reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 457.000 - Freestanding Birth Center Services › Section 457.410 - Recordkeeping Requirements

Current through Register 1525, July 5, 2024
FBCs are governed by recordkeeping provisions at MassHealth
				regulations 130 CMR 457.410 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
, and DPH regulations at
				105 CMR
				140.000:
Licensure of Clinics
.
(A) Payment for any service listed in
			 130 CMR
			 457.000 is conditioned upon its full and complete
			 documentation in the member's medical record. An FBC must maintain a record of
			 all medical services provided to a member for at least six years following the
			 date of service. Payment for maintaining the member's medical record is
			 included in the fee for the FBC service. Each medical record must contain
			 sufficient information to document fully the nature, extent, quality, and
			 necessity of the care furnished to the member for each date of service claimed
			 for payment. If the documentation is not sufficient to justify the service for
			 which payment is claimed by the FBC, the MassHealth agency will not pay for the
			 service or, if payment has been made, may consider such payment to be an
			 overpayment subject to recovery in accordance with
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
.
(B) The
			 medical record for each member must contain, at a minimum, the following
			 information:
(1) member's name, date of birth,
			 home address and telephone number, and spouse or other person to contact in an
			 emergency;
(2) date of each member
			 visit with FBC staff;
(3)
			 obstetrical and medical history;
(4) diagnostic observations, evaluations, and
			 therapeutic plans;
(5) orders for
			 any medication, test, or treatment;
(6) records of any administration of
			 medications, treatment, or therapy;
(7) laboratory, radiology, and other
			 diagnostic reports;
(8) progress
			 notes;
(9) reports of any
			 consultations, special examinations, or procedures;
(10) referrals;
(11) discharge summary where appropriate;
			 and
(12) in addition to items 1
			 through 11 above, in regard to each newborn, the medical record must include
			 the following:
(a) the condition of the infant
			 at birth to include Apgar Score (or its equivalent) at one minute and five
			 minutes, time of sustained respiration, details of physical abnormalities, and
			 pathological states;
(b) date and
			 hour of birth, birth weight, and period of gestation;
(c) number of cord vessels and any
			 abnormalities of the placenta;
(d)
			 verification of eye prophylaxis;
(e) metabolic screening;
(f) treatments, medications, and special
			 procedures; and
(g) condition at
			 discharge or transfer.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.401 - Introduction

Current through Register 1525, July 5, 2024
130 CMR
				461.000 establishes the requirements for participation
				of community support programs in MassHealth. All community support programs
				participating in MassHealth must comply with the MassHealth regulations,
				including, but not limited to, regulations set forth in
				130 CMR
				461.000 and in
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.403 - Eligible Members

Current through Register 1525, July 5, 2024
(A)
MassHealth members
. The MassHealth agency covers CSP
			 services only when provided to eligible MassHealth members, subject to the
			 restrictions and limitations described in the MassHealth agency's regulations.
			 Regulations at
			 130
			 CMR 450.105:
Coverage Types
specifically state, for each MassHealth coverage type, which services are
			 covered and which members are eligible to receive those services.
(B)
Recipients of the Emergency
			 Aid to the Elderly, Disabled and Children Program
. For information
			 on covered services for recipients of the Emergency Aid to the Elderly,
			 Disabled and Children Program,
see
130
			 CMR 450.106:
Emergency Aid to the
			 Elderly, Disabled and Children Program
.
(C) For information on verifying member
			 eligibility and coverage type,
see
130
			 CMR 450.107:
Eligible Members and the
			 MassHealth Card
.
(D) For
			 limitations on mental health disorder and substance use disorder services
			 provided to members enrolled with a MassHealth managed care provider,
see
130
			 CMR 450.105:
Coverage Types
and 130 CMR 450.124:
Behavioral Health Services
.
(E)
Clinical Standards for CSP
			 Services
. Community support program services, including
			 specialized CSP services, are provided to members based on the clinical
			 standards published by the MassHealth agency.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.404 - Provider Eligibility

