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
TRANSMITTAL LETTER ALL-115
July 2003
TO:      All Providers Participating in MassHealth FROM:      Douglas S. Brown, Acting Commissioner.
RE:      All Provider Manuals (Revision to Covered Services for Aliens with Special Status)
This letter transmits a revision to the regulations concerning MassHealth Basic.
MassHealth Basic coverage is no longer available to certain applicants and members described as aliens with special status (AWSS). This population includes persons residing under color of law (PRUCOL) and qualified aliens who are subject to the five-year bar, as described in 130 CMR 504.002(B) and (D) and 130 CMR 518.002(B) and (D).
These regulations were filed as an emergency and were effective July 14, 2003.
NEW MATERIAL
(The pages listed here contain new or revised language.)
All Providers Manual
Pages 1-7 and 1-8
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
All Providers Manual
Pages 1-7 and 1-8 — transmitted by Transmittal Letter ALL-113

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
1 INTRODUCTION (130 CMR 450.000)	PAGE
1-7	

	TRANSMITTAL LETTER
ALL-115	DATE
07/14/03	
(gg) prosthetic services;
(hh) rehabilitation services;
(ii)   renal dialysis services;
(jj)   speech and hearing services;
(kk) therapy services: physical, occupational, and speech/language;
(ll)   transportation services;
(mm) vision care; and
(nn)   X-ray/radiology services.
 (2)	Managed Care Member Participation. MassHealth Standard members must enroll with a MassHealth managed care provider unless excluded from participation in managed care (see 130 CMR 450.117 et seq. and 130 CMR 508.000) or during a period of presumptive eligibility. (See 130 CMR 505.002(C)(4).)
 (3)	Managed Care Organizations. For MassHealth Standard members who are enrolled in a MassHealth MCO, the following rules apply.

 (a)	The Division will not pay a provider other than the MCO for any services that are covered by the Division’s contract with the MCO, except for family planning services that were not provided or arranged for by the MCO. It is the responsibility of the provider to verify the scope of services covered by the Division’s contract with the MCO.
 (b)	The Division will pay providers other than the MCO for those services listed in 130 CMR 450.105(A)(1) that are not covered by the Division’s contract with the MCO. Such payment is subject to all conditions and restrictions of MassHealth, including all applicable prerequisites for payment.
(4)	Behavioral Health Services.
 (a)	MassHealth Standard members enrolled in the PCC Plan receive behavioral health services only through the Division’s behavioral health contractor. (See 130 CMR 450.124 et seq.)
 (b)	MassHealth Standard members enrolled in an MCO receive behavioral health services only through the MCO. (See 130 CMR 450.117 et seq.)
 (c)	MassHealth Standard members who are excluded from participating in managed care under 130 CMR 508.004 or who have not enrolled in an MCO or with the Division’s behavioral health contractor may receive behavioral health services from any participating MassHealth provider of such services.
(5)	Purchase of Health Insurance. The Division may purchase third-party health insurance
for any MassHealth Standard member if the Division determines such premium payment is
cost-effective. Under such circumstances, the Division will pay a provider only for those
services listed in 130 CMR 450.105(A)(1) that are not available through the member’s third-
party health insurer.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
1 INTRODUCTION (130 CMR 450.000)	PAGE
1-8	

	TRANSMITTAL LETTER
ALL-115	DATE
07/14/03	
(B) MassHealth Basic.
(1)	Covered Services. The following services are covered for MassHealth Basic members
(See 130 CMR 505.006).
 (a)	abortion services;
 (b)	acute inpatient hospital services;
 (c)	ambulatory surgery services;
 (d)	audiologist services;
 (e)	behavioral health (mental health and substance abuse) services;
 (f)	Chapter 766: home assessments and participation in team meetings;
 (g)	chiropractor services; (h) community health center services; (i)   dental services;
(j)   durable medical equipment and supplies; (k) family planning services; (l)   emergency ambulance services; (m) hearing aid services; (n) home health services; (o) laboratory services; (p) nurse midwife services; (q) nurse practitioner services; (r)  orthotic services; (s) outpatient hospital services; (t)   oxygen and respiratory therapy equipment; (u) pharmacy services; (v) physician services; (w) podiatrist services; (x) prosthetic services;
(y) rehabilitation services (except in inpatient hospital settings); (z) renal dialysis services; (aa) speech and hearing services;
(bb) therapy services: physical, occupational, and speech/language; (cc) vision care; and (dd) X-ray/radiology services.
(2)	Managed Care Member Participation. MassHealth Basic members for whom eligibility is
determined under 130 CMR 505.006 must participate in managed care as described in 130
CMR 450.117. These members are eligible to receive services listed in 130 CMR
450.105(B)(1) only after enrolling with a MassHealth managed care provider in accordance
with 130 CMR 508.002(I).