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MassHealth: Coronavirus Disease 2019 (COVID-19)—Providers

COVID-19 related information for MassHealth Providers.

 

 

Table of Contents

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 299: Hospital-Determined Presumptive Eligibility (HPE) Updates during COVID-19 Emergency provides clarification to the HPE policies laid out in All Provider Bulletin 295, specifically that an individual may have up to two HPE periods within a 12 month period and that individuals receiving HPE benefits are ineligible for the eligibility protection rules set forth in Eligibility Operations Memo 20-09. PDF | Word
  • MassHealth All Provider Bulletin 298: MassHealth Telehealth Policy reinstates and extends MassHealth's current telehealth policy (as reflected in All Provider Bulletins 289, 291, and 294) until December 31, 2020, with some modifications. This extended policy will help ensure members retain access to covered services, promote social distancing, and mitigate the spread of COVID-19. Note: this bulletin does not apply to MassHealth programs overseen by the Office of Long Term Services and Supports, which will publish separate guidance on telehealth. PDF | Word
  • MassHealth All Provider Bulletin 296:  MassHealth Payment for COVID-19 Specimen Collection and Testing provides additional guidance for providers regarding payment for specimen collection for purposes of testing for COVID-19 and certain related services​, supplementing All Provider Bulletin 294. PDF | Word
  • All Provider Bulletin 295: Hospital-Determined Presumptive Eligibility (HPE) Flexibilities during COVID-19 Emergency provides guidance on expanded HPE flexibilities for all individuals meeting the eligibility criteria for MassHealth Standard coverage. PDF | Word
  • All Provider Bulletin 294: MassHealth Coverage Flexibilities  for Services Related to Coronavirus Disease 2019 ​ provides guidance for providers regarding additional flexibilities including, billing for services rendered to dual-eligible members via audio-only telehealth, coverage and billing for remote patient monitoring, and billing for preventive visits for children and adults. PDF | Word
  • All Provider Bulletin 293: Flexibilities for Substance Use Disorder Treatment Services During COVID-19 State of Emergency ​provides guidance regarding flexibilities for facilities that provide 24-hour substance use disorder treatment and MassHealth providers licensed by the Department of Public Health’s Bureau of Substance Addiction Services. ​PDF | Word
  • All Provider Bulletin 292: Billing Policies for Coronavirus Disease 2019 (COVID-19) Testing and Treatment Services for Uninsured Individuals and MassHealth Limited Members provides guidance regarding how providers should bill for COVID-19 testing and treatment services for uninsured patients and MassHealth Limited members in light of the federal government's claims submission program for uninsured residents. 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 June 17, the CMS approved Massachusetts' second 1915(c) Appendix K Emergency Preparedness Response and COVID-19 Addendum, granting the Commonwealth additional flexibilities for the operation of Home and Community Based Services (HCBS) waivers. PDF | Word
  • On April 29, the Centers for Medicare and Medicaid Services (CMS) approved Massachusetts' 1915(c) Appendix K Emergency Preparedness Response and COVID-19 Addendum, granting the Commonwealth additional flexibilities for the operation of Home and Community Based Services (HCBS) waivers. PDF | Word
  • On April 24, Massachusetts submitted an 1115 Waiver request ​to provide MassHealth additional flexibilities to best respond to the COVID-19 public health emergency PDF | Word
  • On April 23, Massachusetts submitted a third 1135 waiver request to CMS, requesting additional flexibilities for the health care system. 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: Connecting Your Patients with Food Resources: ​During the COVID-19 public health emergency, a growing number of families across Massachusetts face food insecurity, many for the first time. This guide will help providers identify patients with food insecurity and connect them with resources in the community. PDF | Word  Spanish: PDF | Word
    You can also visit https://www.mass.gov/lists/covid-19-food-assistance​ for more information on food assistance available during COVID-19. 
  • 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.

