Message Text – January 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.

01/03/2023

REMINDER: MASSHEALTH IS THE PAYER OF LAST RESORT

Providers are reminded: MassHealth is the payer of last resort and providers, therefore, cannot bill MassHealth members. Please refer to 130 CMR 450.203 (A)(B) – PAYMENT IN FULL which states, in part, that no provider may solicit, charge, receive or accept any money, gift or other consideration from a member.

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

 

HOME HEALTH RETROACTIVE AUTHORIZATION PROCESS

This message is to inform you that MassHealth may create a home health retroactive authorization of payment for home health services when a member experiences a disruption in their MassHealth fee-for-service (FFS) enrollment. Please see the details below.

MassHealth will authorize such a payment for home health services when the following conditions are met:

1. The home health agency was unable to request prior authorization (PA) for home health service delivery due to one of the following circumstances:
   1. The member’s MassHealth eligibility was revoked and subsequently retroactively reinstated;
   2. The member transitioned from a MassHealth-contracted accountable care partnership plan (ACPP), managed care organization (MCO), Senior Care Option (SCO), or a MassHealth-contracted integrated care organization (ICO) to MassHealth FFS and this transition is retroactively adjusted in MassHealth’s system;
2. The home health agency continued to provide home health services to the member during the period of time for which the member’s MassHealth status prevented the home health agency from requesting PA;
3. The home health agency contacts MassHealth or its designee to inform of the situation preventing the agency from submitting a PA request; and
4. Submits to MassHealth or its designee evidence of the PA submission issue (e.g. screen captured image of EVS).

Home health agencies may notify MassHealth of the agency’s inability to submit PA by contacting the LTSS Service Center at [phone] or [e-mail]. Please note, agencies that choose to call the LTSS Service Center will be prompted to email the Service Center with evidence of the PA submission issue. The LTSS Service Center will provide you with an Encounter number to track the notification of your agency’s PA submission problem. Please record this Encounter number for future purposes.

If the above conditions are met, authorization for MassHealth payment of home health services may be applied once the circumstance preventing the agency from submitting a PA request is resolved. MassHealth will apply authorization for payment beginning no earlier than 30 calendar days prior to the home health agency’s notification of the problem. When submitting a request for authorization, the requesting home health agency should include the Encounter number mentioned above in the LTSS Portal’s “comments” section.

When requesting authorization for payment, home health agencies must include medical information and documentation from the time period for which the agency is requesting payment authorization. For example, if an agency is requesting authorization for payment and the dates of services in the request are three months old, the agency should include medical record documentation that is from that period of time.

Please note, MassHealth will continue to make a medical necessity determination once the member’s MassHealth FFS enrollment is resolved. MassHealth will not authorize payment during a period of time the member is receiving or has authorization for services that would be considered duplicative to the request for home health services. Authorization does not establish or waive any prerequisites for payment such as member eligibility.

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

Date published:	January 3, 2023