Message Text – March 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.

03/21/2023

LUMP SUM PAYMENTS FOR WORKFORCE INVESTMENT RATES FOR CERTAIN HEALTH AND HUMAN SERVICES PROGRAMS

As a result of the public health emergency related to COVID-19, MassHealth is working to provide fiscal recovery funds to support health and human services providers and their workforce

In accordance with 101 CMR 452, enacted on September 2, 2022, MassHealth is issuing operational add-on rates for certain services whose basic rates are governed by other regulations.

Pursuant to 101 CMR 452.03(4), MassHealth will pay the operational add-on rate through two lump sum payments to eligible providers. The first payment will pay for the first six months of the covered time period, July 1, 2022 through December 31, 2022, with the exception payment for PT 05: Psychologists who will receive payment for the first three months of the covered time period. The second payment will pay for the second six months of the covered time period, January 1, 2023 through June 30, 2023. The second payment will also include payment for PT 05 for three months of the covered time period from October 1, 2022 to December 31, 2022.

For PT 26, PT 65, and PT 28, the lump sum amount is calculated according to the following formula: Sum of {[(total fiscal year 2022 State spend on the services listed in 101 CMR 452.01(5)/12 (months)]}*(Add on rate of 10%)*(6 units). The factor of six reflects the number of months in the time period for the first payment. For PT 05, the lump sum amount is calculated according to the following formula: Sum of {[(total fiscal year 2022 State spend on the services listed in 101 CMR 452.01(5)/12 (months)]}*(Add on rate of 10%)*(3 units). The factor of three reflects the number of months in the time period.

The following are eligible provider types pursuant to 101 CMR 452:

• PT 26: Mental Health Center
• PT 65: Psychiatric Day Treatment
• PT 28: Substance Use Disorder Treatment
• PT 05: Psychologist

As a condition of payment for the add-on rate, each provider must complete an attestation assuring EOHHS that they will use at least 90% of the funds for direct care workforce development, including hiring and retention bonuses and other categories of worker compensation. As a further condition of payment, a provider must submit a spending report to EOHHS for the use of the add-on rate, as directed by EOHHS. Where a provider delivers certain eligible services through separate businesses, that provider must submit one (1) attestation and one (1) spending report per Employer Identification Number (EIN) or Tax Identification Number (TIN). The provider spending report and attestation must be submitted to EOHHS by December 31, 2023. For additional information and requirements, please see: https://tinyurl.com/4mvvc2ud.

If MassHealth did not make payments to a provider for services rendered in Fiscal Year 2022 , that provider is ineligible to receive a lump sum payment from MassHealth for the add-on rate.

MassHealth anticipates the payment will be processed by March 22 2023. Lump sum payments will be aggregated for organizations with multiple eligible providers, and those organizations will receive one lump sum payment for all the organization’s add-on rate eligible providers. Payments will be labeled “101 CMR 452.00 Workforce Investment” on VendorWeb/remittance advices.

On behalf of MassHealth, thank you for your dedication and partnership as we work together to care for the critical needs and supports of the individuals in our care.

If you have questions regarding this message, please contact the MassHealth Customer Service Center at [e-mail] or [phone].

.

TYPE OF BILL 135 (LATE CHARGE ONLY) CLAIM FOR ACUTE OUTPATIENT UNDER THE ADJUDICATED PAYMENT PER EPISODE OF CARE (APEC) METHODOLOGY

This message is to remind providers that for proper Adjudicated Payment per Episode of Care (APEC) payment, hospitals must include all the APEC-covered services that correspond to the episode on a single claim and must otherwise submit properly completed outpatient hospital claims. This applies to claims for dates of service from December 30, 2016 (when the APEC methodology was implemented). Providers should refer to the Acute Hospital RFA (Request for Applications) for detailed information on the APEC payment methodology. As a reminder, subject to timely filing requirements, if a provider is aware of incorrect payment or improperly submitted claims, the provider should correct and resubmit such claims, including previously adjudicated claims

Effective for claims submitted on or after March 29, 2023, MassHealth will start denying the Type of Bill 135 (Late Charge Only) claim with EOB ‘9972-THIS SERVICE CANNOT BE BILLED SEPARATELY’. The late charge submission may result in inaccurate grouping when 3M Enhanced Ambulatory Patient Grouper’s (EAPG) discounting, consolidation and packaging logic is not applied to all APEC-covered services for an episode. This change will ensure proper payment, including outlier when applicable, under the APEC methodology. Providers should adjust the paid original or replacement claim (Type of Bill 131 or 137) and resubmit with the total charges for one episode of care.

If you have questions regarding this message, please contact the MassHealth Customer Service Center at [e-mail] or [phone].

Date published:	March 21, 2023
Last updated:	March 21, 2023