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Coronavirus Disease 2019 (COVID-19) MassHealth Provider FAQ

COVID-19 related questions and answers for MassHealth Providers.
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Frequently Asked Questions

Will there be any payment, operational, or regulatory flexibilities for providers as a result of COVID-19?

In coordination with agencies across the Executive Office of Health and Human Services (EOHHS), MassHealth/ EOHHS have released a number of provider bulletins and additional guidance in response to COVID-19, which can all be found at: https://www.mass.gov/info-details/masshealth-coronavirus-disease-2019-covid-19-providers

MassHealth will continue to communicate any temporary flexibilities related to payment, regulations, program operations, or services on the MassHealth website (see link above).

Specific information for Long Term Services and Supports (LTSS) providers can also be found on this page; LTSS Providers should review both the All Provider Bulletins and the LTSS-provider specific documents, especially the document titled: “MassHealth LTSS Provider Information: Updates Related to the Coronavirus Disease 2019 (COVID-19)”.

Should I still be seeing patients in person?

We strongly encourage providers to deliver services via telehealth when appropriate. MassHealth released an all provider bulletin on March 13, 2020 outlining how to bill for these services: https://www.mass.gov/doc/all-provider-bulletin-289-masshealth-coverage-and-reimbursement-policy-for-services-related-to/download.  Note that the federal government has also relaxed certain requirements related to telehealth: https://www.hhs.gov/about/news/2020/03/17/ocr-announces-notification-of-enforcement-discretion-for-telehealth-remote-communications-during-the-covid-19.html.

If an in-person visit is necessary and cannot be rescheduled, Providers should ensure proper use of personal hygiene precautions and should screen patients for COVID-19 symptoms before seeing them.

Does the guidance expanding telehealth apply to all providers?

Yes, ALL MassHealth providers may deliver any MassHealth covered service via telehealth if they determine it is medically necessary and clinically appropriate to deliver this service via telehealth (including live video or telephone). Among other providers, this includes dentistry, nutrition appointments with registered dietitians, physical therapy, specialist appointments, and behavioral health care (including Opioid Treatment Programs). This guidance also applies to LTSS providers that offer in-person and home-based services when appropriate.

Will MassHealth pay for services delivered via telehealth when provided by Nurse Practitioners (NPs), Physician Assistants (PAs), or physicians in training (residents)

Yes, as long as the midlevel provider or resident could render the service and the service could be billed for under MassHealth rules if it were an in-person visit, the same service can be billed for if delivered via telehealth. Please note that all MassHealth billing rules for in-person visits apply for services delivered via telehealth, such as physicians needing to bill on behalf of PAs, and services rendered by a resident needing oversight from a physician.

Will I be paid the same amount for services delivered via telehealth as I would for services delivered in-person?

Yes, providers will be paid the same rate for services delivered via telehealth as services delivered in-person.

What are MassHealth’s rates for COVID-19 testing?

MassHealth is paying for COVID-19 testing at 100% of the Medicare fee schedule.

For any services delivered via telehealth between March 12, 2020 - April 1, 2020, are providers to hold billing until April 1, 2020?

Providers will be able to bill MassHealth for these services delivered via telehealth beginning April 1, 2020, for dates of service beginning March 12, 2020. Providers should not submit any claims for these services until April 1, 2020 to allow time for MassHealth to implement the appropriate system changes to accept these claims.

Where should I look for the latest information about ways to access Provider Protective Equipment during the COVID-19 emergency?

All providers should regularly check the DPH website, www.mass.gov/2019coronavirus, for information on ways to optimize and access Provider Protective Equipment.

An uninsured patient/client of mine thinks they have COVID-19. What should I tell them about coverage for testing and treatment?

First, make sure that this individual gets medical treatment right away. Once they have received care, they should apply for MassHealth. Patients can apply online, at www.mahealthconnector.org or call the MassHealth Customer Service Center at (800) 841-2900 TTY: (800) 497-4648. If they are approved for MassHealth, their coverage may be retroactive 10 days prior to the date the application is received.

In addition, if you are a provider at a hospital that is certified for Hospital Presumptive Eligibility, your financial services department can make an on-site MassHealth eligibility determination for certain individuals and their coverage will start on the day that the qualified hospital makes the presumptive eligibility determination. 

Does MassHealth Limited cover COVID-19 testing and treatment?

MassHealth considers COVID-19-related services, including testing and treatment, to be emergency services, and will cover these services for MassHealth Limited members. 

Does the Health Safety Net (HSN) cover COVID-19 testing and treatment?

HSN will pay for COVID-19 testing and treatment provided by hospitals and community health centers.

One of my patients/clients is concerned that COVID-19 testing or treatment will impact their ability to get a green card or change their immigration status because of the public charge rule. What should I tell them?

U.S. Citizenship and Immigration Services (USCIS) has issued guidance that it will not consider testing, treatment, or preventive care related to COVID-19 as part of a public charge inadmissibility determination for immigrants or certain nonimmigrants seeking an extension of stay or change of status even if such treatment is provided or paid for by one or more public benefits, as defined in the rule (e.g. federally funded Medicaid).   

Individuals with symptoms that resemble COVID-19 (fever, cough, shortness of breath) should not forego medical care and are encouraged to seek necessary medical treatment or preventive services. 

I am a Personal Care Attendant and would like to work overtime hours to help support clients whose PCAs are unavailable due to COVID-19. Can I still get paid for that time?

Yes, MassHealth has temporarily suspended PCA overtime limits, and until further notice, a consumer may schedule a PCA to work overtime without a prior authorization (PA).

Prior authorizations are required for at least some of the services I provide to MassHealth members.  Can I expect any delays in usual PA processing timeframes? ​

 

MassHealth is working closely with Optum, a third party administrator, to ensure continued timely processing of PAs.  At this time, MassHealth does not anticipate any delays in the standard PA adjudication process or notifications to providers and members. ​ Expedited PAs submitted under new temporary flexibility guidelines to address the COVID-19 virus are being handled on a case-by-case basis and as expeditiously as possible.  

 

I am an LTSS provider who provides in-home services. Where do I find guidance?

Please refer to the two important websites:

I am an LTSS provider who provides services in a community day program setting (e.g., Adult Day Health, Day Habilitation). Where do I find guidance?

Please refer to the two important websites:

 

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