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 SAT-12 March 2003
TO:      Substance Abuse Treatment Providers Participating in MassHealth
FROM:      Douglas S. Brown, Acting Commissioner
RE:      Substance Abuse Treatment Manual (Revisions to Program Regulations)
The Division is revising its regulations at 130 CMR 418.000 to limit payment for Levels III-B and III-C acute inpatient substance abuse treatment services only to MassHealth members under age 21 and to include a definition of enhanced acute inpatient substance abuse treatment services for pregnant MassHealth members.
These regulations are effective April 1, 2003. Coverage for MassHealth members aged 21 and older for Levels III-B and III-C acute inpatient substance abuse treatment services will end on March 31, 2003.
The Division is also removing Appendix D (SAT Services for Pregnant Recipients) from the Substance Abuse Treatment Manual. The Substance Abuse Treatment Special Services for Pregnant Recipients Notification Form (GEN-20) is now obsolete.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Substance Abuse Treatment Manual
Pages vi, vii, and 4-1 through 4-4
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Substance Abuse Treatment Manual
Page vi — transmitted by Transmittal Letter SAT-10
Pages 4-1 and 4-2 — transmitted by Transmittal Letter SAT-9
Pages 4-3 and 4-4 — transmitted by Transmittal Letter SAT-11
Pages D-1 and D-2 — transmitted by Transmittal Letter SAT-7

Commonwealth of Massachusetts
Medical Assistance Program
Provider Manual Series
SUBSTANCE ABUSE TREATMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
TABLE OF CONTENTS	PAGE
vi	

	TRANSMITTAL LETTER
SAT-12	DATE
04/01/03	
6.   SERVICE CODES AND DESCRIPTIONS
Service Codes and Descriptions 		6-1
Appendix A.     DIRECTORY 		A-1
Appendix B.     ENROLLMENT CENTERS 		B-1
Appendix C.     THIRD-PARTY-LIABILITY CODES 		C-1
Appendix E.     MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM 		E-1
Appendix W.    EPSDT SERVICES: MEDICAL PROTOCOL AND
PERIODICITY SCHEDULE 		W-1
Appendix X.     FAMILY ASSISTANCE COPAYMENTS AND DEDUCTIBLES 		X-1
Appendix Y.     REVS CODES/MESSAGES 		Y-1
Appendix Z.     EPSDT SERVICES LABORATORY CODES 		Z-1

Commonwealth of Massachusetts
Medical Assistance Program
Provider Manual Series
SUBSTANCE ABUSE TREATMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
PREFACE	PAGE
vii	

	TRANSMITTAL LETTER
SAT-12	DATE
04/01/03	
The regulations and instructions of the Division of Medical Assistance governing provider participation in MassHealth are published in the Provider Manual Series. The Division publishes a separate manual for each provider type.
Each manual in the series contains administrative regulations, billing regulations, program regulations, service codes and descriptions, billing instructions, and general information. The Division's regulations are incorporated into the Code of Massachusetts Regulations (CMR), a collection of regulations promulgated by state agencies within the Commonwealth and by the Secretary of State. Regulations promulgated by the Division of Medical Assistance are assigned Title 130 of the Code. The regulations governing provider participation in MassHealth are assigned Chapters 400 through 499 within Title 130. Pages that contain regulatory material have a CMR chapter number in the banner beneath the subchapter number and title.
Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR Chapter 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals.
Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. For substance abuse treatment services, those matters are covered in 130 CMR Chapter 418.000, reproduced as Subchapter 4 in the Substance Abuse Treatment Manual.
Revisions and additions to the manual are made as needed by means of transmittal letters, which furnish instructions for making changes by hand ("pen-and-ink" revisions), and by substituting, adding, or removing pages. Some transmittal letters will be directed to all providers; others will be addressed to providers in specific provider types. In this way, a provider will receive all those transmittal letters that affect its manual, but no others.
The Provider Manual Series is intended for the convenience of providers. Neither this nor any other manual can or should contain every federal and state law and regulation that might affect a provider's participation in MassHealth. The provider manuals represent instead the Division's effort to give each provider a single convenient source for the essential information providers need in their routine interaction with the Division and with MassHealth members.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBSTANCE ABUSE TREATMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 418.000)	PAGE
4-1	

