Commonwealth of Massachusetts Executive Office of Health and Human Services Division of Medical Assistance 600 Washington Street Boston, MA 02111 www.mass.gov/dma MassHealth Acute Outpatient Hospital Bulletin 20 July 2007 TO: Acute Outpatient Hospitals Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Medical Nutrition Therapy and Diabetes Self Management Training MNT/DSM Coverage Effective for dates of service on or after July 1, 2007, MassHealth is reimbursing acute outpatient hospitals for medical nutrition therapy (MNT) and diabetes self-management training (DSMT). Members of all ages enrolled in MassHealth Standard, Prenatal, CommonHealth, and Family Assistance for persons with HIV, and members who get direct coverage (not premium assistance) for MassHealth Basic, Essential, and Family Assistance for children are eligible to receive MNT and DSMT services described in this bulletin. These changes will be further reflected in revised regulations to be issued within the coming months. Changes described in this bulletin, however, are effective July 1, 2007, regardless of the effective date of the regulations. Additional information is provided below. Medical nutritional therapy is nutritional diagnostic therapy and counseling services for the purpose of management of a medical condition. MNT services are payable when provided to eligible MassHealth members by the following providers: -physicians; -dietitians/nutritionists licensed by the Massachusetts Division of Professional Licensure, and the Board of Registration of Dieticians and Nutritionists; -mid-level practitioners credentialed by the Commission on Dietetic Registration (CDR) (e.g., nurse-midwives, nurse practitioners, registered nurses, and physician assistants); or -other health-care roviders licensed by the Massachusetts Division of Professional Licensure, Board of Registration of Dietitians and Nutritionists, with specific training in the provision of nutritional counseling as provided in 42 U.S.C. 1395x(vv)(2). (continued on back) MassHealth Acute Outpatient Hospital Bulletin 20 July 2007 Page 2 MNT/DSM Coverage (cont.) Diabetes self-management training is diabetes self-management training and education, which may include medical nutrition therapy, and are furnished to an individual with pre-diabetes or diabetes. DSMT services are payable when provided to eligible MassHealth members by the following providers: -physicians; -dietitians/nutritionists licensed by the Massachusetts Division of Professional Licensure, Board of Registration of Dieticians and Nutritionists; -mid-level practitioners credentialed by the Commission on Dietetic Registration (CDR) (e.g., nurse-midwives, nurse practitioners, registered nurses, physician assistants); or-other health-care providers with specific training in the provision of DSMT as provided in 42 U.S.C. 1395x(qq)(2). Acute outpatient hospitals (AOHs) will receive the PAPE (clinic visit rate/facility rate) for MNT and DSMT services. AOHs may not bill separately for MNT or DSMT services provided by mid-level practitioners, as it will be included in the PAPE rate. Hospital staff or physicians who supervise MNT or DSMT providers must ensure that those practitioners providing the services possess the appropriate training. Covered Service Codes The following codes are covered for MNT services for dates of service on or after July 1, 2007: 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. 97803 Medical nutrition therapy;re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes. 97804 Medical nutrition therapy;groups (2 or more individuals), each 30 minutes G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes. (continued on next page) MassHealth Acute Outpatient Hospital Bulletin 20 July 2007 Page 3 Covered Service Codes (cont.) G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes. The following codes are covered for members with a diagnosis of diabetes for DSMT services for dates of service on or after July 1, 2007: G0108 Diabetes self-management training services, individual, per 30 minutes G0109 Diabetes self-management training services, group session (2 or more individuals), per 30 minutes. MNT and DSMT services will be paid within the PAPE rate established for each provider.Members enrolled in the PCC Plan do not need a PCC referral for MNT or DSMT services. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900 or e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.