiatives, regular assessments of care outcomes, and adherence to federal Medicare/Medicaid Conditions of Participation. Maintenance of detailed documentation and conduct ongoing evaluations to ensure safety and quality.
 
This policy manual serves as a guide for agencies seeking licensure or certification to provide skilled nursing services in Massachusetts. It supports the delivery of medically necessary care while ensuring adherence to the state's regulatory framework for long-term care and home- and community-based services (HCBS).