	TRANSMITTAL LETTER
SAT-12	DATE
04/01/03	
418.401: Introduction
130 CMR 418.000 establishes the requirements for services provided by public and private substance abuse treatment programs reimbursable under MassHealth in the treatment of substance dependency.
418.402: Definitions
The following terms used in 130 CMR 418.000 have the meanings given in 130 CMR 418.402 unless the context clearly requires a different meaning. The reimbursability of services defined in 130 CMR 418.400 is not determined by these definitions, but by the application of regulations elsewhere in 130 CMR 418.000 and in 130 CMR 450.000.
Acupuncture Detoxification — the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, with or without the application of an electric current, and with or without the application of heat to the needles, skin, or both, in an attempt to withdraw an individual from dependence on substances.
Acute Inpatient Substance Abuse Treatment Services — short-term medical treatment for substance withdrawal, individual medical assessment, evaluation, intervention, substance abuse counseling, and postdetoxification referrals provided by an inpatient unit, either freestanding or hospital-based, licensed as an acute inpatient substance abuse treatment service by the Massachusetts Department of Public Health under its regulations at 105 CMR 160.000 and 161.000. These services are delivered in a three-tiered system consisting of Levels III-A through III-C that must conform with the standards and patient placement criteria issued and enforced by the Massachusetts Department of Public Health's Bureau of Substance Abuse Services.
Case Consultation —
 (1)	Case consultation is a preplanned meeting of at least one-half hour's duration between the substance abuse treatment provider and other providers of treatment concerning a member who is a client of the substance abuse treatment provider.
 (2)	The purpose of case consultation must be one or more of the following:

 (a)	identify and plan for additional services;
 (b)	coordinate a treatment plan with other providers involved in the member's care;
 (c)	review the member’s progress; or
 (d)	revise the treatment plan as required.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBSTANCE ABUSE TREATMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 418.000)	PAGE
4-2	

	TRANSMITTAL LETTER
SAT-12	DATE
04/01/03	
Couple Counseling — rehabilitative counseling provided to a couple whose primary complaint is disruption of their relationship or family due to substance abuse.
Enhanced Acute Inpatient Substance Abuse Treatment Services — a program to detoxify pregnant women from alcohol or drugs that involves special medical protocols to address the needs of pregnancy and that includes other medical and support components to ensure quality of both substance abuse treatment and obstetrical care.
Family Counseling — rehabilitative counseling of more than one member of a family at the same time in the same session, where the primary complaint is disruption of the family due to substance abuse.
Group Counseling — rehabilitative counseling of a group of individuals, most of whom are not related by blood, marriage, or legal guardianship, having a primary complaint that is associated with substance abuse.
Individual Counseling — rehabilitative counseling provided to an individual whose primary complaint is substance abuse.
Methadone Detoxification — the withdrawal of an individual from dependence on heroin or other opiate-like drugs by means of administering or dispensing methadone as a narcotic drug in decreasing dosages in accordance with U.S. Food and Drug Administration regulations.
Methadone Maintenance — the continued administering or dispensing of methadone in conformance with U.S. Food and Drug Administration regulations and in conjunction with the provision of appropriate social and medical services. The methadone is administered at a relatively stable dosage level to an individual dependent on heroin or other opiate-like drugs as an oral substitute for heroin or other opiate-like drugs.
Methadone Treatment Program — a drug treatment program that furnishes a comprehensive range of services using methadone for the detoxification or maintenance of narcotic-dependent individuals, conducts the initial evaluation of individuals, and provides ongoing treatment at a specified location or locations.
Motivational and Supportive Services — counseling as a component of acupuncture detoxification that:
 (1)	encourages the individual to remain in acupuncture detoxification treatment;
 (2)	assists the individual to obtain necessary medical and social services;
 (3)	includes AIDS (acquired immune deficiency syndrome) risk assessment and education services; and
 (4)	motivates the individual to participate in ongoing outpatient substance abuse treatment.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBSTANCE ABUSE TREATMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 418.000)	PAGE
4-3	

