Outdated COVID-19 Guidance for MassHealth Providers

Find previously released guidance for MassHealth Providers that is no longer in effect.

For current COVID-19 guidance, please see MassHealth COVID-19 Guidance for All Providers.

All Providers

• All Provider Bulletin 335: Extension of Coverage and Reimbursement Policy Related to COVID-19 for 24-Hour Substance Use Disorder Services further extended the payment of 24-hour substance use disorder treatment services related flexibilities described in All Provider Bulletin 319 through June 30, 2022, after which they expired. Except as provided herein, or in other guidance published by MassHealth, the remainder of All Provider Bulletins 319 will remain unchanged. PDF | Word
• All Provider Bulletin 334: Temporary Extension of Flexibilities to Permit Separate Payment for Specimen Collection through March 31, 2022 further extends the COVID-19 specimen collection–related flexibilities described in All Provider Bulletins 319 and 325 through March 31, 2022, after which they will expire. PDF | Word
• All Provider Bulletin 320: Expiration of Temporary Extension of Timely Replies for Initial Notices of Overpayment during COVID-19 Emergency informs providers that the temporary extension for a provider to provide a written response to dispute an INOP will expire June 15, 2021, in conjunction with the end of the Massachusetts state of emergency. PDF | Word
• All Provider Bulletin 314: Updated MassHealth Telehealth Policy maintains MassHealth's telehealth policy set forth in All Provider Bulletin 303 and extends the policy 90 days beyond the final date of the Massachusetts Public Health Emergency. PDF | Word
• All Provider Bulletin 311: Temporary Extension of Timely Reply for Initial Notices of Overpayment ​extends the deadline for providers to submit a dispute in writing by adding 15 calendar days to the process. PDF | Word
• All Provider Bulletin 303: Updated MassHealth Telehealth Policy extended MassHealth's telehealth policy established in All Provider Bulletin 298, with some changes, through March 31, 2021. PDF | Word
• MassHealth All Provider Bulletin 298: MassHealth Telehealth Policy reinstates and extends MassHealth's current telehealth policy (as reflected in All Provider Bulletins 289, 291, and 294) until December 31, 2020, with some modifications. This extended policy will help ensure members retain access to covered services, promote social distancing, and mitigate the spread of COVID-19. Note: this bulletin does not apply to MassHealth programs overseen by the Office of Long Term Services and Supports, which will publish separate guidance on telehealth. PDF | Word
• MassHealth All Provider Bulletin 296: MassHealth Payment for COVID-19 Specimen Collection and Testing provides additional guidance for providers regarding payment for specimen collection for purposes of testing for COVID-19 and certain related services​, supplementing All Provider Bulletin 294. PDF | Word
• All Provider Bulletin 295: Hospital-Determined Presumptive Eligibility (HPE) Flexibilities during COVID-19 Emergency provides guidance on expanded HPE flexibilities for all individuals meeting the eligibility criteria for MassHealth Standard coverage. PDF | Word
• All Provider Bulletin 294: MassHealth Coverage Flexibilities  for Services Related to Coronavirus Disease 2019 ​ provides guidance for providers regarding additional flexibilities, including billing for services rendered to dual-eligible members via audio-only telehealth, coverage and billing for remote patient monitoring, and billing for preventive visits for children and adults. PDF | Word
• All Provider Bulletin 293: Flexibilities for Substance Use Disorder Treatment Services During COVID-19 State of Emergency ​provides guidance regarding flexibilities for facilities that provide 24-hour substance use disorder treatment and MassHealth providers licensed by the Department of Public Health’s Bureau of Substance Addiction Services. ​PDF | Word
• All Provider Bulletin 292: Billing Policies for Coronavirus Disease 2019 (COVID-19) Testing and Treatment Services for Uninsured Individuals and MassHealth Limited Members provides guidance regarding how providers should bill for COVID-19 testing and treatment services for uninsured patients and MassHealth Limited members in light of the federal government's claims submission program for uninsured residents. PDF  | Word
• All Provider Bulletin 291: MassHealth Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19) builds off of Bulletin 289 to create additional flexibilities including: relaxing referral requirements, further expanding HPE, allowing medication delivery, waiving pharmacy signature requirements, and providing guidance for Emergency Services Program (ESP) and Mobile Crisis Intervention (MCI) Services PDF | Word
• All Provider Bulletin 290: Coverage Provided via Hospital-Determined Presumptive Eligibility expands eligibility for HPE to include individuals who have received HPE benefits in the past 12 months. PDF | Word
• All Provider Bulletin 289: MassHealth Coverage Reimbursement Policy for Service Related to Coronavirus Disease 2019 creates flexibilities for providers including: covering services delivered via telehealth, covering 90-day supplies and early refills of prescriptions, and billing information for quarantine in hospitals. PDF | Word 
• All Provider Bulletin 288: Coverage Provided via Hospital-Determined Presumptive Eligibility expands eligibility for HPE for individuals diagnosed with or presumptive COVID-19 to include individuals who have received HPE benefits in the past 12 months. PDF | Word

 

