MassHealth COVID-19 Guidance for Managed Care Entities

This page provides Coronavirus Disease (COVID-19) guidance and information from MassHealth specific to managed care entities.

In response to COVID-19, MassHealth managed care entities (MCEs) are required to provide services and support provider flexibilities similar to MassHealth’s fee-for-service program.

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.

Bulletins

• Managed Care Entity Bulletin 90: 90-day Prescription Drug Supply Policy Change directs managed care entities to maintain a 90-day supply program no more restrictive than the MassHealth 90-day supply program described in 130 CMR 406.411(D). PDF | Word

• Managed Care Entity Bulletin 83: Uniform Rate Increase for Inpatient Mental Health Services for COVID-19 Positive Members, Operation of and Payment for Intensive Hospital Diversion for Youth, Updates to Payment for Behavioral Health Urgent Care, and Temporary Suspension of Concurrent Review for Community Crisis Stabilization directs specific managed care entities to implement rate increases for inpatient mental health services delivered to COVID-19 positive members; operationalize and pay at least the rate specified by MassHealth for an Intensive Hospital Diversion program for youth; pay a uniform percentage rate increase for services rendered by Behavioral Health Urgent Care providers designated by EOHHS; and temporarily suspend concurrent review for Community Crisis Stabilization (CCS) services. PDF | Word

• Managed Care Entity Bulletin 80: Coverage of Over-the-Counter Diagnostic Antigen Tests for SARS-CoV-2 instructs managed care plans to institute certain policies to align with MassHealth’s All Provider Bulletin 337, effective January 14, 2022. PDF | Word

• Managed Care Entity Bulletin 77: Coverage and Payment Policy for Booster Doses of Coronavirus Disease 2019 (COVID-19) Vaccines, Pediatric Vaccines, and Monoclonal Antibody Treatments restates and consolidates MassHealth coverage requirements for adult and pediatric COVID-19 vaccinations and monoclonal antibody treatments. PDF | Word

• Managed Care Entity Bulletin 74: Access to Health Services through Telehealth Options for Members Enrolled in Managed Care Entities provides updated telehealth policy requirements for Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care plans, Senior Care Organizations (SCOs), and the behavioral health vendor in response to the 2019 Coronavirus Disease (COVID-19) outbreak. PDF | Word

• Managed Care Entity Bulletin 73: Coverage for Monoclonal Antibodies for Treatment and Post-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) requires managed care plans to conform their coverage policies, including rates of payments, to match those in All Provider Bulletins 318 and 326, when providing monoclonal antibody products for treatment and post-exposure prophylaxis for COVID-19 as Medicaid services. PDF | Word

• Managed Care Entity Bulletin 72: Temporary Rate Increases Due to American Rescue Plan Act–Integrated Care Plans details requirements for One Care plans and SCOs (“integrated care plans”) related to the distribution of ARPA and Medicaid funds to HCBS and behavioral health providers through provider rate increases. PDF | Word

• Managed Care Entity Bulletin 71: Temporary Rate Increases Due to American Rescue Plan Act HCBS–Services and Behavioral Health Services details requirements for Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), and MassHealth’s Behavioral Health Vendors (“managed care plans”) related to the distribution of ARPA and Medicaid funds to HCBS and behavioral health providers through provider rate increase. PDF | Word

• Managed Care Entity Bulletin 69: Coronavirus Disease 2019 (COVID-19) Updated Guidance for Integrated Care Plans provides updated flexibilities and requirements related to COVID-19 and supersedes all prior guidance. PDF| Word

• Managed Care Entity Bulletin 68:  Updated MassHealth Telehealth Policy (September 2021)  provides updated telehealth policy requirements for Accountable Care Partnership Plans, Managed Care Organizations, One Care plans, Senior Care Organizations, and the behavioral health vendor in response to the 2019 Coronavirus Disease (COVID-19) outbreak. PDF | Word