  • MassHealth Community Partner Information: Updates Related to the Coronavirus Disease 2019 (COVID-19) PDF | Word
  • Managed Care Entity Bulletin 35: Temporary Rate Increases due to COVID-19 National Emergency directs One Care plans, Senior Care Organizations (SCOs), and PACE organizations to institute temporary rate increases​ for a number of providers including Residential Rehabilitative Services and Continuous Skilled Nursing Services. PDF | Word
  • Managed Care Entity Bulletin 34: Temporary Extension of Coverage for Early Intervention Services directs Managed Care Organizations (MCOs) and Accountable Care Partnership Plans (ACPPs) to pay for the provision of EI services to eligible children who turn three between March 15, and August 31, 2020, to provide a “bridge” between EI and appropriate Early Childhood Special Education (ECSE) services.PDF | Word
  • MassHealth Managed Care Entity Bulletin 33: Temporary Incremental Rate Increase for Inpatient Mental Health Services In Response to COVID-19 Pandemic directs Managed Care Organizations (MCOs), Accountable Care Partnership Plans (ACPPs), and the MassHealth Behavioral Health Vendor (referred to here collectively as “managed care plans”) to institute temporary rate increases to Department of Mental Health (DMH)-licensed inpatient psychiatric facilities meeting specific eligibility criteria. PDF | Word
  • MassHealth Managed Care Entity Bulletin 32: UPDATE: Temporary Rate Increases Due to COVID-19 National Emergency provides clarifications and updates to Managed Care Entity Bulletin 24 and provides guidance on additional residential rehabilitation services incremental rate increase for May and June 2020. ​PDF | Word
  • MassHealth Managed Care Entity Bulletin 29: Additional Telehealth Guidance, Temporary CPT code for ABA, Coverage of Preventive Visits via Telehealth, Remote Patient Monitoring, Payment for Specimen Collection, Suspension of Prior Authorization for Behavioral Health 24-hour Levels of Care, and Out of Network Access ​provides guidance regarding additional provider and member flexibilities which Managed Care Entities are directed to institute in response to the COVID-19 public health emergency. PDF | Word
  • Managed Care Entity Bulletin 27: Temporary Retainer Payments Due to COVID-19 National Emergency directs One Care plans and Senior Care Organizations (SCOs) to institute temporary payments in the form of retainer payments for Adult Day Health providers to ensure these providers receive crucial stabilization funding for serving members enrolled in integrated care plans during the COVID-19 emergency. PDF | Word
  • Managed Care Entity Bulletin 26: Investments in Community Based Acute Treatment and Intensive Community Based Acute Treatment in Support of Network Management Strategy provides guidance regarding increased investments in Community Based Acute Treatment (CBAT) and Intensive Community Based Acute Treatment (ICBAT) both during the COVID-19 emergency, and through rate year 2020.​​ PDF | Word
  • Managed Care Entity Bulletin 24: Temporary Rate Increases Due to COVID-19 National Emergency directs Managed Care Organizations (MCOs), Accountable Care Partnership Plans (ACPPs), and the MassHealth Behavioral Health Vendor to institute temporary rate increases and provides additional guidance regarding more financial stabilization funding. PDF | Word
  • Managed Care Entity Bulletin 23: Temporary Rate Increases Due to COVID-19 National Emergency directs One Care plans, Senior Care Organizations (SCOs), and Program of All-Inclusive Care for the Elderly (PACE) organizations to institute temporary rate increases and provides additional guidance regarding financial stabilization funding. PDF | Word
  • 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 20-49 101 CMR 613.00: Health Safety Net Eligible Services: Health Safety Net Coverage and Reimbursement Policy for Pharmacy Services During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency​ temporarily removes the limit on the number of times a 340B provider may fill prescriptions from its retail stock for Health Safety Net patients who are not the 340B provider’s regular patients. PDF | Word
  • 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 147: Additional Updates for Pharmacies Serving Health Safety Net Patients provides guidance for how pharmacies should submit claims for Health Safety Net (HSN) patients in light of new flexibilities that temporarily allow patients who are unable to receive their medications from their regular (HSN) provider to have those prescriptions filled by any pharmacy in the MassHealth network. PDF | Word

  • Pharmacy Facts 145: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) provides guidance on how pharmacies should bill for home delivery, and updated information for pharmacies that provide durable medical equipment (DME) including DME prior authorization flexibilities. PDF | Word

  • 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. 