Resources

• COVID-19 Health Care Provider Financial Relief Package​ will support health care providers impacted by and responding to the COVID-19 public health emergency. Through MassHealth, Baker-Polito Administration is distributing over $800 million in critical stabilization funding to the Commonwealth’s vital providers. PDF | Word
• Health Safety Net (HSN), Uninsured, & MassHealth Limited COVID-19 Testing and Treatment Frequently Asked Questions PDF | Word

Behavioral Health

Mental Health Center

• MassHealth Mental Health Center Bulletin 34 UPDATE: Mental Health Center Transformation Incentive Payments makes changes to Mental Health Center Bulletin 32 including an addition to payment eligibility requirements and revisions to performance requirements. PDF | Word
• Mental Health Center Bulletin 32: Mental Health Center Transformation Incentive Payments provides guidance for mental health centers regarding COVID-19 stabilization funding that is intended to support eligible providers as they transition from delivering in-person services to using other care delivery modalities in response to the public health emergency PDF | Word

 

Psychiatric Inpatient Hospital

• Psychiatric Inpatient Hospital Bulletin 26: Limited Modification and Extension of Financial Support for Certain DMH-Licensed Psychiatric Hospitals in Response to the COVID-19 Pandemic provides guidance on modifications to and extensions of some of the financial supports described in Psychiatric Inpatient Hospital Bulletin 25. PDF | Word
• Psychiatric Bulletin 25: Financial Support for DMH-Licensed Psychiatric Hospitals in Response to the COVID-19 Pandemic outlines the financial support MassHealth is providing to Department of Mental Health (DMH)-licensed inpatient psychiatric hospitals meeting specific eligibility criteria and provides guidance on eligibility requirements for this funding. PDF | Word

Community Health Centers, Physicians and Group Practices

Acute Inpatient Hospital

• Acute Inpatient Hospital Bulletin 192: Continued Temporary Suspension of Requirements for Admission Screening for Admissions to Acute Inpatient Hospitals and Prior Authorization for Physician Services Rendered in Connection with Acute Inpatient Hospital Admissions extends the temporary suspension, implemented through Acute Inpatient Hospital Bulletin 187, of admission screenings and prior authorization requirements through May 15, 2022. PDF | Word

• Acute Inpatient Hospital Bulletin 191: Temporary Modification of Certain Utilization Management Functions in Response to the COVID-19 Pandemic confirms that, in accordance with Acute Inpatient Hospital Bulletin 188, MassHealth has resumed postpayment utilization reviews as of February 28, 2022 and extends the deadlines to request reconsideration for any denials from certain prepayment and postpayment review cycles. PDF | Word

• Acute Inpatient Hospital Bulletin 183: Partial Resumption of Certain Utilization Management Functions Previously Suspended in Response to the COVID-19 Pandemic - In response to the initial challenges that the COVID-19 pandemic posed to acute inpatient hospitals, MassHealth modified certain aspects of its UMP, by
  • temporarily exempting claims with a confirmed COVID-19 diagnosis from utilization review;
  • temporarily ceasing the initiation of new pre-pay utilization reviews; and
  • temporarily suspending automatic recoupment for claims payment denied via postpayment review. This policy applied to claims in review cycle 702-758. PDF | Word
• Acute Inpatient Hospital Bulletin 177: Limited Modification and Extension of Financial Support for Certain Acute Inpatient Hospitals with DMH-Licensed Beds in Response to the COVID-19 Pandemic provides guidance on modifications to and extensions of some of the financial support described in Acute Inpatient Hospital Bulletin 175. PDF | Word
• Acute Inpatient Hospital Bulletin 175: Financial Support for Acute Inpatient Hospitals with DMH-Licensed Beds in Response to the COVID-19 Pandemic outlines the financial support MassHealth is providing to acute inpatient hospitals with Department of Mental Health (DMH)-licensed beds (Applicable Hospitals) meeting specific eligibility criteria and provides guidance on the eligibility requirements for this funding. PDF | Word
• Acute Outpatient Hospital Bulletin 37: Temporary Flexibilities for the Provision of Laboratory Services by Acute Outpatient Hospitals allows Acute Outpatient Hospitals to partner with laboratories that are not MassHealth providers to process COVID-19 diagnostic tests that are not processed onsite, for the duration of the Commonwealth's state of emergency. PDF | Word

 

Chronic Disease and Rehabilitation Inpatient Hospital

• Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 98: Continued Temporary Suspension of Requirements for Admission Screening for Admissions to CDR Inpatient Hospitals extends the temporary suspension, implemented through Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 95, of preadmission screenings through May 15, 2022. PDF | Word
• Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 95: Relaxation of Prior Authorization Procedures in Chronic Disease and Rehabilitation Inpatient Hospitals states that MassHealth will not require preadmission screening of individuals seeking admission to a CDRIH between December 15, 2021, and March 15, 2022 (Temporary Suspension Period). Instead, a CDRIH may admit a member after submitting a notification of admission packet to MassHealth with the required documentation described in this bulletin. PDF | Word
• Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 92: Temporary Suspension of the 45-Day Administrative Day Nonpayment Provision Under 130 CMR 435.000 extends the temporary suspension of its enforcement of the 45-day administrative day (AD) nonpayment provision to help address challenges around safely discharging MassHealth members to appropriate settings due to the COVID-19 pandemic. PDF | Word
• Chronic Disease and Inpatient Rehabilitation Hospital Bulletin 91: Temporary Suspension of the 45-Day Administrative-Day Nonpayment Provision under 130 CMR 435.000 provides guidance on the suspension of the 45-day administrative nonpayment provision, which aims to support safe hospital discharges of MassHealth members to appropriate settings. PDF | Word

