Guidance for All Providers
In response to COVID-19, MassHealth has taken steps to create flexibilities for providers, expand benefits including coverage of services delivered via telehealth, and expand eligibility for residents of the Commonwealth. The below guidance applies to all MassHealth providers.
- COVID-19 Health Care Provider Financial Relief Package will support health care providers impacted by and responding to the COVID-19 public health emergency. Through MassHealth, Baker-Polito Administration is distributing over $800 million in critical stabilization funding to the Commonwealth’s vital providers. PDF | Word
- All Provider Bulletin 291: MassHealth Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19) builds off of Bulletin 289 to create additional flexibilities including: relaxing referral requirements, further expanding HPE, allowing medication delivery and waiving pharmacy signature requirements, and providing guidance for Emergency Services Program (ESP) and Mobile Crisis Intervention (MCI) Services PDF | Word
- All Provider Bulletin 290: Coverage Provided via Hospital-Determined Presumptive Eligibility expands eligibility for HPE to include individuals who have received HPE benefits in the past 12 months. PDF | Word
- All Provider Bulletin 289: MassHealth Coverage Reimbursement Policy for Service Related to Coronavirus Disease 2019 creates flexibilities for providers including: covering services delivered via telehealth, covering 90-day supplies and early refills of prescriptions, and billing information for quarantine in hospitals. PDF | Word
- All Provider Bulletin 288: Coverage Provided via Hospital-Determined Presumptive Eligibility expands eligibility for HPE for individuals diagnosed with or presumptive COVID-19 to include individuals who have received HPE benefits in the past 12 months. PDF | Word
- On April 7, Massachusetts submitted a second 1135 waiver request to CMS, requesting additional flexibilities for the health care system. PDF | Word
- On March 26, the Centers for Medicare and Medicaid Services (CMS) approved Massachusetts’ 1135 Waiver, granting the Commonwealth additional flexibilities for the health care system, including MassHealth, and removing barriers that interfere with needed services. Massachusetts’ 1135 Waiver can be found here: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/index.html
- On March 20, Massachusetts submitted its 1135 Waiver request to CMS PDF | Word
- MassHealth Provider Resource: Telephone and Internet Connectivity for Telehealth aims to help providers guide members who want to receive services via telehealth during the COVID-19 emergency, but have concerns about limited phone and internet access. PDF | Word
Guidance for Managed Care Entities
Guidance for Managed Care Entities (Accountable Care Organizations, Managed Care Organizations, Senior Care Organizations, etc.) Bulletins and Guidance
In response to COVID-19, MassHealth Managed Care Entities (MCEs) are required to provide services and support provider flexibilities at the same level and rate as MassHealth’s fee for service program.
- Managed Care Entity Bulletin 22: Updated Coverage and Payment Policies builds off of Bulletin 21 and further requires MCEs to implement provider flexibilities, including several pharmacy requirements PDF | Word
- Managed Care Entity Bulletin 21: Coverage and Reimbursement for Services Related to Coronavirus Disease 2019 (COVID-19) requires MCEs to implement provider flexibilities and cover additional services including: covering services provided via telehealth, relaxing referral and prior authorization requirements, and create a dedicated helpline to support members with questions about COVID-19 PDF | Word
Guidance for Health Safety Net
The Health Safety Net will cover all necessary testing and treatment related to COVID-19, and the program will implement additional flexibilities as described in the guidance below.
- Administrative Bulletin: 20-09: 101 CMR 613.00: Health Safety Net Eligible Services; 101 CMR 614.00: Health Safety Net Payments and Funding: Health Safety Net Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19) establishes provider flexibilities and expanded coverage consistent with MassHealth’s fee for service program PDF | Word
- Application for Health Safety Net (HSN) Presumptive Determination PDF | Word
Guidance for Pharmacies
In response to COVID-19, MassHealth is allowing early refills and 90-day supplies, as well as medication delivery. Pharmacies should review all Pharmacy Facts for the most updated guidance on how to implement these policies.
- Pharmacy Facts 143: Coronavirus Disease 2019 (COVID-19) and New Policies on Chloroquine and Hydroxychloroquine—Effective for Dates of Service on or after March 26, 2020 PDF | Word
- Pharmacy Facts 142: Additional Updates Related to Coronavirus Disease 2019 (COVID-19 Effective Immediately PDF | Word
- Pharmacy Facts 141: Updates Related to Coronavirus Disease 2019 (COVID-19) Effective March 14, 2020 PDF | Word
- For additional guidance related to COVID-19 and MassHealth’s pharmacy program, visit: https://masshealthdruglist.ehs.state.ma.us/MHDL/
Guidance for Clinical Laboratories
MassHealth covers all clinical laboratory testing, including COVID-19 testing.
- Administrative Bulletin 20-13: 101 CMR 320.00: Clinical Laboratory Services (Eff. March 12, 2020) PDF | Word
- Transmittal Letter LAB-51: Independent Clinical Laboratory Manual (Diagnostic Tests for COVID-19) PDF | Word
- Administrative Bulletin 20-08:101 CMR 320.00: Clinical Laboratory Services: Procedure Code Update (Eff. March 12, 2020) PDF | Word
- Transmittal Letter LAB-50 (Updated): Independent Clinical Laboratory Manual (Diagnostic Tests for COVID-19) PDF | Word
Guidance for Long Term Services and Supports (LTSS) Providers
During the COVID-19 emergency, LTSS providers play an important role in serving some of MassHealth’s most vulnerable members. Coupled with the guidance for all providers, LTSS providers can access guidance for their specific programs below.
- MassHealth LTSS Provider Information: Updates Related to the Coronavirus Disease 2019 (COVID-19) PDF | Word
- Home Health Agency Bulletin 56: Temporary Expansion of Home Health Aide Services PDF | Word
- 2019 Novel Coronavirus (COVID-19) Guidance for Integrated Care Programs: One Care, Program of All-inclusive Care for the Elderly (PACE), and Senior Care Options (SCO) PDF | Word
- Guidance for in-home caregivers
- Guidance for community day programs
- Guidance for long term care facilities
Guidance for Behavioral Health Providers
During the COVID-19 emergency, access to behavioral health care is vital. Coupled with the guidance for all providers, behavioral health providers can access specific guidance, including information about telehealth services below.
Guidance for Transportation Brokers & Drivers
During the COVID-19 emergency, transportation brokers and drivers should support telehealth options for their consumers whenever possible, and refer to the guidance below on how to serve consumers safely.
MassHealth has established new procedure and service codes for ambulance services related to COVID-19, as described in the Administrative Bulletin and Transmittal Letter below:
Guidance on MassHealth Eligibility & Applications during COVID-19
- COVID-19 Assister Guidance PDF | Word
- Eligibility Operations Memo 20-09: MassHealth Response to Coronavirus Disease 2019 (COVID-19) PDF | Word
- Eligibility Operations Memo 20-07: Updates to Hospital-Determined Presumptive Eligibility (HPE) Application Process PDF | Word
- Eligibility Operations Memo 20-06: Updates to the Hospital-Determined Presumptive Eligibility (HPE) Application Process PDF | WORD
Guidance for Telehealth Network Providers
In response to COVID-19, MassHealth has established a new temporary provider type called Telehealth Network Providers (TNPs), with the primary purpose of having these providers support member triage related to COVID-19. The following guidance is specific to these new providers.