The Medical Review Team:
Approval for Placement of Children
and Young Adults Up to Age 22
The Massachusetts Medical Review Team (MRT) was established to ensure that all children and young adults under age 22 for whom placement in any skilled care facility was sought are placed appropriately. Responsibility for this team was assigned to the Massachusetts Department of Public Health for implementation, and currently, the Bureau of Family and Community Health, Division for Perinatal, Early Childhood and Special Health Needs oversees the program.
The Medical Review Team reviews applications for pediatric admission (under age 22) to a nursing facility to ensure that the criteria are being met and that when necessary, alternatives to residential placement are explored. The MRT is composed of representation from the private sector in Medicine, Nursing, Social Work and Therapy, and a Parent Consumer, as well as representatives from a variety of state agencies, among them the Dept. of Elementary and Secondary Education (DESE), Dept. of Medical Assistance (DMA), Dept. of Developmental Services (DDS), Mass. Commission for the Blind (MCB), Dept. of Children and Families (DCF) and State Head Injury Program (SHIP - for selected head injury requests). Review is required regardless of payment source and whether the individual is seeking admission to an adult or pediatric facility.
Forms
The following forms need to be completed and submitted:
- Long-Term Care in a Pediatric Facility- LTC form
- Short Term Care in A Pediatric Facility - STC form
- Any placement for those 16-22 in an Adult Facility- ABI form
Criteria for Care in a Pediatric Facility
For placement in a pediatric facility, these criteria are the same whether it is for short or long term placement:
- have at least 2 direct skilled nursing needs and 2 health maintenance and monitoring needs under the supervision of a nurse,
- need ongoing daily or weekly therapy,
- require regular medical supervision of their health status, and
- have every opportunity to reach their fullest potential in the least restrictive environment available to them; understanding that the pediatric nursing home represents the most restrictive environment.
Potential long term residential clients should
- have a cognitive age of 12 months or less.
- Long-Term care application.
Potential short term residential clients should
- have a cognitive age of less than 24 months and be non-ambulatory.
Short term stays are limited to 90 days per calendar year.
Short Term Stay background
In 2001 the admission criteria for short term stays was developed for short-term stays in a pediatric facility for those children who may need medically necessary skilled care, limited sub-acute care that is unavailable in other settings, recovery from post-operative care for wound healing or those in body casts, among others. Approval for short-term expanded the developmental criteria to a cognitive age of less than 24 months and the child must be non-ambulatory. Approval for Admission to an Adult Facility (short or long-term)
Short-Term Post Hospital Stay – Pediatric Facility (30 days, extension up to 90)
This program became a regular part of the MRT in 2010. This program does not add an option for an additional 90 days for children already eligible under the short term program but it extends the pool of children who may be eligible for the short-term stays.
These children could be discharged to home or community placements, but need to remain in a hospital because of requirements for complex skilled nursing care. Unlike other programs administrated through the Medical Review Team, the short term post-hospital placement program allows for care and transfer of eligible children regardless of cognitive/developmental level. The criteria for care is similar to the long and short term programs but the pediatric nursing homes must work with families and providers to help the children return to their homes or other community placements safely and as quickly as possible. The program allows for a 30 day stay at a pediatric nursing home with a possible extension to 90 days.
One of the major components of this program is that the children must have a clear discharge plan. The nursing homes are responsible for consulting with the referring hospitals and developing and implementing this plan so the children can be safely discharged back to the community with the necessary services (nursing, Early Intervention Program, PCA’s etc). The nursing homes are also responsible for securing ongoing educational services for the eligible children in their facilities.
Placement in an Adult Facility
Admission to any skilled nursing facility for children under 22 requires MRT approval and certification. Children between the ages of 16 and 22 may be admitted to ADULT care facilities with ADDITIONAL review by, and approval of the Mass. Department of Public Health, Division of Health Care Quality. This is the agency that licenses all skilled care facilities in the Commonwealth and their approval is required to ensure that the facility is licensed to meet the needs of the client for whom admission is being requested. In addition, requests for persons with Traumatic Brain Injury are also reviewed by the Statewide Head Injury Program to ensure that programs and facilities will be able to meet their needs.
Meeting Schedule
The MRT currently meets the 2 nd and 4 th Thursdays of each month to review cases that come before them for long term care. An expedited review by selected team members is done for Short-term care, Skilled Nursing/Rehab, and Short-Term Post Hospital and does not require the team to meet. These reviews are usually done by phone with the MRT chair coordinating the responses.
Rendering of Decisions
After review, clients may be certified, not-certified or deferred. Once certified, the MRT Chairperson provides the necessary certification notices to the referral source, the family and the facility to which the individual will be placed. In the case of those not certified, the referral source is notified and justification provided, and they are instructed in their appeal rights. For those for whom certification is deferred, the referral source is notified and they are instructed as to what is needed for a decision to be rendered.
For More Information
Contact:
Denise Guilbeault, LICSW, Medical Review Team Coordinator
Bureau of Family Health and Nutrition
(978) 851-7261 x4022
Email: Denise.Guilbeault@state.ma.us-Thanks to Denis Guilbeault, LICSW for her help with this article.
6/10