  • Nursing Facility Bulletin 148: COVID-19 Baseline and Surveillance Testing Requirements for Nursing Facilities ​establishes the requirements that nursing facilities must meet for a second round of baseline testing and on-going surveillance testing of Staff, and testing of symptomatic or COVID-19 exposed residents or exposed Staff, as outlined by the guidance issued on June 30, 2020 by the Department of Public Health (DPH). PDF | Word
  • Nursing Facility Bulletin 147: Signing Bonuses for Nursing Facility Staff ​provides guidance for nursing facilities regarding MassHealth funding for qualifying signing bonuses that eligible nursing facilities pay to incentivize hiring of direct care staff through the Commonwealth's Long Term Care Portal. PDF | Word
  • MassHealth Nursing Facility Provider Bulletin 146: COVID-19 Baseline Testing Requirements for Nursing Facilities ​​outlines the baseline COVID-19 testing requirements nursing facilities must meet to receive supplemental payments and includes the attestation nursing facilities must submit to demonstrate that they have met these requirements. ​PDF | Word
  • Nursing Facility Bulletin 145: Infection Control Competencies and Expectations for Nursing Facilities. This provider bulletin establishes the expectations for COVID-19 infection control competencies at nursing facilities in the Commonwealth.  It also establishes an audit process for evaluating nursing facilities' implementation of the infection control competencies and requires each nursing facility to complete an initial self-assessment and attestation of such competencies. PDF | WORD
    • Self-assessment checklist Excel
    • MassHealth Nursing Facility COVID-19 Accountability and Support Frequently Asked Questions (FAQ) PDF | Word
  • MassHealth LTSS Provider Information: Updates Related to the Coronavirus Disease 2019 (COVID-19) PDF Word
  • EOHHS Support Package for Step-Down Care in Long-Term Acute Care Hospitals, Inpatient Rehabilitation Facilities and Nursing Facilities ​​PDF | Word
  • Home Health Agency Bulletin 58: Implementation of Rate Add-On Applicable to Certain Continuous Skilled Nursing Serves to Address Costs Associated with Coronavirus Disease 2019 (COVID-19) ​provides guidance on program requirements associated with the rate add-on as established in Administrative Bulletin 20-63. PDF | Word
  • Home Health Agency Bulletin 57: Temporary Expansion of Home Health Aide Services 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
    • Personal Care Attendant (PCA) Emergency Paid Sick Leave:
      This notice provides information for Personal Care Attendants (PCAs) about using emergency paid sick leave under the federal Families First Coronavirus Response Act (FFCRA).
      English 
      PDF | Word  Spanish PDF |Word
  • Guidance for community day programs
  • Guidance for long term care facilities
    • Isolated Spaces for Nursing Facility Residents with a positive Coronavirus Disease 2019 (COVID-19) Diagnosis: This bulletin establishes criteria for nursing facilities to designate wings, units, or floors that are separated from the rest of the facility to provide services to COVID-19 positive residents. PDF | Word
    • MassHealth Nursing Facility Investment to Support Dedicated COVID-19 Isolation Spaces PDF| Word
    • MassHealth Investment to Support Signing Bonuses for Nursing Facility Staff​ PDF | Word
    • Information About Signing Bonuses Available for Long Term Care Facility Staff
      English PDF | Word Spanish PDF | Word
  • Resident Care Facility Bulletin 34: COVID-19 Signing Bonuses for Resident Care Facility Staff ​provides guidance regarding signing bonuses that eligible resident care facilities pay to incentivize new direct care staff to work in resident care facilities during the public health emergency. PDF | Word

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.

  • MassHealth Acute Inpatient Hospital Bulletin 175: Financial Support for Acute Inpatient Hospitals with DMH-Licensed Beds in Response to the COVID-19 Pandemic outlines the financial support MassHealth is providing to acute inpatient hospitals with Department of Mental Health (DMH)-licensed beds (Applicable Hospitals) meeting specific eligibility criteria and provides guidance on the eligibility requirements for this funding. PDF | Word
  • MassHealth Psychiatric Bulletin 25: Financial Support for DMH-Licensed Psychiatric Hospitals in Response to the COVID-19 Pandemic outlines the financial support MassHealth is providing to Department of Mental Health (DMH)-licensed inpatient psychiatric hospitals meeting specific eligibility criteria and provides guidance on eligibility requirements for this funding. PDF | Word
  • MassHealth Mental Health Center Bulletin 34 UPDATE: Mental Health Center Transformation Incentive Payments makes changes to Mental Health Center Bulletin 32 including an addition to payment eligibility requirements and revisions to performance requirements. PDF | Word
  • Mental Health Center Bulletin 32: Mental Health Center Transformation Incentive Payments provides guidance for mental health centers regarding COVID-19 stabilization funding that is intended to support eligible providers as they transition from delivering in-person services to using other care delivery modalities in response to the public health emergency PDF | Word
  • Frequently Asked Questions: COVID-19 and Behavioral Health Providers PDF | Word
  • Children’s Behavioral Health Initiative (CBHI) Provider Frequently Asked Questions PDF l Word
  • Applied Behavioral Analysis Provider Frequently Asked Questions PDF | Word
  • Additional Resources for Child and Adolescent Behavioral Health Providers​ PDF | Word
  • COVID-19 Inpatient Psychiatric Facility DMH Guidelines, Support, and MassHealth Investment ​PDF | Word

