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MassHealth Guidelines for Medical Necessity Determination for Augmentative and Alternative Communication Devices and Speech Generation Devices

The MassHealth Guidelines for Medical Necessity Determination (Guidelines) are used by MassHealth's reviewing clinicians to determine the medical necessity of prior-authorization requests submitted by providers.

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Guidelines for Medical Necessity Determination for Augmentative and Alternative Communication Devices and Speech Generation Devices

These Guidelines for Medical Necessity Determination (“Guidelines”) identify the clinical information that MassHealth needs to determine medical necessity for coverage of augmentative and alternative communication (AAC) or speech generation devices. MassHealth bases these Guidelines on generally accepted standards of practice, review of the medical literature, and federal and state policies and laws applicable to Medicaid programs.

Providers should consult MassHealth regulations at 130 CMR 409.000, giving particular attention to Section 409.428. Providers serving members enrolled in a MassHealth-contracted managed care organization (MCO) or a MassHealth-contracted integrated care organization (ICO) should refer to the MCO’s or ICO’s medical policies for covered services.

MassHealth reviews requests for prior authorization (PA) on the basis of medical necessity. If MassHealth approves the request, payment is still subject to all general conditions of MassHealth, including member eligibility, other insurance, and program restrictions.

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