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MassHealth COVID-19 Guidance for Community Health Centers and Physicians

This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information from MassHealth specific to community health centers and physicians.

For MassHealth COVID-19 guidance and information covering all MassHealth providers, please see MassHealth COVID-19 Guidance for All Providers. You may also find it helpful to review DPH’s COVID-19 guidance for health care professionals.

Table of Contents

Acute Inpatient Hospital Bulletins

  • Acute Inpatient Hospital Bulletin 192: Continued Temporary Suspension of Requirements for Admission Screening for Admissions to Acute Inpatient Hospitals and Prior Authorization for Physician Services Rendered in Connection with Acute Inpatient Hospital Admissions extends the temporary suspension, implemented through Acute Inpatient Hospital Bulletin 187, of admission screenings and prior authorization requirements through May 15, 2022. PDF | Word

  • Acute Inpatient Hospital Bulletin 191: Temporary Modification of Certain Utilization Management Functions in Response to the COVID-19 Pandemic confirms that, in accordance with Acute Inpatient Hospital Bulletin 188, MassHealth has resumed postpayment utilization reviews as of February 28, 2022 and extends the deadlines to request reconsideration for any denials from certain prepayment and postpayment review cycles. PDF | Word

  • Acute Inpatient Hospital Bulletin 187: Temporary Suspension of Requirements for Admission Screening for Admissions to Acute Inpatient Hospitals and Prior Authorization for Physician Services Rendered in Connection with Acute Inpatient Hospital Admissions states that MassHealth is temporarily suspending the admission screening requirements that apply to certain admissions to an AIH, and the prior authorization requirements that apply to physician services rendered in connection with certain AIH admissions due to ongoing disruptions to the healthcare delivery system caused by the COVID-19 pandemic. PDF | Word
  • Acute Inpatient Hospital Bulletin 183: Partial Resumption of Certain Utilization Management Functions Previously Suspended in Response to the COVID-19 Pandemic - In response to the initial challenges that the COVID-19 pandemic posed to acute inpatient hospitals, MassHealth modified certain aspects of its UMP, by
    • temporarily exempting claims with a confirmed COVID-19 diagnosis from utilization review;
    • temporarily ceasing the initiation of new pre-pay utilization reviews; and
    • temporarily suspending automatic recoupment for claims payment denied via postpayment review. This policy applied to claims in review cycles 702-758. PDF | Word

Acute Outpatient Hospital Bulletins

  • Acute Outpatient Hospital Bulletin 37Temporary Flexibilities for the Provision of Laboratory Services by Acute Outpatient Hospitals allows Acute Outpatient Hospitals to partner with laboratories that are not MassHealth providers to process COVID-19 diagnostic tests that are not processed onsite, for the duration of the Commonwealth's state of emergency. PDF | Word

Chronic Disease and Rehabilitation Inpatient Hospital Bulletins

  • Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 98: Continued Temporary Suspension of Requirements for Admission Screening for Admissions to CDR Inpatient Hospitals extends the temporary suspension, implemented through Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 95, of preadmission screenings through May 15, 2022. PDF | Word
  • Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 95: Relaxation of Prior Authorization Procedures in Chronic Disease and Rehabilitation Inpatient Hospitals states that MassHealth will not require preadmission screening of individuals seeking admission to a CDRIH between December 15, 2021, and March 15, 2022 (Temporary Suspension Period). Instead, a CDRIH may admit a member after submitting a notification of admission packet to MassHealth with the required documentation described in this bulletin. PDF | Word

Community Health Center Bulletins

  • Community Health Center Bulletin 113: Preventive Behavioral Health Services for Members Younger Than 21 to address and mitigate the negative impacts of the pandemic on children and adolescents, and to further healthy developmental outcomes for MassHealth-enrolled youth, community health centers (CHCs) participating in MassHealth may provide medically necessary preventive behavioral health services for members from birth until age 21 PDF | Word
  • Community Health Center Bulletin 112: Community Health Centers Providing Vaccine Administration Services provides updated guidance regarding billing for vaccines, vaccine administration, and vaccine counseling services provided to MassHealth members by CHCs. PDFWord
  • Community Health Center Bulletin 109: Community Health Centers Providing Vaccine Administration Services provides guidance regarding billing for vaccines and vaccine administration services provided to MassHealth members by CHCs PDF | 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

Transmittal Letters

  • Transmittal Letter AOH-47: Diagnostic Laboratory and Remote Patient Monitoring Codes PDF | Word
  • Transmittal Letter FPA-57: Specimen Collection for COVID-19  PDF | Word
  • Transmittal Letter PHY-158: 2020 HCPCS Code updates and Removal of PA Requirements for Certain Knee Arthroplasty and Knee Arthroscopy Codes PDF | Word
  • Transmittal Letter CHC-114: 2020 HCPCS Code Updates: Telephonic, Home Visit, and Diagnostic Codes PDF | Word
Last updated: December 9, 2021
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