Current through Register 1525, July 5, 2024
Each community support program is eligible to enroll only if
				the community support program meets all provider participation requirements as
				specified in
				130 CMR
				461.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
(A)
CSP and CSP-JI Requirements
. To qualify for
			 participation in MassHealth as a CSP or CSP-JI provider, a provider must be an
			 organization that provides mental health or substance use disorder services and
			 operates under a valid license issued by the Massachusetts Department of Public
			 Health (DPH).
(B)
CSP-HI Requirements
. To qualify for participation in
			 MassHealth as a CSP-HI provider, a provider must have:
(1) experience providing services to persons
			 with mental health disorders or substance use disorders or both; and
(2) at least two years of history providing
			 pre-tenancy, transition into housing, and tenancy sustaining supports to
			 persons experiencing homelessness. This must include experience with serving
			 people experiencing chronic homelessness and with documenting their chronic
			 homeless status in accordance with requirements set by the U.S. Department of
			 Housing and Urban Development.
(3)
			 specialized professional staff with knowledge of housing resources and dynamics
			 of searching for housing such as obtaining and completing housing applications,
			 requesting reasonable accommodations, dealing with housing or credit histories
			 that are poor or lacking, mitigating criminal records, negotiating lease
			 agreements, and identifying resources for move-in costs, furniture and
			 household goods.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.405 - Provider Enrollment Process

Current through Register 1525, July 5, 2024
(A) A
			 separate, complete application for enrollment as a MassHealth CSP provider must
			 be submitted for each CSP. If the CSP is a parent CSP operating satellite
			 locations, the parent CSP must identify all locations of operation in their
			 application, including indicating which site will serve as the parent CSP
			 location and identifying all satellite CSPs and their locations. The applicant
			 must submit the appropriate provider enrollment application to the MassHealth
			 agency. The MassHealth agency may request additional information or perform a
			 site inspection to evaluate the applicant's compliance with the regulations in
			 130 CMR
			 461.000.
(1) Based on
			 the information in the enrollment application, information known to the
			 MassHealth agency about the applicant, and the findings from any site
			 inspection deemed necessary, the MassHealth agency will determine whether the
			 applicant is eligible for enrollment. In the event of an application by a
			 parent CSP with satellite CSP locations, MassHealth may evaluate each
			 identified satellite CSP location for eligibility prior to enrollment.
			 MassHealth determinations of ineligibility of a parent CSP will apply to all
			 its component satellite CSP locations. MassHealth determinations of
			 ineligibility of a constituent satellite CSP location may not result in
			 determination of ineligibility for the parent CSP location or all related
			 satellite CSP locations.
(2) The
			 MassHealth agency will notify the applicant of the determination in writing
			 within 60 days of the MassHealth agency receiving a completed application. An
			 application will not be considered complete until the applicant has responded
			 to all MassHealth requests for additional information, and MassHealth has
			 completed any required site inspection.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.406 - Provider Reporting Requirements

Current through Register 1525, July 5, 2024
(A) Each
			 program must comply with all reporting requirements that may pertain to the
			 practice, facility, policies or staffing of the program as directed by the
			 MassHealth agency, and in compliance with
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
and
			 130 CMR
			 461.000.
(B)
Adverse Incident
			 Reports
. Each provider must report adverse incidents to the
			 MassHealth agency within 24 hours of discovery of the incident, or, if the
			 incident occurs on a holiday or weekend, on the next business day, in a format
			 specified by the MassHealth agency.
(C)
Additional
			 Information
. Eligible providers must file such additional
			 information as EOHHS may from time to time reasonably require.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.407 - Revocation of Enrollment and Sanctions

Current through Register 1525, July 5, 2024
(A)
			 The MassHealth agency has the right to review a CSP's continued compliance with
			 the conditions for enrollment referred to in
			 130
			 CMR 461.405 and the reporting requirements in
			 130
			 CMR 461.406 upon reasonable notice and at any
			 reasonable time during the CSP's hours of operation. The MassHealth agency has
			 the right to revoke the enrollment, subject to any applicable provisions of
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
if such review reveals that the CSP has failed to or
			 ceased to meet such conditions.
(B)
			 If the MassHealth agency determines that there exists good cause for the
			 imposition of a lesser sanction than revocation of enrollment, it may withhold
			 payment, temporarily suspend the CSP from participation in MassHealth, or
			 impose some other lesser sanction as the MassHealth agency sees fit, pursuant
			 to the processes set forth in
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
, as applicable.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.408 - In-state Providers: Maximum Allowable Fees

