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7 130 CMR: DIVISION OF MEDICAL ASSISTANCE
Trans. by E.L. 255 Rev. 02/13/26
130 CMR 515.000: MASSHEALTH: GENERAL POLICIES
Limited English Proficiency. Persons who are unable to communicate effectively in English because their primary language is not English and they have not developed fluency in English.
Look-back Period. A period of consecutive months that the MassHealth agency may review for transfers of resources to determine if a period of ineligibility for payment of nursing-facility services should be imposed.
Lump-sum Payment. A one-time-only payment that represents either a windfall payment or the accumulation of recurring countable income, such as retroactive unemployment compensation or federal veterans’ retirement benefits.
MassHealth Agency. The Executive Office of Health and Human Services in accordance with the provisions of M.G.L. c. 118E.
Medical Benefits. Payment for medical services provided to a MassHealth member.
Member. A person determined by the MassHealth agency to be eligible for MassHealth.
Navigator. An individual who is certified by the Health Connector to assist an applicant with electronic and paper applications to establish eligibility and enroll in coverage through the Health Connector. In addition, a navigator provides outreach and education about insurance options offered through the Health Connector.
Nonqualified Individuals Lawfully Present. See 130 CMR 518.003(A)(3): Nonqualified Individuals Lawfully Present.
Nonqualified Person Residing under Color of Law (nonqualified PRUCOL). See 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs).
Nursing-facility Resident. An individual who is a resident of a nursing facility; is a resident in any institution, including an ICF/MR, for whom payment is based on a level of care equivalent to that received in a nursing facility; is in an acute hospital awaiting placement in a nursing facility; or lives in the community and would be institutionalized without community-based services provided in accordance with 130 CMR 519.007(B): Home- and Community-based Services Waiver—Frail Elder.
Other Noncitizens. See 130 CMR 518.003(D): Other Noncitizens.
Patient-paid Amount. The amount that a member in a long-term-care facility must contribute to the cost of care under the laws of the Commonwealth of Massachusetts.
Period of Ineligibility. The period of time during which the MassHealth agency denies or withholds payment for nursing-facility services because the individual has transferred resources for less than fair market value.