Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth All Provider Bulletin 155 June 2006 TO: All Providers Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Expansion of Services for Adult MassHealth Members and Tobacco Cessation Services for Members of All Ages Background Due to a new state law, effective July 1, 2006, MassHealth will cover more services for eligible members aged 21 years or older (adults). MassHealth already covers these services for members under the age of 21. In addition, MassHealth will cover tobacco cessation services for eligible members of all ages who smoke or use other tobacco products, such as chewing tobacco. Eligible Members The new benefits described in this bulletin are available to the MassHealth members listed below. MassHealth providers can determine a member’s coverage type by using the MassHealth Recipient Eligibility Verification System (REVS). New Services for Adults Adults who are enrolled in MassHealth Standard, Prenatal, CommonHealth, Basic, and Family Assistance for persons with HIV are eligible to receive all of the new adult services listed in this bulletin. Adults who are enrolled in MassHealth Essential are eligible to receive all of the new adult services listed in this bulletin, except for vision, chiropractor, and orthotic services. MassHealth Essential does not cover those services. Tobacco Cessation Services Members of all ages enrolled in MassHealth Standard, Prenatal, CommonHealth, 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 tobacco cessation services described in this bulletin. (continued on next page) New Services for Adults Effective July 1, 2006, MassHealth will cover the following services for the eligible adults described on page 1 of this bulletin. Certain conditions and limitations may apply, including but not limited to prior authorization for certain services. Providers of the services listed below should refer to their MassHealth provider manual for specific conditions and limitations. * Dental Services. MassHealth will cover medically necessary dental services including exams, prophylaxis, restorations, certain endodontics, including root canals, and dentures. Some of these services need prior authorization. Adults will no longer have to qualify for special circumstances designation for services that will be provided on or after July 1, 2006. MassHealth will continue to process all requests for special circumstances designation for services that will be provided before July 1, 2006. * Vision Services. MassHealth will cover medically necessary eyeglasses, eyeglass parts, eyeglass dispensing, certain contact lenses, and other visual aids, including magnifying aids. (These vision services are not covered for members enrolled in MassHealth Essential.) Vision exams continue to be covered by MassHealth. * Chiropractor Services. MassHealth will cover medically necessary services provided by a chiropractor. (Services provided by chiropractors are not covered for members enrolled in MassHealth Essential.) * Orthotics. MassHealth will cover medically necessary orthotic services. In addition to other changes, coverage for orthotic shoes will no longer be restricted to members with severe diabetic foot disease. (Orthotic services are not covered for members enrolled in MassHealth Essential.) * Prosthetics. MassHealth will cover medically necessary prosthetic services. * Certain 24-hour substance abuse treatment services. MassHealth will cover 24-hour post-medical detoxification substance abuse treatment services, defined as Level IIIB and Level IIIC by the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services. * Acute inpatient hospital administratively necessary days. MassHealth will cover all administratively necessary inpatient stays. (continued on next page) Tobacco Cessation Services Effective July 1, 2006, MassHealth will cover tobacco cessation services for eligible members of any age described on page 1 of this bulletin who * are enrolled in the coverage types listed on page 1 of this bulletin; and * smoke or use tobacco products, such as chewing tobacco. MassHealth members may receive group or individual counseling by requesting tobacco cessation counseling services from MassHealth physicians, community health centers, and acute hospital outpatient departments (other than the emergency department). In addition, members may request a prescription from their clinician for nicotine replacement products, including nicotine patches, gum, and lozenges. MassHealth will also cover bupropion, a non-nicotine-based drug, to help members quit. MassHealth will issue additional, separate materials with more details about this benefit for providers who are eligible to furnish tobacco cessation services. Member Notice MassHealth has issued a notice to members informing them of these new benefits. To see a copy of the notice, go to our Web site at www.mass.gov/masshealth. Click on Information for MassHealth Members, then on Coverage Updates. Transmittal Letters MassHealth will publish transmittal letters to update the applicable provider manuals that require revision to accommodate the expansion services for adult members and the new tobacco cessation benefit. More detailed information about these added services will be available in the transmittal letters. Watch for these transmittal letters on the Web at www.mass.gov/masshealthpubs. Click on Provider Library, then on Transmittal Letters. These transmittal letters will be posted on the Web by July 1, 2006. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 6179888974.