Current through Register 1525, July 5, 2024
(A) The MassHealth agency pays for CSP
			 services with rates set by EOHHS, subject to the conditions, exclusions, and
			 limitations set forth in
			 130 CMR
			 461.000. EOHHS fees for CSP services are contained in
			 101 CMR
			 362.00:
Rates for Community Support Program
			 Services
.
(B)
Administrative Operations
. Payment by the MassHealth
			 agency for CSP services includes payment for administrative operations and for
			 all aspects of service delivery not explicitly included in
			 130 CMR
			 461.000, such as, but not limited to;
(1) staff supervision or consultation with
			 another staff member;
(2) providing
			 information for the coordination of referrals; and
(3) recordkeeping.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.409 - Site Inspections

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency, and their agents and designated contractors may, at any time, conduct
			 announced or unannounced site inspections of any and all provider locations to
			 determine compliance with applicable regulations, which can include auditing
			 activities in accordance with
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
. Such site inspections need not pertain to any actual or
			 suspected deficiency in compliance with the regulations.
(B) After any site inspection where
			 deficiencies are observed, the MassHealth agency will prepare a written site
			 inspection report. The site inspection report will include the deficiencies
			 found, and the period within which the deficiency must be corrected. The
			 program must submit a corrective action plan, within the timeframe set forth by
			 the MassHealth agency, for each of the deficiencies cited in the report,
			 including the specific corrective steps to be taken, a timetable for these
			 steps, and the date by which full compliance will be achieved. The MassHealth
			 agency will review the corrective action plan and will accept the corrective
			 action plan only if it conforms to these requirements.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.410 - Scope of Services

Current through Register 1525, July 5, 2024
(A) The CSP provider
			 delivers CSP services on a mobile basis to members in any setting that is safe
			 for the member and staff. Services may be provided
via
telehealth, as appropriate.
(B) A
			 community support program must have the capacity to provide at least the
			 following service components:
(1)
Intake Services
.
(a)
			 The program must initiate service planning immediately by communicating with
			 the referral source, if any, to determine goals, and document appropriateness
			 of services.
(b) If the member is
			 referred by a 24-hour behavioral health level of care, including inpatient and
			 diversionary providers, the program will participate, as appropriate, in member
			 discharge planning at the referring provider.
(c) If, during intake, the member is
			 determined to be ineligible for CSP services pursuant to
			 130
			 CMR 461.403, the program must provide
			 referrals to alternative services that may be medically necessary to meet the
			 member's needs, if any.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.411 - Staffing Requirements

Current through Register 1525, July 5, 2024
(A)
Minimum Staffing Requirements
. Each program must meet
			 the minimum staffing and staff composition requirements outlined in
			 130
			 CMR 461.411 to adequately provide the
			 required scope of services set forth in
			 130
			 CMR 461.410. The staff must include an
			 adequate number of qualified personnel to fulfill the program's
			 objective.
(B)
Minimum
			 Staff Composition
.
(1)
Program Director
. The CSP program must designate a
			 professional as overall administrator and program director in charge of
			 day-to-day administration of the program. The program director's
			 responsibilities include:
(a) hiring and
			 firing of CSP staff;
(b)
			 establishing and implementing a supervision protocol;
(c) establishing CSP policies and
			 procedures;
(d) accountability for
			 adequacy and appropriateness of member service;
(e) coordinating staff activities to meet
			 program objectives;
(f) program
			 evaluation; and
(g) establishing
			 and supervising in-service training and education.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.412 - Supervision, Training, and Other Staff Requirements

Current through Register 1525, July 5, 2024
(A)
Staff Supervision
			 Requirements
. CSP staff must have access to a licensed,
			 master's-level behavioral health clinician or licensed psychologist, with
			 training and experience in providing support services to adults or youth with
			 behavioral health conditions, to provide supervision. Each staff member must
			 receive supervision appropriate to the staff member's skills and level of
			 professional development. Supervision must occur in accordance with the
			 program's policies and procedures and must include review of specific member
			 issues, as well as a review of general principles and practices related to
			 mental health, substance use disorder, and medical conditions.
(B)
Staff Training
.
			 The program must ensure that staff receive training to enhance and broaden
			 their skills. Recommended training topics may include, but are not limited to:
(1) common diagnoses across medical and
			 behavioral healthcare;
(2)
			 engagement and outreach skills and strategies;
(3) Service coordination skills and
			 strategies;
(4) behavioral health
			 and medical services, community resources, and natural supports;
(5) principles of recovery and
			 wellness;
(6) cultural
			 competence;
(7) managing
			 professional relationships with members including but not limited to
			 boundaries, confidentiality, and peers as CSP workers;
(8) service termination;
(9) motivational interviewing;
(10) accessibility and
			 accommodations;
(11)
			 trauma-informed care;
(12)
			 traumatic brain injuries; and
(13)
			 safety protocols.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.413 - Schedule of Operations

