Message Text – April 2024

MassHealth Provider Remittance Advice

The messages listed below may be general All Provider messages, applicable to several provider types or services, or provider specific. 

You can request a copy of a prior message by:

• Emailing [e-mail]
• Sending a letter to

  MassHealth Customer Service
  P.O. Box 278
  Quincy, MA 02171

• Calling MassHealth Customer Services at [phone],
  Hours: Monday through Friday 8 a.m. to 5 p.m.

04/30/2024

NOTICE OF PUBLIC HEARING FOR INDEPENDENT NURSE PROGRAM REGULATIONS

The Executive Office of Health and Human Services (EOHHS) is holding a public hearing on the proposed amendments to 130 CMR 414.000: Independent Nurse.

The proposed amendments to 130 CMR 414.000 clarify and reorganize sections of the regulation and add requirements for independent nurse providers, including recordkeeping, incident and accident reports, prior authorizations, overtime allowances, limit of hours, a continuous skilled nursing (CSN) high-tech rate add on, prohibited marketing activities, and providing CSN services out of state.

The regulation amendments are being proposed with an effective date of August 30, 2024.

There will be a virtual public hearing on May 17, 2024, from 2:00pm - 4:00pm.

A copy of the Notice of Public Hearing and links to register to testify at the public hearing can be found here: www.mass.gov/doc/notice-of-public-hearing-535/download

A copy of the proposed amendments and regulations can be found here: www.mass.gov/doc/proposed-regulation-date-filed-april-26-2024-0/download

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at [phone] or [e-mail].

NOTICE OF PUBLIC HEARING FOR CONTINUOUS SKILLED NURSING (CSN) AGENCY REGULATIONS

The Executive Office of Health and Human Services (EOHHS) is holding a public hearing on the proposed amendments to 130 CMR 438.000: Continuous Skilled Nursing (CSN) Agency.

The proposed amendments to 130 CMR 438.000 clarify and reorganize sections of the regulation and add requirements for CSN agency providers, including recordkeeping, incident and accident reports, clinical criteria for nursing services, limitations on covered services, biweekly supervision requirements for complex care assistant services, face-to-face encounters, a CSN high-tech rate add on, and annual staffing report requirements.

The regulation amendments are being proposed with an effective date of August 30, 2024.

There will be a virtual public hearing on May 17, 2024, from 12:00pm - 2:00pm.

A copy of the Notice of Public Hearing and links to register to testify at the public hearing can be found here: www.mass.gov/doc/notice-of-public-hearing-537/download

A copy of the proposed amendments and regulations can be found here: www.mass.gov/doc/proposed-regulation-date-filed-april-26-2024-2/download

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at [phone] or [e-mail].

UPDATED - VIRTUAL GATEWAY MULTIFACTOR AUTHENTICATION (MFA)

The Executive Office of Health and Human Services (EOHHS) Virtual Gateway (VG) will be implementing Multifactor Authentication (MFA) later this spring. All Provider Online Service Center (POSC) users will be required to set up MFA to be able to continue accessing the POSC via the VG.

The VG will be communicating with individual users prior to the implementation. They will begin contacting individual users, via email, with general information and instructions on setting up their MFA. The sender will be: [e-mail]. The following messages are scheduled:

1. Friday, April 26: All active VG users announcing upcoming changes - introducing users to upcoming changes (high level).
2. Monday, May 6: All active VG users announcing upcoming changes - more details on how to prepare for MFA.
3. Sunday, May 19: All active VG users announcing the new VG site.

It is imperative that all POSC users ensure the email address associated with their Virtual Gateway account (User ID) is up to date. Additionally, the email address used to set up multifactor authentication must be an exact match to the email associated with the VG account.

Please note: MFA and the VG terms and conditions require that a unique email address be associated to a single VG account. Prior to the implementation, please ensure that your organization completes the following:

1. All users review and ensure that the email address associated with their VG User ID is unique and is not duplicated with any other VG User ID that is currently used;
2. The Primary User must coordinate with users to ensure that each user only has a single, unique VG User ID and must eliminate multiple User IDs currently assigned to the same individual;
3. The Primary User must coordinate with users to ensure that “common” named User IDs that are being shared amongst staff are eliminated; each User ID that is created and assigned to an individual must always include a first name and a last name.