 

Community Health Center

• Community Health Center Bulletin 102: Temporary Flexibilities for the Provision of Health Services by Community Health Centers provides guidance on how community health centers can bill for certain additional health services during the COVID-19 emergency PDF | Word
• Community Health Center Bulletin 101: Temporary Flexibilities for the Provision of Laboratory Services by Community Health Centers outlines how MassHealth will allow community health centers to partner with laboratories that are not MassHealth providers to process COVID-19 diagnostic tests that cannot be processed onsite PDF | Word
• UPDATED (New Due Date for Applications) – MassHealth Physician Bulletin 101: Alternative Interim Payments ​provides guidance on eligibility criteria providers must meet to request an alternative interim payment pursuant to this bulletin and Administrative Bulletin 20-62. UPDATED PDF | UPDATED Word

Day Programs

Adult Day Health

• Adult Day Health Bulletin 31: One-time Supplemental Payment for Eligible Adult Day Health (ADH) Providers to Address Decreased On-site Attendance During the COVID-19 Omicron Variant Surge announces that MassHealth is offering a one-time supplemental payment to qualifying ADH providers that experienced a 20% decrease or greater in average on-site daily attendance at one or more of their ADH program sites in January and/or February 2022. PDF | Word
• Adult Day Health Bulletin 27: COVID-19 Guidance and Requirements for Adult Day Health Programs through the Remainder of the Federal Public Health Emergency (September 2021) provides Adult Day Health (ADH) providers with COVID-19 guidance and requirements that will stay in effect until the end of the federal COVID-19 public health emergency. PDF | Word
• Adult Day Health Bulletin 24: Enhanced Rates and Billing Instructions for Adult Day Health Services for Dates of Service from June 1, 2021, through June 30, 2021 sets forth enhanced rates and billing instructions to address reduced member utilization of day program services during the COVID-19 pandemic. PDF | Word
• Adult Day Health Bulletin 22: Enhanced Rates and Billing Instructions for Adult Day Health Services for Dates of Service Provided on or after December 1, 2020, through May 31, 2021 sets forth the enhanced rates and billing instructions in effect for MassHealth-covered ADH services. PDF | Word
• Adult Day Health Bulletin 21: Additional Guidance and Requirements for Adult Day Health Programs during the Public Health Emergency provides guidance and requirements that supersede guidance published in Adult Day Health Bulletin 19. PDF | Word
• Adult Day Health Bulletin 20: Guidance for Adult Day Health Providers Delivering Multi-model Hybrid Services During the COVID-19 Public Health Emergency ​consolidates and restates, with relevance to adult day health (ADH) services, MassHealth’s telehealth policy, as well as policies for services provided in an in-home setting.​ PDF | Word
• Adult Day Health Bulletin 19: Additional Guidance and Requirements for Reopening Adult Day Health Programs During Phase III outlines additional guidelines and requirements for ADH programs including use of risk/benefit tools, reporting to MassHealth on program rosters, and reporting processes when a staff member or participant tests positive for COVID-19. PDF | Word
• Adult Day Health Bulletin 18: Guidance for Adult Day Health (ADH) Providers Delivering Telehealth/Remote Services During the COVID-19 Public Health Emergency consolidates and restates, with relevance to ADH services, MassHealth’s current telehealth policy, as well as in-home setting services and extends that policy through December 31, 2020.  PDF | Word
• Adult Day Health Bulletin 17: Enhanced Rates for Adult Day Health Services During the Reopening Period (August 1, 2020, through November 30, 2020) and Billing Instructions for Standard Rates sets forth enhanced rates that have been established to address reduced member utilization of day program services that is occurring as day programs ramp up and reopen following their required closure during the spring of 2020. PDF | Word

 

