Message Text – January 2025

MassHealth Provider Remittance Advice

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.

01/28/2025

END STAGE RENAL DISEASE AND MEDICARE CLAIM ADJUSTMENTS

Medicare recently notified MassHealth that it will be adjusting certain End Stage Renal Disease (ESRD) claims for members in Medicare’s ESRD Treatment Choice Model. The adjustments start on January 20, 2025. Renal Dialysis providers are reminded that Medicare claim adjustments do not automatically cross over to MassHealth. Providers should adjust the crossover claim previously paid by MassHealth and include the revised Medicare adjudication information on the claim.

If you have questions, please contact MassHealth at [e-mail] or [phone].

UPDATE FOR QUARTERLY DRUG CODE RATES EFFECTIVE JANUARY 1, 2025

MassHealth has completed the rate updates for the January 1, 2025, quarterly drug codes. The impacted claims will be reprocessed and/or adjusted and will appear on a future remittance advice.

If you have questions, please contact MassHealth at [e-mail] or [phone].

01/14/2025

BEHAVIORAL HEALTH PROVIDER LISTENING SESSIONS

We invite MassHealth behavioral health providers to several provider listening sessions hosted by UMass Chan Medical School. We’d like your input about successes you’ve had and improvements you’d like to see in best serving members with Serious Mental Illness/Serious Emotional Disturbance (SMI/SED) and/or Substance Use Disorder (SUD).

Please see the information below about these listening sessions and how to register.

SMI/SED Listening Session:

When: Time: January 28, 2025, at 9:15-10:45am EST

Where: Zoom

Register at https://umassmed.co1.qualtrics.com/jfe/form/SV_1SKg4PLjnAZ7aRw

Topics will include:

• Quality of care in psychiatric hospitals and residential settings
• Care coordination and transitions to community-based care
• Access to crisis stabilization and the full continuum of mental health service
• Early identification and engagement in treatment for mental health

SUD Listening Session:

When: January 21, 2025, at 9:15-10:45am EST

Where: Zoom

Register at https://umassmed.co1.qualtrics.com/jfe/form/SV_1TgULwA0smC5SOa

Topics will include:

• Access to critical levels of care for opioid use disorder (OUD) and other SUDs
• Use of evidence-based, SUD-specific patient placement criteria
• Use of nationally recognized SUD-specific program standards to set provider qualifications for residential treatment facilities
• Sufficient provider capacity at critical levels of care including for medication assisted treatment for OUD
• Implementation of comprehensive treatment and prevention strategies to address opioid abuse and OUD
• Improved care coordination and transitions between SUD levels of care

Your voice is essential to ensure that the behavioral health system continues to meet the needs of our communities. Please join us in this important conversation!

For questions or more information, contact Sue Pfefferle at [e-mail].

PSYCHIATRIC DAY TREATMENT CENTER SERVICES PROVIDER LISTENING SESSION

MassHealth is beginning its biennial review of rates for services governed by 101 CMR 307.00: Rates for Psychiatric Day Treatment (PDT) Center Services. In anticipation of this review, MassHealth will host a virtual provider listening session on Wednesday, January 22, 2025, from 1:00-3:00 pm. This listening session is part of the biennial rate review process and is separate from other provider engagement activities currently taking place regarding PDT services.

Listening Session Information:

Topic: 101 CMR 307.00: Rates for Psychiatric Day Treatment Center Services Provider Session

Date & Time: January 22, 2025, at 1:00-3:00 pm EST

Join Zoom Meeting: https://zoom.us/j/93587126389?pwd=ArY82nxq60ABm89hNetYsdBC2n2jhU.1

Meeting ID: 935 8712 6389

Passcode: 615533

MassHealth invites all providers of these services to attend and provide information they would like MassHealth to consider during the rate review. If you plan to attend and speak, please email Paul Velho ([e-mail]) by the end of the day on Monday, January 20, 2025. (There will also be time for comments from those who have not sent notification in advance.)

MassHealth also encourages the submission of written feedback from providers who cannot attend the session or who would like to provide more detailed information. Please email any written feedback to by Paul Velho ([e-mail]) by the end of the day on Friday, January 24, 2025. Comments provided at the session will not automatically be part of the official public hearing process. The public hearing will be held later for this regulation when providers can submit official testimony.

RETROACTIVE CLAIMS ADJUSTMENT FOR CERTAIN CSN PROCEDURE CODES WITH MODIFIER U6

MassHealth was made aware that certain continuous skilled nursing (CSN) procedure codes when billed with modifier U6, for CSN training time, were paying at a lower and incorrect rate. MassHealth has since corrected its claims system, so all CSN procedure codes billed with modifier U6 pay the correct rates as established in 101 CMR 361.00.

MassHealth has also reprocessed all submitted claims to correct the training time rate. Providers should expect to see these adjustments on or after January 10, 2025.