Current through Register 1525, July 5, 2024
(A) The CSP must
			 operate at least one location that is open and operated at least 40 hours per
			 week within the Commonwealth of Massachusetts with the ability to provide
			 onsite and community-based services.
(B)
Accessibility
.
(1) Provider staff must be directly
			 accessible to the member, in person Monday through Friday, 9:00 A.M. to 5:00
			 P.M.
(2) The Program must be
			 accessible on an on-call basis when the site is closed to triage needs and
			 offer referrals to qualified professionals, emergency services, or other
			 mechanisms for effectively responding to a crisis.
(3) CSP-TPP providers may modify business
			 hours to reflect the operating hours of the Housing Court and do not need to be
			 accessible when the Housing Court is closed.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.415 - Written Policies and Procedures

Current through Register 1525, July 5, 2024
Each community support program must have and adhere to written
				policies and procedures that include
(A) a statement of its philosophy and
			 objectives and of the geographical area served;
(B) an intake policy;
(C) admission procedures;
(D) service delivery procedures, including,
			 but not limited to, development of the service plan, case assignment, case
			 review, discharge planning, and follow-up on members who leave the
			 CSP;
(E) a referral policy,
			 including procedures for ensuring uninterrupted and coordinated member
			 care;
(F) recordkeeping policies,
			 including what information must be included in each record, and procedures to
			 ensure confidentiality;
(G)
			 personnel and management policies, including policies for hiring, training,
			 evaluation, supervision, and termination protocol for all staff;
(H) conflict of interest.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.416 - Administration

Current through Register 1525, July 5, 2024
(A)
Organization
.
			 The CSP must establish an organizational chart showing major operating programs
			 of the organization, the personnel in charge of each program, and the lines of
			 authority, responsibility, and communication among and between
			 personnel.
(B)
Staff
			 Development and Supervision
. Each staff member must receive
			 supervision appropriate to the person's skills and level of professional
			 development. Supervision must be documented and must occur within the context
			 of a formalized relationship that provides frequent and regularly scheduled
			 individual or group personal contact with the supervisor.
(C) All documents described above must be
			 made accessible and available upon request.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 461.000 - Community Support Program Services › Section 461.417 - Service Limitations

Current through Register 1525, July 5, 2024
(A)
Services Provided When the Member Is in an Inpatient
			 Setting
. The MassHealth agency does not pay for services when a
			 member is receiving inpatient or long-term-care services in an acute or chronic
			 hospital, a psychiatric hospital, or a level II or level III nursing facility.
			 The MassHealth agency also does not pay for services when the member resides in
			 the facility in which services are provided. However, the MassHealth agency
			 will pay for CSP services provided as part of support for transition between
			 service settings, including connecting with the member as part of the member's
			 discharge planning from an inpatient or 24-hour diversionary setting and
			 supporting them through the transition to accessing outpatient and
			 community-based services and supports.
(B)
Housing Related
			 Expenses
. The MassHealth agency does not pay for costs related to
			 housing move-in or fees related to eviction prevention.
(C)
Services Provided When the
			 Member Is in the Custody of a Correctional Institution
. The
			 MassHealth agency does not pay for services when a member is in the custody of
			 a correctional institution. The MassHealth agency also does not pay for
			 services when the member is incarcerated or detained in a correctional
			 institution in which services are provided.
(D)
Travel Time
. The
			 MassHealth agency pays for travel time that is to or from community-based
			 locations, including the member's home, and is specifically related to the
			 engagement of a member in CSP services, or direct provision of CSP services.
			 The MassHealth agency does not pay for any other travel time.
(E)
Transportation
.
			 CSP providers may provide referrals to community-based transportation
			 resources. CSP providers may pay for a member's transportation costs related to
			 CSP services. The MassHealth agency does not reimburse CSP providers for
			 transportation costs.
(F)
Funding Availability
. Reimbursement for MassHealth
			 services is subject to limitation based on the availability of full federal
			 financial participation, and requirements for federal funding, pursuant to
			 EOHHS' Section 1115 Demonstration waiver and any other applicable federal
			 statute, regulation, or payment limit.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.401 - Introduction