Day Habilitation Program

• Day Habilitation Program Bulletin 24: One-time Supplemental Payment for Eligible Day Habilitation (DH) Providers to Address Decreased On-site Attendance During the COVID-19 Omicron Variant Surge announces that MassHealth is offering a one-time supplemental payment to qualifying DH providers that experienced a 20% decrease or greater in average on-site daily attendance at one or more of their DH program sites in January and/or February 2022. PDF | Word
• Day Habilitation Program Bulletin 20: COVID-19 Guidance and Requirements for Day Habilitation Programs through the Remainder of the Federal Public Health Emergency (November 2021) extends existing COVID-19 guidance for Day Habilitation (DH) programs until the end of the federal COVID-19 public health emergency. The guidance and requirements in this bulletin supersede guidance published in MassHealth Day Habilitation Program Bulletin 14 and Day Habilitation Program Bulletin 19 through the Remainder of the Federal Public Health Emergency (September 2021). PDF | Word
• Day Habilitation Program Bulletin 16: Enhanced Rates and Billing Instructions for Day Habilitation Services for Dates of Service from June 1, 2021, through June 30, 2021 sets forth enhanced rates and billing instructions to address reduced member utilization of day program services during the COVID-19 pandemic. PDF | Word
• Day Habilitation Program Bulletin 15: Enhanced Rates and Billing Instructions for Day Habilitation Services for Dates of Services on or after December 1, 2020 through May 31, 2021 sets forth the enhanced rates and billing instructions in effect for MassHealth-covered Day Habilitation services. PDF | Word
• Day Habilitation Program Bulletin 14: Additional Guidance and Requirements for Day Habilitation Programs during the Public Health Emergency provides guidance and requirements that supersede guidance published in MassHealth Day Habilitation Bulletin 12. PDF | Word
• Day Habilitation Program Bulletin 13: Guidance for Day Habilitation Providers Delivering Multi-model Hybrid Services during the COVID-19 Public Health Emergency consolidates and restates, with relevance to day habilitation (DH) services, MassHealth’s telehealth policy, as well as policies for services provided in an in-home setting. PDF | Word
• Day Habilitation Bulletin 12: Additional Guidance and Requirements for Reopening Day Habilitation Programs During Phase III outlines additional guidelines and requirements for DH programs including use of risk/benefit tools, reporting to MassHealth on program rosters, and reporting processes when a staff member or participant tests positive for COVID-19. PDF | Word
• Day Habilitation Bulletin 11: Guidance for Day Habilitation (DH) Providers Delivering Telehealth/Remote Services During the COVID-19 Public Health Emergency consolidates and restates, with relevance to DH services, MassHealth’s current telehealth policy, as well as in-home setting services, and extends that policy through December 31, 2020. PDF | Word
• Day Habilitation Bulletin 10: Enhanced Rates for Day Habilitation Services During the Reopening Period (August 1, 2020, through November 30, 3030) and Billing Instructions for Standard Rates - Corrected sets forth the enhanced rates and billing instructions for standard rates that have been established to address reduced member utilization of day program services that is occurring as day programs ramp up and reopen following their required closure during the spring of 2020. PDF | Word

Dental

• UPDATED (New Due Date for Applications) MassHealth Dental Bulletin 47: Alternative Interim Payments provides guidance on eligibility criteria dental providers must meet to request an alternative interim payment pursuant to this bulletin and Administrative Bulletin 20-61. UPDATED PDF | UPDATED Word

Early Intervention

• Early Intervention Bulletin 3: Temporary Extension of Coverage for Early Intervention Services​ outlines the MassHealth policy to pay for the provision of Early Intervention services to eligible children who turn three years old between March 15, and August 31, 2020, to provide a “bridge” between EI and appropriate Early Childhood Special Education (ECSE) services​. PDF | Word

Health Safety Net

• Health Safety Net (HSN), Uninsured, & MassHealth Limited COVID-19 Testing and Treatment Frequently Asked Questions PDF | Word

Home Health Agencies, CSNs, and PCAs

Continuous Skilled Nursing Agency

• Continuous Skilled Nursing Agency Bulletin 3: Requirements for Continuous Skilled Nursing Rate Amendments Effective for Dates of Service on or after January 1, 2022 set spending expectations for the additional 20% rate increase EOHHS that is applying to all CSN rates for dates of service January 1, 2022, through June 30, 2022. PDF | Word

 

Home Health Agency

• Home Health Agency Bulletin 73: Requirements for Continuous Skilled Nursing Rate Amendments Effective for Dates of Service on or after January 1, 2022 set spending expectations for the additional 20% rate increase EOHHS that is applying to all CSN rates for dates of service January 1, 2022, through June 30, 2022. PDF | Word
• Home Health Agency Bulletin 68: Extended MassHealth Telehealth Policy for Home Health Services and New Telehealth Documentation Requirement describes a COVID-19-related telehealth flexibility for MassHealth home health services that will remain in effect beyond September 13, 2021, until the end of the FPHE; clarifies that telehealth visits may be used for follow-up visits that do not require any hands-on care; and describes a new recordkeeping and documentation requirement regarding telehealth services. PDF | Word
• Home Health Agency Bulletin 63: MassHealth Telehealth Policy for Home Health Services - Extension explains MassHealth’s policy for the use of telehealth for certain home health services and extends the policy until 90 days after the final date of the Governor’s Declaration of a State of Emergency. PDF | Word
• Home Health Agency Bulletin 60: MassHealth Telehealth Policy for Home Health Services explains MassHealth’s policy for the use of telehealth for certain home health services through March 31, 2021. PDF | Word
• Home Health Agency Bulletin 59: FY19 Supplemental Budget Surplus Distribution outlines changes to the implementation of the Commonwealth of Massachusetts’ FY19 Supplemental Budget and distribution of funds to home health agencies. PDF | Word
• Home Health Agency Bulletin 58: Implementation of Rate Add-On Applicable to Certain Continuous Skilled Nursing Serves to Address Costs Associated with Coronavirus Disease 2019 (COVID-19) ​provides guidance on program requirements associated with the rate add-on as established in Administrative Bulletin 20-63. PDF | Word
• Home Health Agency Bulletin 57: Temporary Expansion of Home Health Aide Services   PDF | Word
• Home Health Agency Bulletin 56: Temporary Expansion of Home Health Aide Services   PDF | Word

