Message Text - August 2023

The messages listed below may be general All Provider messages, applicable to several provider types or services, or provider specific. 

You can request a copy of a prior message by:

• Emailing [e-mail]
• Sending a letter to

  MassHealth Customer Service
  P.O. Box 278
  Quincy, MA 02171

• Calling MassHealth Customer Services at [phone],
  Hours: Monday through Friday 8 a.m. to 5 p.m.

08/29/2023

RETRO RATE ADJUSTMENTS FOR HOME HEALTH PROVIDERS

EOHHS has promulgated amendments to 101 CMR 350.000: Rates for Home Health Services (https://tinyurl.com/58m4bt5t). These amendments were effective for dates of service starting on or after July 1, 2023.

At this time, MassHealth has completed an automatic retro claims adjustment of home health services. The timeframe of the automatic retro claims adjustment included dates of service starting July 1, 2023 through July 31, 2023. Providers should review their most recent remittance advice (RA) for accuracy.

Proposed corrections must be submitted to the MassHealth LTSS Provider Service Center within 30 days from the date of this RA at [e-mail] or by calling [phone]. For more information, refer to the POSC job aid “View Remittance Advice Reports” on the Job aids for the Provider Online Service Center (POSC) web page at https://tinyurl.com/y95aaqjk.

For questions, please contact the MassHealth LTSS Provider Service Center at [e-mail] or call [phone].

08/22/2023

ADJUSTMENTS OF CERTAIN DAY HABILITATION CLAIMS THAT REQUIRE A PRIOR AUTHORIZATION THAT WERE PAID IN ERROR

MassHealth has identified a payment error with Day Habilitation claims that require a prior authorization (PA). This error caused certain claims to be overpaid. The affected claims with dates of service from April 1, 2023 to July 28, 2023 have been adjusted and will appear on this or a subsequent remittance advice. Any applicable claims that do not have a PA, have an invalid PA number, or have insufficient PA units will deny and applicable monies will be recouped.

If you have questions, please contact the LTSS Provider Service Center at [phone] or [e-mail].

ADJUSTMENTS OF CERTAIN ADULT DAY HEALTH CLAIMS THAT REQUIRE A PRIOR AUTHORIZATION THAT WERE PAID IN ERROR

MassHealth has identified a payment error with Adult Day Health claims that require a prior authorization (PA). This error caused certain claims to be overpaid. The affected claims with dates of service from April 1, 2023 to July 28, 2023 have been adjusted and will appear on this or a subsequent remittance advice. Any applicable claims that do not have a PA, have an invalid PA number, or have insufficient PA units will deny and applicable monies will be recouped.

If you have questions, please contact the LTSS Provider Service Center at [phone] or [e-mail].

08/08/2023

REMINDER: ROBOTICS PROCESSING AUTOMATION (RPA) POLICY

Reminder: MassHealth requires that all providers, business partners, and relationship entities (which will be referred to as “organizations”) that use Robotics Processing Automation (RPA) tools (AKA “bots”) on MassHealth’s Medicaid Management Information System (MMIS) Provider Online Service Center (POSC) register the bot and request approval from MassHealth prior to the implementation of any bot technology.

RPA is the use of software automation to perform high-volume, repetitive, labor-intensive online tasks that previously required humans to perform. RPA involves robotic rule-based decision making to simulate human interaction with digital systems and software.

If your organization is using RPA tools without MassHealth approval that is a violation of MassHealth’s RPA policy and you must bring your organization into compliance as soon as possible.

Please refer to All Provider Bulletin 345: Robotics Processing Automation (RPA) Policy at https://www.mass.gov/masshealth-provider-bulletins and the MassHealth Robotics Processing Automation (RPA) Policy web page at https://www.mass.gov/rpapolicy for more information.

If you have any questions regarding this RPA policy, please contact MassHealth at [e-mail].

IMPORTANT NOTICE TO PROVIDERS: CONTINUED SUSPENSION OF REFERRAL REQUIREMENTS THROUGH DECEMBER 31, 2023

MassHealth will continue suspending referral requirements for services provided to members enrolled in the PCC plan or a Primary Care ACO through December 31, 2023. Notwithstanding the requirements of 130 CMR 450.118(J): Referral for Services and 130 CMR 450.119(I): Referral for Services, members enrolled in the PCC plan or a Primary Care ACO do not need a referral to receive any MassHealth-covered services that would otherwise require a referral. This is an extension of the policy announced in All Provider Bulletin 291 and extended in All Provider Bulletin 319 and All Provider Bulletin 367. This policy will remain in place through at least December 31, 2023. MassHealth will provide more guidance before ending this flexibility.

08/01/2023

MASSHEALTH CSN SPENDING/REPORTING REQUIREMENTS AND OVERTIME PROCEDURES

Amendments to the Continuous Skilled Nursing (CSN) Agency program regulations at 130 CMR 438.000, which include details on the new complex care assistant service type, are effective for dates of service on or after July 21, 2023. The regulation amendments can be found at https://tinyurl.com/266jurn4.

Additionally, the updated CSN rates at 101 CMR 361.00 have been published. The amended rates are effective for dates of service on or after July 1, 2023. The updated CSN rate regulations can be found at https://tinyurl.com/msj974kz.

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at [phone] or [e-mail].

 

MASSHEALTH ORDERING, REFERRING, PRESCRIBING REQUIREMENTS

Ordering, referring, and prescribing (ORP) requirements under Section 6401(b) of the Affordable Care Act resumed on July 1, 2023. These requirements had been in place previously, but due to the COVID-19 pandemic, claim denials were paused in March 2020.

For services that require ORP and have dates of service on or after July 1, 2023, claims will be denied if they do not meet the following ORP requirements:

• The National Provider Identifier (NPI) of the ORP provider must be included on the claim.
• The ORP provider must be an authorized ORP provider type (see list on page 2 of APB 286).

For additional details, please refer to All Provider Bulletin 286 at https://tinyurl.com/26huvnt7 and All Provider Bulletin 361 at https://tinyurl.com/56pk7jfc.

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at [phone] or [e-mail].

Date published:	August 1, 2023
Last updated:	August 28, 2023