Guidance for Community Health Centers, Physicians and Group Practices

In addition to the "Guidance for All Providers" above, Community Health Centers can find COVID-19 guidance and bulletins that are specific to their organizations below

  • UPDATED (New Due Date for Applications) – MassHealth Physician Bulletin 101: Alternative Interim Payments ​provides guidance on eligibility criteria providers must meet to request an alternative interim payment pursuant to this bulletin and Administrative Bulletin 20-62. UPDATED PDF | UPDATED Word
  • Community Health Center Bulletin 102: Temporary Flexibilities for the Provision of Health Services by Community Health Centers provides guidance on how community health centers can bill for certain additional health services during the COVID-19 emergency PDF | Word
  • Community Health Center Bulletin 101: Temporary Flexibilities for the Provision of Laboratory Services by Community Health Centers outlines how MassHealth will allow community health centers to partner with laboratories that are not MassHealth providers to process COVID-19 diagnostic tests that cannot be processed onsite PDF | Word

Guidance for Dental Providers

UPDATED (New Due Date for Applications) MassHealth Dental Bulletin 47: Alternative Interim Payments provides guidance on eligibility criteria dental providers must meet to request an alternative interim payment pursuant to this bulletin and Administrative Bulletin 20-61. UPDATED PDF | UPDATED Word

Guidance for Transportation Brokers, Transportation Providers, and Drivers

During the COVID-19 emergency, transportation brokers, transportation providers, and drivers should support telehealth options for their consumers whenever possible, and refer to the guidance below on how to serve consumers safely.

  • Updated (5/20/2020) Broker and Driver Guidance PDF | Word
  • Transportation Bulletin 17: MassHealth Coverage and Reimbursement Policy for Transportation Services Related to the 2019 Novel Coronavirus Disease (COVID-19) PDF | Word

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:

  • Administrative Bulletin 20-12 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services​ PDF | Word
  • Transmittal Letter TRN-37: Transportation Manual (COVID-19 Updates to Subchapter 6)​ PDF | Word
  • Transmittal Letter TRN-36: Transportation Manual (COVID-19 Updates to Subchapter 6)​ PDF | Word

Guidance for Early Intervention Providers

  • Early Intervention Bulletin 3: Temporary Extension of Coverage for Early Intervention Services​ outlines the MassHealth policy to pay for the provision of Early Intervention services to eligible children who turn three years old between March 15, and August 31, 2020, to provide a “bridge” between EI and appropriate Early Childhood Special Education (ECSE) services​. PDF | Word

Guidance on MassHealth Eligibility & Applications during COVID-19

  • MassHealth Eligibility Flexibilities for COVID-19: In response to the current Coronavirus Disease 2019 (COVID-19) public health national emergency, MassHealth has implemented the following temporary changes in eligibility-related policies and processes to support the public health efforts to expedite access to necessary health care and maintain health care coverage for both new MassHealth applicants and existing members. PDF | Word
  • For information on food assistance, see the All Provider section on this page.
  • COVID-19 Assister GuidancePDF | Word
  • Eligibility Operations Memo 20-13: Hospital-Determined Presumptive Eligibility (HPE) Updates during COVID-19 Emergency PDF | Word
  • Eligibility Operations Memo 20-10: Hospital-Determined Presumptive Eligibility (HPE) Flexibilities during COVID-19 Emergency 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.

  • Provider Participation Requirements, Covered Encounters and Other Information​ PDF​ | Word

 

Frequently Asked Questions

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