Taking the aforementioned steps will ensure that your organization is compliant with the VG terms and conditions that each user signs upon initial login to the VG.

More information will be coming as we get closer to the implementation.

For additional questions or concerns:

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

04/23/2024

INVITATION TO MASSHEALTH PROVIDER LISTENING SESSION - 130 CMR 411, 130 CMR 462, AND 101 CMR 329

MassHealth is beginning its regulatory review process of the rate and programmatic regulations for psychologist services and licensed independent clinical social worker services. MassHealth will hear feedback on the rates in 101 CMR 329, and the programmatic requirements 130 CMR 329 and 130 CMR 411. In anticipation of this review, MassHealth invites all providers of these services to attend the upcoming listening session and share information they would like MassHealth to consider during the rate and program review process.

Date: May 2, 2024

Time: 12:00pm-1:30pm

Governing Regulations: 130 CMR 411; 130 CMR 462; 101 CMR 329

Registration: Please use this Zoom link: https://tinyurl.com/yder2whf

If you are planning to provide verbal feedback, please notify [e-mail] by end of day May 1, 2024.

MassHealth also encourages written feedback from providers who cannot attend this session or who would like to provide more detailed information. Please email any written feedback to [e-mail] by end of day May 2, 2024.

Please note, there will be a separate public hearing to provide official testimony on the draft regulation at a later date.

JANUARY 2024 HCPCS CODE UPDATE TO THE SUBCHAPTER 6 ORTHOTICS AND PROSTHETICS MANUAL

The Centers for Medicare & Medicaid Services (CMS) have published the HCPCS codes for January 2024. MassHealth has updated Subchapter 6 of the Orthotic (ORT) and Prosthetic (PRT) Manual to incorporate those January 2024 HCPCS service code updates, as applicable.

Please reference Transmittal Letter ORT-28 and Transmittal Letter PRT-29 at https://www.mass.gov/lists/2024-masshealth-transmittal-letters for more information.

Additionally, Orthotic and Prosthetic providers are advised that the MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool has been updated on 4/11/24 and posted on the MassHealth website.

Please refer to our online MassHealth ORT and PRT Payment and Coverage Guideline Tool for HCPCS codes that have been added to the Tool to be effective as of 1/1/24 and for further instructions regarding coverage, limits, and prior authorization requirements.

To confirm that you are using the most recent version of the applicable Tool, go to www.mass.gov/service-details/masshealth-payment-and-coverage-guideline-tools.

If you have questions regarding this change, please contact the LTSS Provider Service Center at [e-mail] or call [phone].

JANUARY 2024 HCPCS CODE UPDATE TO THE SUBCHAPTER 6 DME MANUAL

The Centers for Medicare & Medicaid Services (CMS) have published the HCPCS codes for January 2024. MassHealth has updated Subchapter 6 of the DME Manual to incorporate those January 2024 HCPCS service code updates, as applicable.

Please reference Transmittal Letter DME-46 at https://www.mass.gov/lists/2024-masshealth-transmittal-letters for more information.

Additionally, Pharmacy providers with a Durable Medical Equipment and Supplies (DME) or Oxygen and Respiratory Therapy Equipment (OXY) specialty, DME and Oxygen providers are advised that the MassHealth DME and OXY Payment and Coverage Guideline Tool has been updated on 1/31/24 and posted on the MassHealth website.

Please refer to our online MassHealth DME and OXY Payment and Coverage Guideline Tool for HCPCS codes that have been added to the Tool to be effective as of 1/1/24 and for further instructions regarding coverage, limits, and prior authorization requirements.

To confirm that you are using the most recent version of the applicable Tool, go to www.mass.gov/service-details/masshealth-payment-and-coverage-guideline-tools.

If you have questions regarding this change, please contact the LTSS Provider Service Center at [e-mail] or call [phone].

RETRO RATE ADJUSTMENTS FOR HOSPICE PROVIDERS

Please be advised that the most recent remittance advice (RA) may contain rate adjustments resulting from the certification of revised Federal Fiscal Year 2024 rates (October 1, 2023) by the Executive Office of Health and Human Services. See MassHealth Administrative Bulletin 24-05 at https://tinyurl.com/2rtjknft.

Please review this RA for accuracy. Proposed corrections must be submitted to the MassHealth LTSS Provider Service Center within 30 days from the date of this RA at [e-mail] or by calling [phone].

