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 195 June 2009 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Changes for Access to Behavioral-Health Services for Certain MassHealth Members Background Effective July 1, 2009, MassHealth is revising the regulations at 130 CMR 508.000 and 450.105 to change the managed care enrollment rules for MassHealth Standard and CommonHealth members under the age of 21. Under these proposed regulations, most Standard and CommonHealth members under the age of 21 who currently receive behavioral-health services on a fee-for-service basis, including those who have comprehensive third-party insurance or Medicare, will be required to enroll in the MassHealth behavioral health (mental health and substance abuse) managed-care plan, currently the Massachusetts Behavioral Health Partnership (MBHP). MassHealth members affected by these proposed changes will receive their behavioral-health services through MBHP, but will continue to receive all other MassHealth-covered services on a fee-for-service basis. Certain members under the age of 21, including members receiving services under the Kaleigh Mulligan Program or through the Home- and Community- Based Waiver Program, will be able to receive their behavioral-health services through the MassHealth fee-for-service network if they choose. Enrollment of Members in MBHP In July 2009, affected members will receive a letter from MassHealth informing them that they have been enrolled in MBHP. The mailing will include the MBHP Member Handbook, which explains their MBHP behavioral-health benefits. These members will be required to access their behavioral-health services through MBHP network providers. The regulations at 130 CMR 450.105 list the services covered for each MassHealth coverage type. (continued on next page) Using EVS to Identify Members Enrolled in MBHP In NewMMIS, providers may determine if a member is enrolled in MBHP by checking the Eligibility Verification System (EVS), formerly known as REVS. MassHealth uses EVS for day-specific eligibility verification and to communicate a member’s MassHealth eligibility, coverage type, managed-care status, restrictions, and other insurance information to health-care providers. Becoming an MBHP Network Provider If you want to continue to be paid for seeing your MassHealth patients who are being enrolled in MBHP, you must be enrolled in the MBHP provider network. If you are not currently enrolled in the MBHP provider network and would like to learn more about becoming an MBHP provider, you should contact MBHP at 1-800- 495-0086. Choose option 1 for English or option 2 for Spanish. Then choose option 3 and then option 1 to speak to someone in MBHP Community Relations. Service Authorizations from MBHP Providers who are enrolled in the MBHP provider network must follow MBHP service authorization policies to obtain authorization for behavioral- health services for members enrolled in MBHP. Please refer to the MBHP policy and procedure manual or call MBHP Community Relations at 1-800-495-0086 to learn more about MBHP service authorization procedures. MassHealth providers who are not currently enrolled in the MBHP provider network should contact MBHP at 1-800-495-0086 to obtain service authorization. Choose option 1 for English or option 2 for Spanish. Then choose option 2 and enter extension 455634 at the prompt. MBHP Coordination with Third-Party Coverage MBHP will provide further instructions to its network providers about how it will coordinate benefits for members enrolled in MBHP who also have comprehensive third-party insurance coverage or Medicare. In general, since MassHealth is the secondary payer, claims to MBHP must be submitted with an explanation of benefits (EOB) from the source of the primary insurance coverage. For more information on how to submit claims for MBHP for members who have other comprehensive insurance coverage, providers should contact MBHP at 1-800-495- 0086. Choose option 1 for English or option 2 for Spanish. Then choose option 3 and then option 1 to speak to someone in MBHP Community Relations. 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 617-988-8974.