Long Term Services and Supports (LTSS)

Adult Foster Care

• Adult Foster Care Bulletin 18: MassHealth Telehealth Policy for Adult Foster Care and Group Adult Foster Care Services explains MassHealth’s policy for the use of telehealth for certain adult foster care services and certain group adult foster care services, which will remain in effect for 90 days after the final date of the Governor’s Declaration of a State of Emergency to Respond to COVID-19. PDF | Word

 

Durable Medical Equipment

• Durable Medical Equipment Bulletin 25: COVID-19 Related Administrative Flexibilities for Durable Medical Equipment Providers provides updates to MassHealth’s COVID-19 related flexibilities for providers of MassHealth-covered durable medical equipment to help ensure members retain access to appropriate durable medical equipment, promote social distancing, and mitigate the spread of COVID-19​. PDF | Word

HCBS Waiver

• HCBS Waiver Provider Bulletin 11: Enhanced Rates and Billing Instructions for ABI and MFP Waiver Day Services, Community-based Day Supports, Prevocational Services, and Supported Employment for Dates of Service from June 1, 2021, through June 30, 2021 set forth enhanced rates and billing instructions to address the reduced member utilization of day program services as waiver participants began returning to day programs following closures and/or access limitations related to the COVID-19 pandemic. PDF | Word
• HCBS Waiver Provider Bulletin 9: Additional Guidance and Requirements for Day Services During Phase IV of the Reopening Plan replaced and superseded HCBS Waiver Provider Bulletin 5 to outline guidance and requirements for HCBS Waiver providers in addition to EOHHS guidance. PDF | Word
• HCBS Waiver Provider Bulletin 8: Enhanced Rates and Billing Instructions for ABI and MFP Waiver Day Services, Community-based Day Supports, Prevocational Services, and Supported Employment for Dates of Service from December 1, 2020, through May 31, 2021 set forth the enhanced rates and billing instructions for day services in effect for MassHealth-covered ABI and MFP Waiver day services, CBDS, prevocational services, and supported employment. PDF | Word
• HCBS Waiver Provider Bulletin 4:  Guidance for Home and Community-Based Services (HCBS) Waiver Providers Delivering Telehealth/Remote Services During the COVID-19 Public Health Emergency consolidates and restates MassHealth’s current telehealth policy for HCBS Waiver services, and extends that policy through February 28, 2021, consistent with Appendix K. PDF | Word
• HCBS Waiver Provider Bulletin 5:  Additional Guidance and Requirements for Day Services During Phase III ​outlines additional guidelines and requirements for MassHealth-covered ABI and MFP Waiver day services​ including use of risk/benefit tools, reporting to MassHealth on program rosters, and reporting processes when a staff member or participant tests positive for COVID-19. PDF | Word
• HCBS Waiver Provider Bulletin 3: Enhanced Rates for ABI and MFP Waiver Day Services, Community-Based Day Supports, Prevocational Services, and Supported Employment During the Reopening Period (August 1, 2020, through November 30, 2020) and Billing Instructions for Standard Rates for Day Services sets forth the enhanced rates and billing instructions for standard rates for day services, community-based day supports, prevocational services, and supported employment that have been established to address reduced member utilization of day program services that is occurring as waiver participants begin returning to day programs following closures and/or access limitations related to COVID-19 during the spring of 2020. PDF | Word
• HCBS Waiver Provider Bulletin 2: FY19 Supplemental Budget Surplus Distribution outlines changes to the implementation of the Commonwealth of Massachusetts’ FY19 Supplemental Budget and distribution of funds to HCBS waiver providers. PDF | Word

 

Hospice

• Hospice Bulletin 16: MassHealth Telehealth Policy for Hospice Services explained MassHealth’s policy for the use of telehealth for certain hospice services through March 31, 2021. PDF | Word

 

Rehabilitation Center

• Rehabilitation Center Bulletin 12: COVID-19 Related Administrative Flexibilities for Therapy Services Including Telehealth provides updates to COVID-19 related flexibilities for MassHealth therapist services, including services delivered via telehealth, at rehabilitation centers (physical therapy, occupational therapy, and speech and language therapy). PDF | Word

 

Resident Care Facility

• Resident Care Facility Bulletin 34: COVID-19 Signing Bonuses for Resident Care Facility Staff ​provides guidance regarding signing bonuses that eligible resident care facilities pay to incentivize new direct care staff to work in resident care facilities during the public health emergency. PDF | Word

 

