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

MassHealth
Psychiatric Inpatient Hospital Bulletin 18
November 1999

TO:      Psychiatric Inpatient Hospitals Participating in MassHealth

FROM:      Mark E. Reynolds, Acting Commissioner

RE:      Psychiatric Inpatient Hospital Services for Eligible MassHealth Members Aged 21
through 64 Not Enrolled in Managed Care

Coverage for                     Effective October 1, 1998, the Division expanded coverage to include MassHealth Members         psychiatric inpatient hospital services provided to eligible MassHealth Aged 21-64                        members aged 21 through 64 not enrolled in managed care.  Psychiatric Not Enrolled in                   inpatient hospital services for eligible MassHealth members in this age Managed Care                   group are covered up to a maximum of 30 consecutive days per member
per admission, and 60 total days per member per year.  For the purpose of this expanded coverage, a year was defined as the period of 365 consecutive days prior to the date of an admission to a psychiatric inpatient hospital.

This policy applies only to services provided on a fee-for-service basis by both state-owned and private psychiatric inpatient hospitals.  Services provided to members enrolled in a managed care organization or in the Behavioral Health Plan are not included.

Counting Psychiatric          Effective October 1, 1999, the Division will not count toward these length-
Inpatient Days                   of-stay limits any day for which it has paid only the Medicare Part A coinsurance, deductible, or both.  Once a MassHealth member’s Medicare Part A psychiatric inpatient hospital benefits have been exhausted, all other days for which the Division makes payment will be counted toward these service limitations.

MassHealth Psychiatric Inpatient Hospital Bulletin 18
November 1999
Page 2

Definition of a Year            For the purpose of counting psychiatric inpatient hospital days toward these length-of-stay limits, the Division has revised the definition of a
“year” to be the calendar year in which the psychiatric inpatient hospital services were provided.  For example, the period January 1, 2000, through December 31, 2000 (Calendar Year 2000) would be considered a
“year” when counting these days.  Eligible MassHealth members aged 21 through 64 will be covered up to a maximum of 30 consecutive days per member per admission, and 60 total days per member per calendar year.

Billing Instructions            There are no changes to the billing procedures for psychiatric inpatient hospital services.

SC-1 Form                         When admitting members aged 65 and older, you must complete the
SC-1 Form and submit it to the following address.

MassHealth Enrollment Center
300 Ocean Avenue, Suite 4000
Revere, MA  02151

Exception:  When admitting a member on medical leave of absence from a nursing facility, psychiatric inpatient hospitals are no longer required to submit an SC-1 Form.

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