Facility did not provide appellant with sufficient preparation and orientation to ensure a safe and orderly discharge from the facility to another safe and appropriate place; facility did not designate a discharge location; clinical record lacks progress note from physician to document he no longer needs the facility’s services; no progress note by physician documenting appellant’s danger to safety of other residents.
Category: Paul C. Moore
- Issue is whether MassHealth was correct in determining the number of CSN hours and PCA hours that are medically necessary for the appellant. MassHealth ordered to remove aid pending and rescind notice. Then send notice of the authorized hours that appellant can receive.
Trust assets are countable; after date of notice of MassHealth ineligibility and prior to appeal hearing appellant transferred assets out of trust for a number of purposes, including to fund a pre-paid irrevocable burial arrangement, and to fund a pooled trust account in her name; transfers made to pooled trust were permissible; transfer to purchase prepaid funeral and burial was also permissible; however, 60-day clock to revise trust to comply with criteria of pooled trust begins when MassHealth issues notice of ineligibility; insufficient information for hearing officer to determine whether additional amounts transferred out of trust were permissible.
Hearing officer agreed facility had sufficient grounds to discharge; appellant smoked without supervision in facility including in her room; danger to other residents; discharge notice met regulatory requirements; however, there was a lack of the required documentation by a physician.
Nursing facility did not meet its burden to support its discharge notice; nursing facility did not appear at hearing; nursing facility did not show good cause regarding failure to appear.
Community spouse refused to provide information about her assets; appellant has assigned to MassHealth right to support from the community spouse.
Appellant must have “sufficient preparation and orientation to ensure a safe and orderly transfer to another safe and appropriate place”; the record strongly suggests that the appellant’s previous place of residence, shared with her son, is not a “safe and appropriate place.”
Appellant-wife submitted no evidence to substantiate her claim that she has unusual medical expenses constituting the “exceptional circumstances” that would justify an increase in the SMND when calculating the appellant-husband’s PPA.