For more information regarding CSN training time units, please see CSN Agency Bulletin 19 at https://tinyurl.com/e7z2hjjz. As a reminder, MassHealth pays for training time units delivered during the week, Monday through Friday at the standard weekday rate, and will not pay night rates during the week for training time units.

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

UPDATED: VIRTUAL GATEWAY (VG) MULTIFACTOR AUTHENTICATION (MFA) LEGACY LOGIN WILL BE REMOVED FEBRUARY 23, 2025

The Executive Office of Health and Human Services (EOHHS) Virtual Gateway (VG) is removing the Legacy Login option to access MassHealth systems on February 23, 2025. MassHealth is requiring all Provider Online Service Center (POSC) users that have not transitioned to Multi Factor Authentication (MFA) to update their email address associated with their user ID and set up MFA to continue accessing the POSC via VG before February 14, 2025.

If you are using the Legacy Login option, it is imperative that you transition to the MFA process as soon as possible. Instructions can be found on Mass.gov: https://tinyurl.com/4ar5cns9

Please note: Each VG User ID is required to have a unique email address associated to a single VG account. Please ensure that your organization completes the following:

1. All users review and ensure that the email address associated with their VG User ID is unique and is not duplicated with any other VG User ID that is currently used;
2. The Primary User must coordinate with users to ensure that each user only has a single, unique VG User ID and must eliminate multiple User IDs currently assigned to the same individual;
3. The Primary User must coordinate with users to ensure that “common” named User IDs that are being shared amongst staff are eliminated; each User ID must be assigned to an individual with a unique email address.

Taking the aforementioned steps are required to ensure that your organization is compliant with the VG terms and conditions. Accounts that are not transitioned by February 23, 2025 will be deactivated.

MassHealth has outreached to the email addresses associated with each VG User ID that has not yet migrated to MFA to notify them of their non-compliance and changes that must be implemented. MassHealth is conducting a series of Informational Sessions to provide an overview of the changes and what providers are required to do to transition to MFA. These sessions are also being scheduled to answer questions providers that may have regarding the transition.

Provider Informational Sessions:

- January 15, 2025, at 1:00 pm

- January 30, 2025, at 10:00 am

- February 12, 2025, at 1:00 pm

Register for a session here: https://tinyurl.com/y6xkjehr

For additional questions or concerns:

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

01/07/2025

IMPLEMENTATION OF SECTION 24 OF CHAPTER 197 0F THE ACTS OF 2024 FOR MEMBERS ACCESSING POST-ACUTE HEALTH SERVICES

In accordance with Section 24 of Chapter 197 of the Acts of 2024 (the Long Term Care [LTC] Act), found at https://tinyurl.com/45rd4n99, payers are required to approve or deny, within one business day after receiving all necessary documentation, all requests for prior authorization (PA) for members who transfer from an inpatient acute-care hospital to a post-acute care facility or agency.

If MassHealth receives a complete PA request on a non-business day, when PA cannot be reviewed, PA may be waived under certain circumstances as a matter of law under the LTC Act. 

Specific to home health services, the LTC Act requirements impact the PA request process for services for some MassHealth members who have had an inpatient acute-care hospitalization and are directly starting or resuming home health services.

See Home Health Agency Bulletin 93 to view the process for the expedited PAs and waiver of certain PA submission requirements for impacted members. The bulletin can be viewed at https://tinyurl.com/4v9fx5me.

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

CONTINUATION OF TELEHEALTH FOR FACE-TO-FACE VISITS AND CERTAIN HOME HEALTH SERVICES AFTER DECEMBER 31, 2024

In 2023, MassHealth issued Home Health Agency Bulletin 87, which provides guidance for providing home health services via telehealth. Bulletin 87 also recognized telehealth face-to-face encounters as conforming face-to-face encounters for the purposes of home health agency service delivery.

MassHealth is issuing this communication to provide clarification regarding the extension of telehealth, and to avoid service disruptions for MassHealth members after December 31, 2024. MassHealth is waiving the portion of Bulletin 87 that would have prohibited telehealth home health services after December 31, 2024. Services described on pages 3 and 4 of Bulletin 87 may continue indefinitely pending the issuance of further MassHealth guidance by bulletin.

Face-to-Face Encounter Visits:

• MassHealth is continuing to recognize face-to-face encounters provided via telehealth indefinitely for dates of service after December 31, 2024. The State has discretion to provide this flexibility per https://tinyurl.com/2mhnvafe, which says the face-to-face encounter may occur through telehealth, as implemented by the State.
• M.G.L. c. 118E, s. 79 provides authority for MassHealth to cover telehealth services when appropriate, in addition to in-person services. Providers may continue to provide home health services as described by Bulletin 87. To view this guidance on rendering services via telehealth, see https://tinyurl.com/yckvye9r.
• As a reminder, home health providers are required to use the modifier GT when a visit has been conducted via telehealth. Correct use of the modifier is necessary for MassHealth to comply with state and federal requirements around member access.

Certain Home Health Services via Telehealth:

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

Date published:	January 6, 2025