Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Transmittal Letter IDTF-13 December 2013 TO: Independent Diagnostic Testing Facilities Participating in MassHealth FROM: Kristin L. Thorn, Medicaid Director RE: Independent Diagnostic Testing Facility Manual (Revisions to MassHealth Regulations-Affordable Care Act) This letter transmits revisions to the independent diagnostic testing facility program regulations in Subchapter 4 of the Independent Diagnostic Testing Facility Manual. The revised regulations implement a change in coverage for diagnosis of infertility. This change was prompted by requirements of the Affordable Care Act regarding coverage of Essential Health Benefits. These regulations are effective January 1, 2014. MassHealth Website This transmittal letter and attached pages are available on the MassHealth website at www.mass.gov/masshealth. Questions 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.) Independent Diagnostic Testing Facility Manual Pages 4-5 and 4-6 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Independent Diagnostic Testing Facility Manual Pages 4-5 and 4-6 — transmitted by Transmittal Letter IDTF-1 ? Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 4. Program Regulations (130 CMR 431.000) Page 4-5 Independent Diagnostic Testing Facility Manual Transmittal Letter IDTF-13 Date 01/01/14 (B) If the order is communicated via telephone or electronic message, the treating clinician and the testing facility must document the telephone call or electronic message in their respective copies of the member’s medical records. 431.410: Payment (A) Global Fee. Payment for a diagnostic procedure performed at an IDTF will include facility costs, technical costs, and professional costs. (B) Terminated Procedures. Upon review, the MassHealth agency may pay for procedures that were unable to be completed after the procedure was initiated. 431.411: Service Descriptions and Limitations: Levels of Physician Supervision Independent diagnostic testing facilities must provide the appropriate level of physician supervision for each procedure in accordance with Medicare requirements at 42 CFR §410.323 (b)(3). The definition of each level of physician supervision is set forth in 130 CMR 431.402. 431.412: Service Descriptions and Limitations: Sleep Centers (A) Sleep centers enrolled as IDTFs may bill for at-home pulse oximetry services. The MassHealth agency will pay only for pulse oximetry tests and polysomnography used to determine sleep disorders. (B) For sleep testing to be performed in an IDTF, the supervising physician must be certified by boards in psychiatry and neurology, internal medicine with pulmonary specialty, or in sleep medicine. IDTF technologists must be certified in electroneurodiagnostic testing or registered in polysomnography. 431.413: Covered Services The MassHealth agency pays for IDTF services necessary for the diagnosis, detection, and treatment of disease, and for the maintenance of the health of MassHealth members, subject to all restrictions and limitations described in MassHealth regulations at 130 CMR 431.000 and 450.000. 431.414: Noncovered Services The MassHealth agency does not pay for the following services: (A) tests performed for experimental or investigational purposes, or that are themselves experimental or investigational; and (B) tests performed for forensic purposes or any purpose other than those described in 130 CMR 431.413, including but not limited to: (1) tests performed to establish paternity; and (2) post-mortem examinations ? Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 4. Program Regulations (130 CMR 431.000) Page 4-6 Independent Diagnostic Testing Facility Manual Transmittal Letter IDTF-13 Date 01/01/14 431.415: Recordkeeping Requirements (A) The IDTF is responsible for ensuring the medical necessity of the tests and maintaining test results in the member’s health record. (B) IDTFs must maintain a medical-record system promoting quality and confidential member care in accordance with Massachusetts Department of Public Health regulations at 105 CMR 140.000: Licensure of Clinics. This system must collect and retain data in a comprehensive and efficient manner and permit the prompt retrieval of information. Accurate and complete medical records must be maintained for each member receiving testing services from the IDTF. The data maintained in the member's medical record must also be sufficient to justify any further diagnostic procedures. The medical record must be clear and legible, and readily accessible to health-care practitioners and the MassHealth agency. The medical record must be maintained by the IDTF for at least six years. (C) The medical record must contain, at a minimum, the following information: (1) the member's name, address, telephone number, date of birth, and MassHealth identification number; (2) the date of service; (3) the name, title and signature of the referring clinician; (4) a written order for the tests to be performed; (5) the name, title, and signature of the person performing the service; (6) the name of the supervising physician; (7) pertinent findings on examination; and (8) tests performed and results. REGULATORY AUTHORITY 130 CMR 431.000: M.G.L. c. 118E, §§. 7 and 12