	TRANSMITTAL LETTER
SAT-12	DATE
04/01/03	
Nurse Practitioner — an individual licensed in accordance with M.G.L. c. 112, s. 80B, and knowledgeable in the field of substance addiction.
Physician Assistant — an individual licensed in accordance with M.G.L. c. 112, s. 9G, and knowledgeable in the field of substance addiction.
Pregnant Member — for purposes of these regulations, a MassHealth member qualifies for services as a pregnant member from the time her pregnancy is clinically verified until the end of the calendar month in which the 60-day postpartum period ends.
Registered Nurse — an individual licensed by the Massachusetts Board of Registration in Nursing in accordance with M.G.L. c. 112, s. 74, and knowledgeable in the field of substance addiction.
Substance Abuse Outpatient Counseling Service — an outpatient counseling service that is a rehabilitative treatment service for individuals and their families experiencing the dysfunctional effects of the use of substances.
418.403: Eligible Members
(A)	(1) MassHealth Members. The Division covers substance abuse treatment services only
when provided to eligible MassHealth members, subject to the restrictions and limitations
described in the Division’s regulations. The Division’s regulations at 130 CMR 450.105
specifically state, for each MassHealth coverage type, which services are covered and which
members are eligible to receive those services.
 (2)	Age Limitations. In addition to any other restrictions and limitations set forth in 130 CMR 418.000 and 450.000, the Division covers the following services only when provided to eligible MassHealth members under age 21: Levels III-B and III-C Acute Inpatient Substance Abuse Treatment Services.
 (3)	Recipients of the Emergency Aid to the Elderly, Disabled and Children Program. For information on covered services for recipients of the Emergency Aid to the Elderly, Disabled and Children Program, see 130 CMR 450.106.
(B)	For information on verifying member eligibility and coverage type, see 130 CMR 450.107.
(C)	The Division pays for special services for eligible pregnant members. Special services for
pregnant members are subject to the requirements set forth in 130 CMR 450.124.
(D)	See 130 CMR 450.124 for limitations on mental health and substance abuse services
provided to members enrolled with a MassHealth managed care provider.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBSTANCE ABUSE TREATMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 418.000)	PAGE
4-4	

	TRANSMITTAL LETTER
SAT-12	DATE
04/01/03	
418.404: Provider Eligibility
Payment for services described in these regulations will be made only to providers of substance abuse treatment services who are participating in MassHealth on the date of service. The eligibility requirements for providers of substance abuse treatment services are as follows.
(A)	In State. The following requirements apply when the provider is located in Massachusetts.
 (1)	Methadone Treatment Program. A provider who furnishes methadone detoxification and methadone maintenance services must be licensed as a methadone treatment program by the Massachusetts Department of Public Health under its regulations at 105 CMR 750.000.
 (2)	Acute Inpatient Substance Abuse Treatment Services. A provider who furnishes acute inpatient substance abuse treatment services must be licensed or approved, or both, as a provider of acute inpatient substance abuse treatment services by the Massachusetts Department of Public Health pursuant to its regulations at 105 CMR 160.000 and 161.000.
 (3)	Substance Abuse Outpatient Counseling Program. A provider who furnishes substance abuse outpatient counseling services must be licensed by the Massachusetts Department of Public Health to provide such services under its regulations at 105 CMR 162.000. These services include counseling services and acupuncture detoxification.
 (4)	Special Services for Pregnant Members. A provider who furnishes intensive outpatient, day treatment, or case management services must be approved by the Massachusetts Department of Public Health to provide each of those services under its regulations at 105 CMR 162.000. A provider who furnishes enhanced acute inpatient substance abuse treatment services must be approved by the Massachusetts Department of Public Health to provide such services under its regulations at 105 CMR 160.000 and 161.000.
(B)	Out of State. To participate in MassHealth, an out-of-state substance abuse treatment
program must obtain a MassHealth provider number and meet the following criteria: