Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER ADH-20 June 2006 TO: Adult Day Health Providers Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Adult Day Health Manual (Removal of Transitional Payment Rate) This letter transmits an amendment to the adult day health regulations, abolishing the transitional payment rate for eligible dementia day service providers. Eligible dementia day service providers are paid at rates established by the Division of Health Care Finance and Policy (DHCFP) pursuant to regulations at 114.3 CMR 10.03. The transitional payment rate was set in August 2002 to pay a limited group of adult day health providers. As of May 2005, the transitional rate was surpassed by rates set by DHCFP, making this portion of the regulation obsolete. This amendment removes the areas of the MassHealth regulations that no longer apply, including service codes established in Subchapter 6 of the Adult Day Health Manual. This transmittal letter and the adult day health regulations are available on the MassHealth Web site at www.mass.gov/masshealth. If you have any questions about the information in this transmittal letter 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. NEW MATERIAL (The pages listed here contain new or revised language.) Adult Day Health Manual Pages 4-21, 4-22, 6-1, and 6-2 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Adult Day Health Manual Pages 4-21 and 4-22 — transmitted by Transmittal Letter ADH-19 Pages 6-1 and 6-2 — transmitted by Transmittal Letter ADH-18 Commonwealth of Massachusetts MassHealth Provider Manual Series Adult Day Health Manual Subchapter Number and Title 4. Program Regulations (130 CMR 404.000) Page 4-21 Transmittal Letter ADH-20 Date 07/01/06 (D) Rates of Payment. (1) Rates for Basic Level of Care and Complex Level of Care. The MassHealth agency pays for basic level of care and complex level of care adult day health services at rates established by the Division of Health Care Finance and Policy. (2) Health Promotion and Prevention Rate (HPPR). The MassHealth agency pays providers at the HPPR for adult day health services to a member who meets the clinical eligibility requirements at the time the member is admitted to the program but who, due to improved health, no longer meets these clinical requirements. 404.415: Conditions of Payment (A) The MassHealth agency pays for adult day health services beginning with the effective date of the authorization. (B) The MassHealth agency pays an adult day health provider for only those attendance days attended by an eligible MassHealth member. (C) The MassHealth agency pays for adult day health services only when the member attends for at least two six-hour days. Members must attend the program at least six hours each day, excluding transportation time to and from the program. Any alteration from this requirement is at the discretion of MassHealth and must be approved. 404.416: Noncovered Services The MassHealth agency does not pay for adult day health services for: (A) individuals who reside in an institutional setting; (B) any canceled program days or any attendance days missed by a member for any reason; and (C) any portion of a day during which the member is absent from the site, unless the program documents that the member was receiving services from the program staff outside of the adult day health site in a community setting. REGULATORY AUTHORITY 130 CMR 404.000: M.G.L. c. 118E, §§ 7 and 12. Commonwealth of Massachusetts MassHealth Provider Manual Series Adult Day Health Manual Subchapter Number and Title 4. Program Regulations (130 CMR 404.000) Page 4-22 Transmittal Letter ADH-20 Date 07/01/06 This page is reserved. Commonwealth of Massachusetts MassHealth Provider Manual Series Adult Day Health Manual Subchapter Number and Title 6. Service Codes and Descriptions Page 6-1 Transmittal Letter ADH-20 Date 07/01/06 601 Service Codes and Descriptions: Per Diem Services Service Code - Modifier Service Description S5102 Day care services, adult; per diem. (Use for adult day health-basic level of care.) S5102-U1 Day care services, adult; per diem. (Use for adult day health-HPPR.) S5102-TG Day care services, adult; per diem. (Use for adult day health-complex level of care.) 602 Service Codes and Descriptions: Transportation Services See 130 CMR 404.413. Service Code - Modifier Service Description T2003 Nonemergency transportation; encounter/trip. (Use for transportation furnished on a single date or on consecutive dates. Bill per one-way trip.) Commonwealth of Massachusetts MassHealth Provider Manual Series Adult Day Health Manual Subchapter Number and Title 6. Service Codes and Descriptions Page 6-2 Transmittal Letter ADH-20 Date 07/01/06 This page is reserved