Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 319.00 - Rates for Doula Services › Section 319.02 - Definitions

Current through Register 1525, July 5, 2024
Terms used in
				101 CMR
				319.00 have the meanings set forth in
				101
				CMR 319.02. The descriptions and five-digit
				codes included in
				101 CMR
				319.00 utilize the Healthcare Common Procedure Code
				System (HCPCS) for Level I and Level II coding. Level 1 CPT-4 codes are
				obtained from the Physicians' 2023 Current Procedural Terminology® by the
				American Medical Association (AMA), unless otherwise specified. Level II codes
				are obtained from 2023 HCPCS maintained jointly by the Centers for Medicare
				& Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and
				the Health Insurance Association of America. HCPCS is a listing of descriptive
				terms and identifying codes and modifiers for reporting medical services and
				procedures performed by physicians and other healthcare professionals, as well
				as associated non-physician services.
				101 CMR
				319.00 includes only HCPCS numeric and alpha-numeric
				identifying codes and modifiers for reporting medical services and procedures
				that were selected by EOHHS. Any use of CPT outside the fee schedule should
				refer to the Physicians' 2023 Current Procedural Terminology®.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
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.
Eligible Doula Provider
.
(1) A provider of doula services who meets
			 the conditions of participation of a governmental unit purchasing such
			 services.
(2) MassHealth providers
			 of doula services must satisfy the provider eligibility requirements set forth
			 in 130 CMR
			 463.000:
Doula Services
and
			 130 CMR
			 450.000:
Administrative and Billing
			 Regulations
.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth of
				Massachusetts or any of its departments, agencies, boards, commissions, or
				political subdivisions.
Individual Consideration (I.C.)
. Doula
				services that are authorized but not listed in
				101 CMR
				319.00, doula services performed in unusual
				circumstances, and services whose fees are designated by the letters "I.C." are
				individually considered items. The governmental unit or purchaser analyzes the
				eligible provider's operative report, which must contain a diagnosis, a
				pertinent medical history, a description of the services rendered, and the
				length of time spent with the patient. In making the determination of whether
				the service is appropriately classified as an individually considered item the
				following criteria are used:
(1)
			 policies, procedures, and practices of other third-party purchasers of care,
			 both governmental and private;
(2)
			 the severity and complexity of the patient's disorder or disability;
(3) prevailing provider ethics and accepted
			 practice; and
(4) time, degree of
			 skill, and cost including equipment cost required to perform the
			 procedure(s).
Labor and Delivery
. Childbirth or
				delivery of a fetus following pregnancy, inclusive of all pregnancy
				outcomes.
Modifiers
. Listed services may be
				modified under certain circumstances. When applicable, the modifying
				circumstances must be identified by the addition of the appropriate two-digit
				number or letters.
Perinatal
. The period encompassing
				pregnancy and labor and delivery, through 12 months following delivery,
				inclusive of all pregnancy outcomes.
Publicly Aided Individual
. A person
				who receives health care and services for which a governmental unit is in whole
				or in part liable under a statutory program of public
				assistance.