• Managed Care Entity Bulletin 67: Coverage and Payment Policy for Services Related to COVID-19 Vaccine Counseling and 3rd Dose of Pfizer-BioNTech Vaccine and Moderna COVID-19 Vaccine for Immunocompromised Individuals, in accordance with All Provider Bulletin 321 and All Provider Bulletin 322, mandates managed care plans and PACE organizations to cover clinically appropriate, medically necessary COVID-19 vaccine counseling services and third doses of Pfizer-BioNTech and Moderna for immunocompromised members. PDF | Word
• Managed Care Entity Bulletin 66: Coverage and Reimbursement Policy Updates for Services Related to COVID-19 After the Termination of the State of Emergency outlines certain MassHealth flexibilities implemented in response to the COVID-19 pandemic in 2020 that are being retained after the State of Emergency terminated in the Commonwealth. It also describes certain additional flexibilities and requirements that will continue after the end of the State of Emergency. PDF | Word
• Managed Care Entity Bulletin 65: Preventive Behavioral Health Services for Members Younger than 21 mandates managed care plans to cover medically necessary preventive behavioral health services, for dates of service on or after September 1,2021, for eligible members under the age of 21. PDF | Word
• Managed Care Entity Bulletin 62: Update to Authorized Providers and Payment for Coronavirus Disease 2019 (COVID-19) Vaccine Administration requires managed care entities to conform their coverage policies when providing COVID-19 vaccines as Medicaid services, including rates of payments, to match those in All Provider Bulletin 317 PDF | Word
• Managed Care Entity Bulletin 57: Update to Payment for Coronavirus Disease 2019 (COVID-19) Vaccine Administration, Authorized Vaccine Providers, and Mass Immunizer Providers requires managed care plans to conform their coverage policies, including rates of payment, for COVID-19 vaccines with MassHealth’s fee-for-service policies. PDF | Word
• Managed Care Entity Bulletin 56: Coverage of and Reimbursement for Hospital-at-Home Services directs managed care entities to conform their coverage policies, including hospital eligibility requirements, payment methodology and billing instructions, to match those in AIH Bulletin 180 when providing Hospital-at-Home services as Medicaid services. PDF | Word
• Managed Care Entity Bulletin 55: Temporary Incremental Rate Increase for Inpatient Hospitals Accepting COVID-Positive MassHealth Members for Inpatient Mental Health Services directs managed care organizations (MCOs), accountable care partnership plans (ACPPs), and the MassHealth behavioral health vendor (MBHP) to temporarily increase payments to providers that admit COVID-19 positive MassHealth members and meet specific eligibility criteria. PDF | Word
• Managed Care Entity Bulletin 52:  Update to Payment for Coronavirus Disease 2019 (COVID-19) Vaccine Administration, Update to Authorized Vaccine Providers, and New Mass Immunizer Providers requires managed care plans and PACE organizations to match the payment and coverage policies of MassHealth's fee-for-service program for COVID-19 vaccines, as described in All Provider Bulletin 307. PDF | Word
• Managed Care Entity Bulletin 50: Coverage and Payment for Coronavirus Disease 2019 (COVID-19) Vaccine Administration, Testing, and Monoclonal Antibody Product Infusion​ provides guidance regarding coverage and payment for COVID-19 vaccines for the MassHealth members enrolled in an Accountable Care Partnership Plan (ACPPs), Managed Care Organization (MCOs), Senior Care Organization (SCOs) or One Care plan. It also provides coverage and payment guidance regarding two monoclonal antibody therapies to treat COVID-19 as well as guidance on new testing codes. PDF | Word
• Managed Care Entity Bulletin 49: Flu Vaccine Access and Birth Control Supply Flexibility makes changes to the out-of-network flu vaccine coverage and guidance on birth control supplies for Accountable Care Partnership Plans (ACPPs) and Managed Care Organizations (MCOs) to provide greater flexibility in providing care to MassHealth members​. PDF | Word
• Managed Care Entity Bulletin 41: Updated Pharmacy Coverage Policies contains updated policies for Accountable Care Partnership Plans (ACPPs) and Managed Care Organizations (MCOs) that align with certain coverage and payment policies of MassHealth’s Fee-for-Service program, Primary Care Clinician (PCC) Plan, and Primary Care Accountable Care Organizations relating to pharmacy services, referrals, and payment. PDF | Word
• Managed Care Entity Bulletin 39: Updated MassHealth Telehealth, Durable Medical Equipment (DME), and Home Health Policies provides guidance on the extension of telehealth policy requirements and also contains information on DME and home health policy requirements for managed care plans and organizations in the Program of All-inclusive Care for the Elderly (PACE). PDF | Word
• Managed Care Entity Bulletin 36: Community Support Program for Homeless Individuals Residing in Department of Housing and Community Development-Funded New Temporary Shelters ​provides direction for managed care entities regarding the delivery of MassHealth Community Support Program (CSP) services to members experiencing homelessness during the outbreak and residing in Department of Housing and Community Development (DHCD)-funded new temporary shelters. 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 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 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 22: Updated Coverage and Payment Policies builds on Managed Care Entity 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 creating a dedicated helpline to support members with questions about COVID-19. PDF | Word

Resources

• MassHealth Community Partner Information: Updates Related to the Coronavirus Disease 2019 (COVID-19) (Updated 10/19/2021) PDF | Word

Last updated:	February 8, 2023