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MassHealth Provider Manuals & Regulations

This is a part of the MassHealth Provider Handbook

Table of Contents

Provider Manuals & Regulations

All MassHealth providers are required to understand and comply with applicable regulations. Each provider type/program has a Provider Manual that includes subchapters that are specific to the provider type/program. Subchapter 5 (Administrative and Billing Instructions) is often referred to as the All Provider Regulations. While all of the subchapters are important providers should pay attention to Subchapter 4, which outlines the requirement and conditions of the program that providers are required to be in compliance with at all times. Providers will also need to review the Subchapter 6 that outlines the covered services (services and codes) for each program. Below is high level chart of the Provider Manual subchapters.

MassHealth Provider Manual chart

MassHealth Provider Manual chart

Provider Rates

Fees are published in the 101 CMR series of rate regulations*. Please reference your provider manual to confirm that a service is covered, as the rate regulations house a repository of codes that are not necessarily reflective of covered services. To view rate information, please refer to the Provider Payment Rates web page.

*Hospital providers should refer to their RFA to research and find answers related to payment methodologies.

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MassHealth regulations are periodically updated. Current versions can be found at https://www.mass.gov/info-details/masshealth-provider-regulations.

If you’d like to see proposed changes to the regulations, as well as information about public hearings, you’ll find that at https://www.mass.gov/info-details/masshealth-proposed-regulations.

Everything you need to know about provider manuals is at https://www.mass.gov/lists/masshealth-provider-manuals.

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Date published: July 29, 2022

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