As you may know, MassHealth recently issued a bulletin to clarify the acceptable use of Administratively Necessary Days (AND) for inpatient psychiatric hospital stays. 

If you provide care for Tufts Health Together, Tufts Health One Care, or Tufts Health Plan Senior Care Options (SCO) members, please keep in mind that patients being treated in an inpatient psychiatric hospital can only be moved to AND status when they are clinically ready for discharge to a lower level of care, but a bed in the appropriate setting is not available. Patients who are awaiting discharge to an equivalent inpatient level of care are not eligible for Administratively Necessary Days.   

Prior to moving a patient to AND status, a clinical case review is required to demonstrate: 

  • the patient’s clinical presentation calls for discharge to a lower level of care, but an appropriate placement has not yet been secured; and
  • any clinical barriers to discharge have been addressed and the discharge plan is ready to be implemented when an appropriate discharge placement has been secured; and
  • the patient does not require a high degree of clinical resources daily.

Providers can request reimbursement for Administratively Necessary Days using revenue code 169. For more information, refer to the Tufts Health Public Plans and Senior Products Inpatient and Intermediate/Diversionary Behavioral Health/Substance Use Disorder Facility Payment Policies.