Current through Register 1525, July 5, 2024
All licensed independent clinical social workers participating
				in MassHealth must comply with the regulations of the MassHealth agency
				including, but not limited to, regulations set forth in
				130 CMR
				462.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR
				462.000 have the meanings given in
				130
				CMR 462.402, unless the context clearly
				requires a different meaning.
Case Consultation
- intervention,
				including scheduled audio-only telephonic, audio-video, or in person meetings,
				for behavioral and medical management purposes on a member's behalf with
				agencies, employers, or institutions which may include the preparation of
				reports of the member's psychiatric status, history, treatment, or progress
				(other than for legal purposes) for other physicians, agencies, or insurance
				carriers.
Child and Adolescent Needs and Strengths
				(CANS)
- a tool that provides a standardized way to organize
				information gathered during behavioral-health clinical assessments. A
				Massachusetts version of the tool has been developed and is intended to be used
				as a treatment decision support tool for behavioral-health providers serving
				MassHealth members younger than 21 years old.
Diagnostic Service Evaluation
- the
				examination and determination by interview techniques of a member's physical,
				psychological, social, economic, educational, and vocational capabilities and
				disabilities for the purposes of developing a diagnostic formulation and
				designing a treatment plan.
Family Consultation
- a scheduled
				meeting of at least one-half hour with one or more of the parents, legal
				guardian, or foster parents of a child who is being treated by the provider
				when the parents, legal guardian, or foster parents are not clients of the
				provider.
Family Therapy
- the psychotherapeutic
				treatment of more than one member of a family simultaneously in the same
				session.
Group Therapy
- the application of
				psychotherapeutic or counseling techniques to a group of persons, most of whom
				are not related by blood, marriage, or legal guardianship.
Individual Therapy
- psychotherapeutic
				services provided to an individual.
Telehealth
- the use of synchronous or
				asynchronous audio, video, electronic media or other telecommunications
				technology, including, but not limited to:
(1) interactive audio-video
			 technology;
(2) remote patient
			 monitoring devices;
(3) audio-only
			 telephone; and
(4) online adaptive
			 interviews, for the purpose of evaluating, diagnosing, consulting, prescribing,
			 treating or monitoring of a patient's physical health, oral health, mental
			 health or substance use disorder condition.
Treatment Service
- a service related
				to diminishing the distress and symptoms of mental health or substance use
				disorder, as defined by the current edition of the
Diagnostic and
				Statistical Manual of Mental Disorders
including, but not limited to,
				individual, couple, family, and group psychotherapy. The use of evidence-based
				treatment modalities is encouraged.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.403 - Eligible Members

Current through Register 1525, July 5, 2024
(A)
(1)
MassHealth
			 Members
. The MassHealth agency covers licensed independent
			 clinical social work services only when provided to eligible MassHealth
			 members, subject to the restrictions and limitations described in
			 130 CMR
			 462.000 and
			 450.000:
Administrative and Billing Regulations
. The regulations at
			 130
			 CMR 450.105:
Coverage Types
specifically state, for each MassHealth coverage type, which services are
			 covered and which members are eligible to receive those services.
(2)
Recipients of the Emergency
			 Aid to the Elderly, Disabled and Children Program
. For information
			 on covered services for recipients of the Emergency Aid to the Elderly,
			 Disabled and Children (EAEDC) Program,
see
130
			 CMR 450.106:
Emergency Aid to the
			 Elderly, Disabled and Children Program
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.404 - Provider Eligibility

Current through Register 1525, July 5, 2024
Payment for the services described in
				130 CMR
				462.000 is made only to providers who are
				participating in MassHealth as of the date of service. The eligibility
				requirements are as follows.
(A)
In State
. A licensed independent clinical social
			 worker is eligible to participate in MassHealth only if the licensed
			 independent clinical social worker is licensed to practice and engage in the
			 independent practice of clinical social work by the Massachusetts Board of
			 Registration of Social Workers and is a Medicare provider.
(B)
Out of State
. A
			 clinical social worker located outside of Massachusetts is eligible to
			 participate in MassHealth only if the clinical social worker is licensed to
			 practice at the independent clinical level by his or her state's appropriate
			 board of registration and is a Medicare provider. Out-of-state independent
			 clinical social work services are covered only as provided in
			 130
			 CMR 450.109:
Out-of-state
			 Services
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.405 - Payable Services