Speech and Hearing Center

• Speech and Hearing Center Bulletin 12: COVID-19 Related Administrative Flexibilities for Therapy Services Including Telehealth provides updates to MassHealth’s COVID-19 related flexibilities for MassHealth speech and language therapist services , including telehealth, at speech and hearing centers to help ensure that members retain access to appropriate therapist services, promote social distancing, and mitigate the spread of COVID-19. PDF | Word

 

Therapist

• Therapist Bulletin 15: COVID-19 Related Administrative Flexibilities for Therapy Services Including Telehealth provides updates to MassHealth’s COVID-19 related flexibilities for MassHealth therapist services (physical therapy, occupational therapy, and speech and language therapy), including telehealth, to help ensure that members retain access to appropriate therapist services, promote social distancing, and mitigate the spread of COVID-19. PDF | Word

 

Resources

• MassHealth LTSS Provider Information: Updates Related to the Coronavirus Disease 2019 (COVID-19) PDF | Word
• Guidance for community day programs
• Guidance for long term care facilities
  • Isolated Spaces for Nursing Facility Residents with a positive Coronavirus Disease 2019 (COVID-19) Diagnosis: This bulletin establishes criteria for nursing facilities to designate wings, units, or floors that are separated from the rest of the facility to provide services to COVID-19 positive residents. PDF | Word
  • MassHealth Nursing Facility Investment to Support Dedicated COVID-19 Isolation Spaces PDF| Word
  • MassHealth Investment to Support Signing Bonuses for Nursing Facility Staff​ PDF | Word
  • Information About Signing Bonuses Available for Long Term Care Facility Staff
    English PDF | Word Spanish PDF | Word

Managed Care Entities

• Managed Care Entity Bulletin 79: Extension of Coverage and Reimbursement Policy Related to COVID-19 for 24-Hour Substance Use Disorder Services further extended the payment of 24-hour substance use disorder treatment services–related flexibilities described in All Provider Bulletin 319 through June 30, 2022, after which they expired. Except as provided herein, or in other guidance published by MassHealth, the remainder of All Provider Bulletin 319 will remain unchanged. PDF | Word

• Managed Care Entity Bulletin 78: Temporary Extension of Flexibilities to Permit Separate Payment for Specimen Collection further extends the COVID-19 specimen collection–related flexibilities described in All Provider Bulletin 325 and Managed Care Entity Bulletin 70 through March 31, 2022. Except as provided herein, or in other guidance published by MassHealth, the remainder of All Provider Bulletin 325 and Managed Care Entity Bulletin 70 will remain the same. PDF | Word

• Managed Care Entity Bulletin 70: Temporary Extension of Flexibilities to Permit Separate Payment for Specimen Collection extended the COVID-19 specimen collection-related flexibilities described in All Provider Bulletin 319 and Managed Care Entity Bulletin 66 through December 31, 2021, after which they expired. PDF | Word

• Managed Care Entity Bulletin 63: MassHealth Rate Floor Enhancements for Acute Treatment Services, Clinical Stabilization Services, and Residential Rehabilitation Services directs managed care plans to pay at least the same enhanced rates as MassHealth’s fee-for-service program for Acute Treatment Services, Clinical Stabilization Services, and Residential Rehabilitation Services from dates of service April 1, 2021 through June 30, 2021. PDF | Word

• Managed Care Entity Bulletin 60: Updated MassHealth Telehealth Policy contains updated telehealth policy requirements for Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care plans, Senior Care Organizations (SCOs), and the behavioral health vendor. PDF | Word

• Managed Care Entity Bulletin 46: Updated MassHealth Telehealth Policy ​updates telehealth requirements for managed care entities to align with MassHealth fee-for-service requirements, extending telehealth policy requirements, with some changes, through March 31, 2021. PDF | Word
• Managed Care Entity Bulletin 45: Temporary COVID-19 Flexibilities for the Dispensing of Hearing Aids for Members Age 18 and Older provides guidance on COVID-related flexibilities for evaluating the need for and providing hearing aids to MassHealth members​. PDF | Word
• Managed Care Entity Bulletin 43: Requirements for Adult Day Health Services Delivered Remotely (via Telehealth and In-Home Settings) and Enhanced Rates for Adult Day Health Services During the Reopening Period (August 1, 2020, through November 30, 2020) outlines MassHealth’s expectations for integrated care plans regarding payment, coverage, and billing for the delivery of Adult Day Health (ADH) services remotely via telehealth or in an in-home setting and directs plans to institute temporary rate increases. PDF | Word
• Managed Care Entity Bulletin 40: Payment for COVID-19 Specimen Collection and Testing clarifies managed care plan requirements for payment to a provider for specimen collection when the provider also conducts or bills for the laboratory test and directs managed care plans to pay for medically necessary specimen collection, testing, and resulting services as set forth in this bulletin. PDF | Word
• Managed Care Entity Bulletin 38: Limited Modification and Extension of Temporary Incremental Rate Increase for Inpatient Mental Health Services in Response to COVID-19 Pandemic directs managed care plans to modify and extend the temporary rate increases for facilities designated as Tier 2 by the Department of Mental Health (DMH) as set forth in this bulletin. PDF | Word
• Managed Care Entity Bulletin 35: Temporary Rate Increases due to COVID-19 National Emergency directs One Care plans, Senior Care Organizations (SCOs), and PACE organizations to institute temporary rate increases​ for a number of providers including Residential Rehabilitative Services and Continuous Skilled Nursing Services. PDF | Word
• MassHealth Managed Care Entity Bulletin 32: UPDATE: Temporary Rate Increases Due to COVID-19 National Emergency provides clarifications and updates to Managed Care Entity Bulletin 24 and provides guidance on additional residential rehabilitation services incremental rate increase for May and June 2020. ​PDF | Word
• Managed Care Entity Bulletin 27: Temporary Retainer Payments Due to COVID-19 National Emergency directs One Care plans and Senior Care Organizations (SCOs) to institute temporary payments in the form of retainer payments for Adult Day Health providers to ensure these providers receive crucial stabilization funding for serving members enrolled in integrated care plans during the COVID-19 emergency. PDF | Word
• Managed Care Entity Bulletin 23: Temporary Rate Increases Due to COVID-19 National Emergency directs One Care plans, Senior Care Organizations (SCOs), and Program of All-Inclusive Care for the Elderly (PACE) organizations to institute temporary rate increases and provides additional guidance regarding financial stabilization funding. PDF | Word
• MassHealth Community Partner Information: Updates Related to the Coronavirus Disease 2019 (COVID-19) PDF | Word

