§ 4J — Multi–Disciplinary Medical Review Team; certification of nursing home care eligibility

Section 4J. No individual from birth to age twenty-two shall be admitted to a nursing home unless, prior to such admission, application has been made by or on behalf of such individual for certification by the Department's Multi–Disciplinary Medical Review Team of eligibility for nursing home care in the nursing home to which the individual seeks admission. A majority of the members of the medical review team shall consist of currently licensed health and allied health professionals who are not employees of the commonwealth and who have been engaged full time in primary care practice in their respective areas of specialization within the two years immediately prior to the commencement of service on the medical review team. Such other individuals as the department may, from time to time, deem appropriate may also serve on the medical review team. No person shall serve on the medical review team for a period exceeding two years. The medical review team shall, in consultation with the individual's referring physician, discharge planners at the individual's referring health care institution, the individual's parents, next-of-kin or guardians, the individual's primary care physician, and, to the extent deemed necessary, the departments of mental health, children and families, welfare, education, department of early education and care and the commission for the blind, assess the medical, nursing, developmental and social needs of such individuals. In the event that the medical review team fails to render a decision on certification within ten business days after submission of any application for certification, the individual may, with the approval of his or her referring physician, be admitted to the nursing home. In reviewing applications for certification of eligibility, the medical review team shall not deny certification on the basis of sex, nationality, religious affiliation, residency or domicile, source of payment or reimbursement, type of illness or injury sustained or suffered by the individual, or, if the nursing home to which the individual seeks admission is able to provide requisite care, the ability of any other health care facility, wherever located, to provide such care. In the event that the medical review team denies certification, it shall recommend an alternative care program appropriate to each individual's needs.