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency pays for the following services personally provided by an eligible
			 licensed independent clinical social worker:
(1) diagnostic service evaluation;
(2) psychotherapy including:
(a) individual therapy;
(b) couple therapy;
(c) family therapy; and
(d) group therapy.
(3) case consultation and family
			 consultation.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.407 - Nonpayable Circumstances

Current through Register 1525, July 5, 2024
The MassHealth agency does not pay a licensed independent
				clinical social worker for services provided under any of the following
				circumstances.
(A) The licensed
			 independent clinical social worker provided the service in a facility approved
			 by the MassHealth agency and is paid by the facility to provide that service,
			 whether or not the cost of the service is included in the MassHealth agency's
			 rate of payment for that facility.
(B) The licensed independent clinical social
			 worker provided the service in a facility that is organized to provide
			 primarily nonmedical services and is paid by the facility to provide the
			 service.
(C) The licensed
			 independent clinical social worker has received or will receive payment for the
			 service from the Commonwealth, county, or municipality.
(D) Under comparable circumstances, the
			 licensed independent clinical social worker does not customarily bill patients
			 who do not have health insurance.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.408 - Maximum Allowable Fees

Current through Register 1525, July 5, 2024
The Executive Office of Health and Human Services (EOHHS)
				determines the maximum allowable fees for licensed independent clinical social
				work services as set forth in
				101 CMR
				329.00:
Rates for Psychological and
				Independent Clinical Social Work Services
. The fees include payment
				for the complete cost of psychological diagnostic and treatment services.
				Payment is always subject to the conditions, exclusions, and limitations set
				forth in
				130 CMR
				462.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
. Payment for a service is made at the lower of the
				following:
(A) the licensed
			 independent clinical social worker's usual and customary charge to the general
			 public for the same or similar service; or
(B) the maximum allowable fee listed in the
			 applicable EOHHS fee schedule.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.409 - Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services

Current through Register 1525, July 5, 2024
The MassHealth agency pays for all medically necessary services
				for EPSDT-eligible members provided by licensed independent clinical social
				workers in accordance with
				130
				CMR 450.140:
Early and Periodic
				Screening, Diagnostic and Treatment (EPSDT) Services: Introduction
,
				without regard to service limitations described in
				130 CMR
				462.000, and with prior
				authorization.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 462.000 - Licensed Independent Clinical Social Work Services › Section 462.411 - Service Limitations

Current through Register 1525, July 5, 2024
(A)
Diagnostic and Individual Treatment Services
. The
			 MassHealth agency pays for diagnostic and treatment services only when an
			 independent licensed clinical social worker, as defined by
			 130 CMR
			 462.000, personally provides these services to the
			 member or the member's family. The services must be provided to the member on
			 an individual basis.
(B)
Multiple Visits on a Same Date of Service
. The
			 MassHealth agency pays for only one visit of a single type of service (except
			 for diagnostics) provided to an individual member on one date of service.
			 Return visits on the same date of service are not reimbursable.
(C)
Multiple
			 Therapies
. The MassHealth agency pays for more than one mode of
			 therapy used for a member during one week when it is clinically justified and
			 when any single approach has been shown to be necessary but insufficient. The
			 need for multiple therapies must be documented in the member's
			 record.
(D)
Case
			 Consultation
.
(1) The MassHealth
			 agency pays only for a case consultation that involves a personal meeting with
			 a professional of another agency. Personal meetings may be conducted
via
audio-only telephonic, audio-video, or in person
			 meetings.
(2) The MassHealth agency
			 pays for case consultation only when written communication and other
			 non-reimbursable forms of communication clearly will not suffice. Such
			 circumstances must be documented in the member's record. Such circumstances are
			 limited to situations in which both the provider and the other party are
			 actively involved in treatment or management programs with the member (or
			 family members) and where a lack of direct communication would impede a
			 coordinated treatment program.
(3)
			 The MassHealth agency does not pay the provider for court testimony.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.401 - Introduction