MassHealth Eligibility & Applications during COVID-19

• Eligibility Operations Memo 20-10: Hospital-Determined Presumptive Eligibility (HPE) Flexibilities during COVID-19 Emergency PDF | Word
• Eligibility Operations Memo 20-07: Updates to Hospital-Determined Presumptive Eligibility (HPE) Application Process PDF | Word
• Eligibility Operations Memo 20-06: Updates to the Hospital-Determined Presumptive Eligibility (HPE) Application Process PDF | WORD

Nursing Facilities

• Nursing Facility Bulletin 167: Updated COVID-19 Ongoing Surveillance Testing Requirements for Nursing Facilities superseded Nursing Facility Bulletin 164 to align with Department of Public Health surveillance testing requirements, effective August 12, 2021 PDF | Word
• Nursing Facility Bulletin 164: Updated COVID-19 Ongoing Surveillance Testing Requirements for Nursing Facilities superseded Nursing Facility Bulletin 162 to align with Department of Public Health surveillance testing requirements, effective June 3, 2021. PDF | Word
• Nursing Facility Bulletin 162: Updated COVID-19 Ongoing Surveillance Testing Requirements for Nursing Facilities superseded MassHealth Nursing Facility Bulletin 158 beginning March 18, 2021, to update surveillance testing requirements for nursing facilities in light of ongoing staff vaccinations. PDF | Word
• Nursing Facility Bulletin 163: Reporting on Staff Hours and Staffing Preparedness for Nursing Facilities requires nursing facilities to report on their staffing levels each month, effective April 1, 2021. The requirements align with, and supplement, the quarterly reporting on staffing levels required by 42 CFR 483.70(q) and will be used to determine facilities’ standard rate adjustments under 101 CMR 206.13(2). PDF | Word
• Nursing Facility Bulletin 159: Updated Coronavirus Disease 2019 (COVID-19) Isolated Spaces for Nursing Facilities ​updates the policy for nursing facilities that meet the criteria to establish designated wings, units, floors or other isolation spaces separated from the rest of the facility to care for COVID-19 positive residents and new COVID-positive admissions PDF | Word
• Nursing Facility Bulletin 158: Updated COVID-19 Ongoing Surveillance Testing Requirements for Nursing Facilities provides updated guidance for ongoing COVID-19 Surveillance Testing Requirements at Resident Care Facilities. This Nursing Facility Bulletin was effective January 1, 2021, and superseded relevant provisions in Nursing Facility Bulletins 152 and 157 to align with and incorporate the testing requirements established under the Department of Public Health’s Updates to Long-Term Care Surveillance Testing guidance (DPH LTC Testing Guidance). PDF | Word
• Nursing Facility Bulletin 157: Updated COVID-19 Ongoing Surveillance Testing Requirements for Nursing Facilities supersedes previous Nursing Facility bulletins regarding surveillance testing to provide updates in alignment with the most recent Department of Public Health guidance. PDF | Word
• Nursing Facility Bulletin 156: Updated Coronavirus Disease 2019 (COVID-19) Isolated Spaces for Nursing Facilities ​supersedes previous bulletins to establish criteria for nursing facilities to designate wings, units, or floors, separated from the rest of the facility and referred to here as “isolation spaces,” to provide nursing facility services to COVID-19 positive residents. PDF | Word
• Nursing Facility Bulletin 153: Deadline Extension for Reporting Room Density in Nursing Facilities ​extends the submission deadline for attestation and reporting requirements outlined in Nursing Facility Bulletin 151 to 11:59 p.m. on October 30, 2020. PDF | Word
• Nursing Facility Bulletin 152: COVID-19 Ongoing Surveillance Testing Requirements for Nursing Facilities​ ​outlines updated requirements for surveillance testing in nursing homes, superseding Nursing Facility Bulletin 148 to align with updated guidance​ from the Dep​artment of Public Health. PDF | Word
• Nursing Facility Bulletin 151: Room Density Reporting and Planning for Nursing Facilities describes new requirements for nursing facilities to report the number of rooms by type (single, two-bedded, three-bedded, and four-bedded) within their facility and attest to taking immediate steps towards reducing or eliminating three and four bedrooms. PDF | Word
• Nursing Facility Bulletin 150: Coronavirus Disease 2019 (COVID-19) Isolated Spaces for Nursing Facilities establishes criteria for nursing facilities to designate wings, units, or floors, separated from the rest of the facility, to provide nursing facility services to COVID-19 positive residents. PDF | Word
• Nursing Facility Bulletin 148: COVID-19 Baseline and Surveillance Testing Requirements for Nursing Facilities ​establishes the requirements that nursing facilities must meet for a second round of baseline testing and on-going surveillance testing of Staff, and testing of symptomatic or COVID-19 exposed residents or exposed Staff, as outlined by the guidance issued on June 30, 2020 by the Department of Public Health (DPH). PDF | Word
• Nursing Facility Bulletin 147: Signing Bonuses for Nursing Facility Staff ​provides guidance for nursing facilities regarding MassHealth funding for qualifying signing bonuses that eligible nursing facilities pay to incentivize hiring of direct care staff through the Commonwealth's Long Term Care Portal. PDF | Word
• MassHealth Nursing Facility Provider Bulletin 146: COVID-19 Baseline Testing Requirements for Nursing Facilities ​​outlines the baseline COVID-19 testing requirements nursing facilities must meet to receive supplemental payments and includes the attestation nursing facilities must submit to demonstrate that they have met these requirements. ​PDF | Word
• Nursing Facility Bulletin 145: Infection Control Competencies and Expectations for Nursing Facilities. This provider bulletin establishes the expectations for COVID-19 infection control competencies at nursing facilities in the Commonwealth.  It also establishes an audit process for evaluating nursing facilities' implementation of the infection control competencies and requires each nursing facility to complete an initial self-assessment and attestation of such competencies. PDF | WORD
  • Self-assessment checklist Excel
  • MassHealth Nursing Facility COVID-19 Accountability and Support Frequently Asked Questions (FAQ) PDF | Word

