Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Adult Day Health Bulletin 9
April 2000




TO:	Adult Day Health Providers (Contracted to Provide Dementia Services) 
Participating in MassHealth

FROM:	Mark E. Reynolds, Acting Commissioner

RE:	Reimbursement for Dementia Day-Care Services


Background

In November 1999, the Legislature appropriated $1,014,170 to be used 
for payment of dementia-specific adult day-care services.  This bulletin 
explains the implementation of a new rate for dementia day-care services 
covered under the Home- and Community-Based Services Waiver (Waiver).

Only those providers that have a contract with an Aging Service Access 
Point (ASAP) to provide dementia day-care services may bill MassHealth 
for these services.  Elder Affairs has issued instructions about 
MassHealth member eligibility standards for these services, and how to 
complete required documentation before a provider can bill for dementia 
day-care services.  A copy of the Elder Affairs instructions is attached.

Once member eligibility is established and documentation is completed, 
Elder Affairs will notify providers of the effective date the member is 
enrolled in the Waiver.  Providers may submit claims for dementia day-
care services provided on or after July 1, 1999, only if the member was 
enrolled in the Waiver effective as of the date the service was rendered.  
If the effective date of enrollment in the Waiver is after the start date of 
services, then the provider may submit claims only for dates of service on 
or after the effective date of enrollment in the Waiver.  Providers may not 
submit claims for dementia day-care services rendered before July 1, 
1999.

Dementia Day Rate

The rate for dementia day-care services covered under the Waiver has been 
established at $55 per day, effective July 1, 1999.

MassHealth
Adult Day Health Bulletin 9
April 2000
Page 2

Service Code

The new service code for dementia day-care services is X9842—Administrative 
Rate-Dementia.  When dementia day-care services are billed in conjunction with 
the Adult Day Health (ADH) Service Code X9841, the combined rate is $55.
	
Retroactive Billing

For dates of service for which the provider has already submitted ADH 
claims, the provider must submit claims with the new Service Code
X9842 to receive the difference between the ADH rate for the date of 
service and the dementia-day rate of $55.

When billing for service dates that exceed the Division’s 90-day billing 
deadline requirement, providers must submit their claims with the new 
Service Code X9842 to the 90-Day Waiver Unit at Unisys at the following 
address:
		
90-Day Waiver Unit
P.O. Box 9126
Somerville, MA  02145.
	

Current Billing	

For dates of service for which the provider has not yet submitted ADH claims, 
the provider must submit claims for dementia day care using the standard ADH 
service code and the service code for dementia day-care services—X9842.  These 
current claims can be submitted directly to Unisys.

Questions

If you have any questions about the information in this bulletin, please contact 
the Unisys Provider Services Department at (617) 628-4141 or 1-800-325-5231.