For more information, refer to the POSC job aid, View Remittance Advice Reports, on the Job aids for the Provider Online Service Center (POSC) web page at https://tinyurl.com/y95aaqjk.

04/02/2024

VIRTUAL GATEWAY MULTIFACTOR AUTHENTICATION (MFA)

The Executive Office of Health and Human Services (EOHHS) Virtual Gateway (VG) will be implementing Multifactor Authentication (MFA) later this spring. All Provider Online Service Center (POSC) users will be required to set up MFA to be able to continue accessing the POSC via the VG.

The VG will be communicating with individual users prior to the implementation. They will begin contacting individual users, via email, with instructions on setting up their MFA with an email subject line saying “Business Account Registration for login.mass.gov”, and the sender will be: [e-mail].

It is imperative that all POSC users ensure the email address associated with their Virtual Gateway account (User ID) is up to date. Additionally, the email address used to set up multifactor authentication must be an exact match to the email associated with the VG account.

Please note: MFA and the VG terms and conditions require that a unique email address be associated to a single VG account. Prior to the implementation, please ensure that your organization completes the following:

1. All users review and ensure that the email address associated with their VG User ID is unique and is not duplicated with any other VG User ID that is currently used;
2. The Primary User must coordinate with users to ensure that each user only has a single, unique VG User ID and must eliminate multiple User IDs currently assigned to the same individual;
3. The Primary User must coordinate with users to ensure that “common” named User IDs that are being shared amongst staff are eliminated; each User ID that is created and assigned to an individual must always include a first name and a last name.

Taking the aforementioned steps will ensure that your organization is compliant with the VG terms and conditions that each user signs upon initial login to the VG.

More information will be coming as we get closer to the implementation.

For additional questions or concerns:

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

INVITATION TO MASSHEALTH PROVIDER LISTENING SESSION - 130 CMR 362 COMMUNITY SUPPORT PROGRAM SERVICES

MassHealth is beginning its regulatory review process of rates for Community Support Program (CSP), Community Support Program Tenancy Preservation Program (CSP-TPP), Community Support Program for Homeless Individuals (CSP-HI), and Community Support Program for individuals with Justice Involvement (CSP-JI). In anticipation of this review, MassHealth invites all providers of these services to attend the upcoming listening session and share information they would like MassHealth to consider during the rate review process.

Date: April 5, 2024

Time: 10:00am-12:00pm: A half hour will be dedicated to each of the CSP and CSP Specialty services, as follows: CSP-TPP 10:00-10:30am, CSP-HI 10:30-11:00am, CSP 11:00-11:30am, and CSP-JI 11:30am-12:00pm.

Governing Regulation: 101 CMR 362: https://tinyurl.com/bdzkustr

Registration: Please use this Zoom link: https://tinyurl.com/93st9dfn

If you are planning to attend and speak, please notify [e-mail] by end of day April 2, 2024.

MassHealth also encourages written feedback from providers who cannot attend this session or who would like to provide more detailed information. Please email any written feedback to [e-mail] by end of day April 5.

Please note, there will be a separate public hearing to provide official testimony on the draft regulation at a later date.

90-DAY WAIVER SUBMISSIONS FOR MEDICARE CROSSOVER CLAIMS

All Provider Bulletin 220, dated December 2011, instructs providers to use delay reason code 1, 4 or 8 when submitting a 90-day waiver request. MassHealth recently became aware that Medicare crossover claims submitted with one of these delay reason codes are denying for edit 851 “Orig claim has exceeded 90-day billing deadline” instead of suspending for review with edit 818 “Special handling 90-day waiver”.

MassHealth is working on an MMIS systems change to correct this issue to allow Medicare crossover claims to suspend. In the meantime, as a temporary workaround, providers may use delay reason code 10 when submitting a 90-day waiver request for Medicare crossover claims. The claims will suspend for review with edit 827 “Special Handling - paper waiver providers - 90-day waiver”. All other claims, including Medicare denied claims, must continue to be submitted per All Provider Bulletin 220.

If you have questions regarding this message, please contact MassHealth at [phone] or [e-mail]. LTSS providers should contact the LTSS Provider Service Center at [phone] or [e-mail].

Date published:	April 1, 2024