Current through Register 1525, July 5, 2024
130 CMR
				463.000 establishes the requirements for the provision
				and payment of doula services under MassHealth. All doulas participating in
				MassHealth must comply with MassHealth regulations including, but not limited
				to, 130 CMR
				463.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR
				463.000 have the meanings given in
				130
				CMR 463.402 unless the context clearly
				requires a different meaning. The reimbursability of services defined in
				130 CMR
				463.000 is not determined by these definitions, but by
				application of
				130 CMR
				463.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
Doula
. A qualified professional who
				provides non-medical emotional, informational, and physical support to
				individuals and families during pregnancy, delivery, and the post-pregnancy
				period.
Doula Group Practice
. An entity that
				is not part of a hospital, other group practice, or other healthcare facility
				and that possesses its own legal identity, maintains its own patient records,
				administers its own budget and personnel, and is organized primarily for the
				purpose of rendering doula services.
Labor and Delivery
. Childbirth or
				delivery of a fetus following pregnancy, inclusive of all pregnancy
				outcomes.
Perinatal
. The period encompassing
				pregnancy and labor and delivery, through 12 months following delivery,
				inclusive of all pregnancy outcomes.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.403 - Eligible Members

Current through Register 1525, July 5, 2024
(A)
(1)
MassHealth
			 Members
. The MassHealth agency pays for doula services only when
			 provided to eligible MassHealth members during the perinatal period, subject to
			 the restrictions and limitations described in MassHealth regulations.
			 130
			 CMR 450.105:
Coverage Types
specifically states, for each coverage type, which services are covered and
			 which members are eligible to receive those services.
(2)
Recipients of the Emergency
			 Aid to the Elderly, Disabled and Children Program
. For information
			 on covered services for recipients of the Emergency Aid to the Elderly,
			 Disabled and Children Program,
see
130
			 CMR 450.106:
Emergency Aid to the
			 Elderly, Disabled and Children Program
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.405 - Maximum Allowable Fees

Current through Register 1525, July 5, 2024
EOHHS determines the payment rate for doula services in
				accordance with
				101 CMR
				319.00:
Rates for Doula Services
.
				Payment is subject to the conditions, exclusions, and limitations set forth in
				130 CMR
				463.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.406 - Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services

Current through Register 1525, July 5, 2024
The MassHealth agency pays for all medically necessary doula
				services for EPSDT-eligible members in accordance with
				130
				CMR 450.140:
Early and Periodic
				Screening, Diagnostic and Treatment (EPSDT) Services: Introduction
,
				without regard to service limitations described in
				130 CMR
				463.000, and with prior
				authorization.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.407 - Covered Services

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency pays for medically necessary doula services including perinatal visits
			 and labor and delivery support provided in-person or
via
telehealth.
(B) Doula services must
			 be recommended by a physician or other licensed practitioner of the healing
			 arts acting within the scope of their practice under state law. Such licensed
			 practitioners include the following:
(1)
			 certified nurse practitioners, certified nurse midwives, certified registered
			 nurse anesthetists, clinical nurse specialists, psychiatric clinical nurse
			 specialists, physician assistants, clinical social workers, psychologists;
			 and
(2) other licensed
			 practitioners as indicated in written guidance from the MassHealth
			 agency.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.408 - Noncovered Services

Current through Register 1525, July 5, 2024
The MassHealth agency does not pay for the following:
(A) Doula services for purposes other than
			 those identified in
			 130
			 CMR 463.407;
(B) Otherwise payable service codes when
			 those codes are used to bill for circumstances that are not payable under
			 130
			 CMR 463.409; or
(C) Travel time and mileage.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.409 - Service Limitations

Current through Register 1525, July 5, 2024
(A) The MassHealth
			 agency pays for up to eight hours of perinatal visits per perinatal period per
			 member without prior authorization. Visits above these limits require prior
			 authorization in accordance with
			 130
			 CMR 463.410.
(B) The MassHealth agency pays for labor and
			 delivery support, one per perinatal period.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.410 - Prior Authorization

