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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 239 Rev. 07/01/21 MASSHEALTH FINANCIAL ELIGIBILITY Chapter 520 Page 520.026 (4 of 4)

3. The MassHealth agency allows the deduction only if the guardianship services provided include the attendance and participation of the guardian in quarterly care meetings held by the nursing facility where the member lives. 4. The MassHealth agency allows this deduction only if each year the guardian submits to the MassHealth agency a copy of the affidavit that describes the guardianship services provided to the member. 5. The deduction is made from the member’s monthly patient-paid amount over a 12-month period. (e) Expenses Incurred by the Guardian in Connection with Monthly Guardianship Services. 1. The MassHealth agency allows a deduction up to, but not exceeding, the member’s monthly patient-paid amount for filing and court fees incurred by the guardian in connection with monthly guardianship services that are essential to consent to medical treatment for the member. 2. If monthly guardianship services are provided, these expenses are included in the affidavit of services required under 130 CMR 520.026(E)(3)(d)4. 3. The deduction is made from the member’s monthly patient-paid amount in the month following receipt of the affidavit of services. (f) Hardship. 1. If exceptional circumstances exist that make the deductions allowed under 130 CMR 520.026(E) insufficient to cover the expenses required for a guardian to provide essential guardianship services needed to gain access to or consent to medical treatment, the guardian, on behalf of the member, may appeal to the Office of Medicaid Board of Hearings for an increased deduction. 2. A hearing officer may allow for an increased deduction for guardianship expenses only in circumstances where the issues surrounding the member’s need to gain access to or consent to medical treatment are extraordinary. 3. Extraordinary circumstances may exist when a. there is a need for a guardian to consistently spend more than 24 hours per year providing guardianship services to appropriately consent to medical treatment needed by the member; or b. the circumstances of a MassHealth member cause the guardian appointment or application process to be particularly complex and significantly more costly than the deduction allowed at 130 CMR 520.026(E)(3)(a) or (b).