Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 413.000 - Speech And Hearing Center Services
Section 413.418 - Service Limitations

Universal Citation: 130 MA Code of Regs 130.413

Current through Register 1531, September 27, 2024

(A) The MassHealth agency pays the speech and hearing centers for no more than one individual treatment and one group therapy session per member per day.

(B) The MassHealth agency does not pay for a treatment claimed for the same date of service as a comprehensive evaluation, since the evaluation fee includes payment for both a written report and for any treatment provided at the time of the evaluation.

(C) The MassHealth agency pays speech and hearing centers for providing therapy services in a Medicare-certified long-term-care facility only in the following circumstances.

(1) The member is not covered under Medicare Part A or B.

(2) The member is covered under Medicare, the facility has submitted the claim to Medicare, and Medicare has denied payment.

(D) The MassHealth agency pays for the establishment of a maintenance programand the training of the member, member's family, or other persons to carry it out, as part of a regular treatment visit, not as a separate service.

(1) The MassHealth agency does not pay for performance of a maintenance program, except as provided in 130 CMR 413.418(D)(2).

(2) In certain instances, the specialized knowledge and judgment of a licensed therapist may be required to perform services that are part of a maintenance program, to ensure safety or effectiveness that may otherwise be compromised due to the member's medical condition. At the time the decision is made that the services must be performed by a licensed therapist, a ll information that supports the medical necessity for performance of such services by a licensed therapist, rather than a non-therapist, must be documented in the medical record.

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