Current through Register 1525, July 5, 2024
(A)
Services that Require Prior Authorization
. The
			 MassHealth agency requires that doulas obtain prior authorization as a
			 prerequisite to payment for more than eight hours of perinatal visits per
			 member per perinatal period.
(B)
Submission Requirement
. The doula must submit all
			 prior authorization requests in accordance with the billing instructions in
			 Subchapter 5 of the
Doula Manual
. Prior authorization
			 determines only the medical necessity of the authorized service, and does not
			 establish or waive any other prerequisites for payment, such as member
			 eligibility, or resort to health insurance payment.
See
130
			 CMR 450.303:
Prior
			 Authorization
for additional information about prior
			 authorization.
(C)
Notice of Approval or Denial of Prior Authorization
.
(1)
Notice of
			 Approval
. For all approved prior authorization requests for doula
			 services, the MassHealth agency sends written notice to the member and the
			 doula about the frequency, duration, and intensity of care authorized, and the
			 effective date of authorization.
(2)
Notice of Denial or
			 Modification and Right of Appeal
.
(a) For all denied or modified prior
			 authorization requests, the MassHealth agency notifies both the member and the
			 doula of the denial or modification and the reason. In addition, the member
			 will receive information about the member's right to appeal and the appeal
			 procedure.
(b) A member may request
			 a fair hearing from the MassHealth agency if it denies or modifies a prior
			 authorization request. The member must request a fair hearing in writing within
			 30 days after the date of receipt of the notice of denial or modification. The
			 MassHealth Board of Hearings will conduct the hearing in accordance with
			 130 CMR
			 610.000:
MassHealth: Fair Hearing
			 Rules
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 463.000 - Doula Services › Section 463.411 - Recordkeeping Requirements

Current through Register 1525, July 5, 2024
(A) Providers of
			 any service covered under
			 130 CMR
			 463.000 must maintain complete records of all services
			 rendered for each MassHealth member. All records must be kept for a minimum of
			 six years after the date of service. Payment for maintaining the member's
			 record is included in the fee for doula services. Each record must contain
			 sufficient information to document fully the nature, extent, quality, and
			 necessity of the care furnished to the member for each date of service claimed
			 for payment. If the documentation is not sufficient to justify the service for
			 which payment is claimed by the provider, the MassHealth agency will not pay
			 for the service or, if payment has been made, may consider such payment to be
			 an overpayment subject to recovery in accordance with
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
.
(B) The doula
			 provider records must contain, at a minimum, the following:
(1) MassHealth member identification,
			 including name, date of birth, and the MassHealth member's identification
			 number;
(2) the date, location,
			 duration, and purpose of each perinatal visit, including a summary of doula
			 services provided, signed by the doula;
(3) the date, location, duration, and summary
			 of doula services provided for labor and delivery support, signed by the
			 doula;
(4) upon completion of
			 services, a summary of the services provided to the member, including any
			 referrals made, signed by the doula; and
(5) if the record or any component included
			 therein is released for use by another party, the record must also contain a
			 release form signed by the member. Release of the record to MassHealth for
			 authorized use does not require the member's consent.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 484.000 - Abortion Clinic Services › Section 484.001 - Definition of Payable Abortions

Current through Register 1525, July 5, 2024
(A) The
			 MassHealth agency pays for abortion services performed in a Department of
			 Public Health licensed clinic when provided to MassHealth recipients
			 (categories of assistance 0, 1, 2, 3, 5, 6, 7, and 8) if all of the following
			 conditions are met:
(1) the abortion is a
			 medically necessary abortion, or the abortion is performed upon a victim of
			 rape or incest when such rape or incest has been reported to a law enforcement
			 agency or public health service within 60 days of the incident;
(2) the abortion is performed in accordance
			 with law; and
(3) the abortion
			 claim is made in accordance with
			 130
			 CMR 484.000.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 484.000 - Abortion Clinic Services › Section 484.002 - Assurance of Recipient Rights

Current through Register 1525, July 5, 2024
No provider shall use any form of coercion in the provision of
				abortion services. Neither the MassHealth agency nor any provider, nor any
				agent or employee of a provider, shall mislead any recipient into believing
				that a decision to have or not to have an abortion will adversely affect the
				pregnant individual's entitlement to benefits or services for which the
				pregnant individual would otherwise be eligible. The MassHealth agency has
				strict requirements for confidentiality of patient records for abortion
				services as well as for all other medical services payable under
				MassHealth.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 484.000 - Abortion Clinic Services › Section 484.003 - Participation by MassHealth Agency Staff

Current through Register 1525, July 5, 2024
Any employee or agent of the MassHealth agency who objects on
				moral or religious grounds to participation in the furnishing of information or
				other assistance concerning abortion services to recipients, and who reports
				such objection to their superiors, shall not be required to participate in such
				activities. The refusal thereafter of such person to participate in such
				activities shall not form the basis for any disciplinary or recriminatory
				action against such person.