Pharmacy

• Pharmacy Facts 163: Removal of Prior Authorization (PA) Requirements for Chloroquine and Hydroxychloroquine removes the requirement that members must go through a PA process before chloroquine and hydroxychloroquine can be dispensed. PDF | Word
• Pharmacy Facts 157: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) allows pharmacists to dispense up to a 365-day supply of drugs used for family planning if requested by a MassHealth member or that member’s prescriber. PDF | Word
• Pharmacy Facts 155 provides guidance on additional flexibilities for pharmacy coverage and billing for individuals who are Health Safety Net patients. PDF| Word
• Pharmacy Facts 154: Additional Update Related to Coronavirus Disease 2019 (COVID-19) ends a policy change made during the COVID-19 pandemic regarding albuterol inhaler prescribing requirements. PDF | Word
• Pharmacy Facts 150: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) ends several temporary policy changes made in response to COVID-19, including early refills and some prior authorization flexibilities PDF | Word
• Pharmacy Facts 147: Additional Updates for Pharmacies Serving Health Safety Net Patients provides guidance for how pharmacies should submit claims for Health Safety Net (HSN) patients in light of new flexibilities that temporarily allow patients who are unable to receive their medications from their regular (HSN) provider to have those prescriptions filled by any pharmacy in the MassHealth network. PDF | Word
• Pharmacy Facts 145: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) provides guidance on how pharmacies should bill for home delivery, and updated information for pharmacies that provide durable medical equipment (DME) including DME prior authorization flexibilities. PDF | Word
• Pharmacy Facts 143: Coronavirus Disease 2019 (COVID-19) and New Policies on Chloroquine and Hydroxychloroquine—Effective for Dates of Service on or after March 26, 2020 PDF | Word
• Pharmacy Facts 142: Additional Updates Related to Coronavirus Disease 2019 (COVID-19 Effective Immediately PDF | Word
• Pharmacy Facts 141: Updates Related to Coronavirus Disease 2019 (COVID-19) Effective March 14, 2020 PDF | Word

Telehealth Network

• Provider Participation Requirements, Covered Encounters and Other Information​ PDF​ | Word

Transportation Brokers, Transportation Providers, and Drivers

• Transportation Bulletin 17: MassHealth Coverage and Reimbursement Policy for Transportation Services Related to the 2019 Novel Coronavirus Disease (COVID-19) PDF | Word
• Transmittal Letter TRN-36: Transportation Manual (COVID-19 Updates to Subchapter 6)​ PDF | Word

MassHealth has established new procedure and service codes for ambulance services related to COVID-19, as described in the administrative bulletin and transmittal letters below:

• Administrative Bulletin 20-12: 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services​ PDF | Word

Last updated:	February 8, 2023