MassHealth and State Health Care Reform

Information on how the Health Care Reform legislation/1115 Demonstration Waiver Amendment will affect MassHealth members and providers.

1115 Demonstration ("Waiver") Amendment Request (To be filed May 31, 2013)

Open for Public Comment: May 1, 2013 – May 30, 2013. Please see Summary for details on how to submit comments.

• Summary of 1115 Demonstration Amendment and Public Comment Process 
• 1115 Demonstration Amendment Request Draft 
• ACA Transition Plan Draft 
• 1115 Demonstration Amendment Budget Neutrality Draft 

1115 Demonstration ("Waiver") Extension Approved (December 20, 2011)

• Demonstration Extension Approval Documents 

1115 Demonstration Extension Request (June 2010)

• Demonstration Extension Request Documents (PDF)  file size 1MB

1115 Demonstration ("Waiver") Amendment Request (Filed March 1, 2010)

• Cover Letter (PDF) 
• Amendment Request Proposal Submitted to CMS (PDF) 
• Redlined Special Terms and Conditions March 1, 2010) (PDF)  file size 1MB
• Federal Budget Neutrality Summary March 1, 2010 (XLS) 
• Payment Methodology -Transitional Relief to Private Hospitals (PDF) 
• Waiver Amendment as Approved September 30, 2010 (PDF)  file size 1MB
• Waiver Amendment as Approved January 19, 2011 (PDF)  file size 1MB file size 1MB

1115 Demonstration ('Waiver") Extension Approved (December 22, 2008)

• Demonstration Extension Approval Documents (PDF)  file size 3MB file size 1MB

1115 Demonstration Extension Request (December 2007)

• Cover Letter (PDF) 
• Demonstration Extension Proposal Submitted to CMS 12/21/07 (PDF) 

Attachments

(A) MA Budget Neutrality Calculation for SFY 2009 - 2011 (PDF) 

(B) Healthy Massachusetts Compact (PDF) 

1115 Demonstration Extension Request (June 2007)

• Cover Letter (PDF) 
• Demonstration Extension Proposal Submitted to CMS 6/29/07 (PDF) 

Attachments

• (A) Public Education Plan (PDF) 
• (B) Health Care Quality and Cost Council SFY 2008 Statewide Goals (PDF) 
• (C) Proposed Changes to Section 2 of the Program Specifications (PDF) 
• (D) Proposed Changes to Section 11 of the Program Specifications (PDF) 

1115 Demonstration Waiver Special Terms and Conditions (June 2007)

• Approval Letter and Special Terms and Conditions (6/19/07) (PDF) 

1115 Demonstration Waiver Amendment (Health Care Reform) Publications

Amendment Submission to CMS

• Cover Letter (05/01/06) (PDF  ) | Word 
  
  
• Waiver Amendment (PDF) 

Attachments

(A) Chapter 58 of the Acts of 2006

(B) Title XXI SCHIP State Plan Amendment (PDF) 

• Exhibit - MassHealth Eligibility Standards (PDF) 
  
  
• Exhibit - MassHealth Coverage by Federal Reimbursement Matrix (PDF) 

(C) Safety Net Care Pool Sources and Uses (PDF) 

(D) Safety Net Care Pool Payment Methodologies (PDF) 

(E) Budget Neutrality Projection (PDF) 

Amendment Approval from CMS

• Approval Letter (07/26/06) (PDF)  file size 64MB
  
  
• Expenditure Authority (PDF) 
  
  
• Special Terms and Conditions (PDF) 
  
  
• Waiver List (PDF) 
  
  

MassHealth Publications Related to Health Care Reform

• New Services for Adults and Tobacco Cessation Services for Members of All Ages - English (PDF) 
  
  
• New Services for Adults and Tobacco Cessation Services for Members of All Ages - Spanish (PDF) 
  
  

Provider Publications Related to Health Care Reform

• Transmittal Letter PHY-112: Revised    Regulations About New Tobacco Cessation Services: Correction (PDF) 
  
  
• All Provider Bulletin 155: Expansion    of Services for Adult MassHealth Members and Tobacco Cessation Services for Members of All Ages (PDF) 
  
  
• Transmittal Letter AIH-41: Coverage    of Administrative Days for Members Aged 21 Years or Older (PDF) 
  
  
• Transmittal Letter AOH-8: Revised Regulations About New Tobacco Cessation Services (PDF) 
  
  
• Transmittal Letter CHC-74: Revised    Regulations About Tobacco Cessation Services (PDF) 
  
  
• Transmittal Letter CRP-21: Coverage    of Chiropractor Services for Members Aged 21 Years or Older (PDF) 
  
  
• Transmittal Letter DEN-77: Coverage  file size 1MB   of Dental Services for Members Aged 21 Years or Older (PDF)  file size 1MB
  
  
• Transmittal Letter DEN-76: Revised    Regulations About New Tobacco Cessation Services (PDF) 
  
  
• Transmittal Letter FAS-16: Coverage    of Dental Services for Members Aged 21 Years or Older (PDF) 
  
  
• Transmittal Letter OPD-59: Revised    Regulations About Tobacco Cessation Services (PDF) 
  
  
• Transmittal Letter ORT-18: Coverage    of Medically Necessary Orthotics to Members Aged 21 Years or Older (PDF) 
  
  
• Transmittal Letter PHM-55: Revised    Regulations About Tobacco Cessation Services (PDF) 
  
  
• Transmittal Letter PHY-111: Physician    Manual (Revised Regulations About New Tobacco Cessation Services and Independent Diagnostic Testing Facility (IDTF) Services) (PDF) 
  
  
• Transmittal Letter POD-53: Coverage of Medically Necessary Orthotic Shoes for Members Aged 21 Years or Older PDF 
  
  
• Transmittal Letter POD-52: Revised    Regulations About New Tobacco Cessation Services (PDF) 
  
  
• Transmittal Letter PRT-18: Coverage    of Medically Necessary Prosthetics to Members Aged 21 Years or Older (PDF) 
  
  
• Transmittal Letter SAT-15: Coverage    of 24-Hour Post-Medical Detoxification Services for Members Aged 21 Years or Older PDF 
  
  
• Transmittal Letter VIS-35: Coverage of     Vision Care Services for Members Aged 21 Years or Older (PDF) 

---

This information is provided by MassHealth.