Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 413.000 - Speech And Hearing Center Services
Section 413.419 - Medical Referral Requirements

Universal Citation: 130 MA Code of Regs 130.413

Current through Register 1531, September 27, 2024

(A) The MassHealth agency pays only for those treatments and evaluations for which the speech and hearing center has obtained written referral from a licensed physician or licensed nurse practitioner. The referral must include the following information:

(1) a complete diagnosis of the member;

(2) the date of onset of the disability for which therapy is recommended;

(3) a statement of previous treatment, if any;

(4) the date of the member's last physical examination;

(5) the reason for the referral;

(6) the date of the referral; and

(7) the physician's or nurse practitioner's signature and address.

(B) A referral from the physician or nurse practitioner does not authorize payment. The speech therapy or aural rehabilitation prescribed by the physician pursuant to the comprehensive evaluation described in 130 CMR 413.416(A) must constitute appropriate and effective treatment, within accepted medical standards, for the member's condition.

The speech and hearing center must maintain a health-care service record for each member for a period of at least four years following the date of service. The record must contain all pertinent information about the services provided, including the date of service and the dates on which materials were ordered and dispensed. The record must include the following:

(A) a licensed physician's or licensed nurse practitioner's written and dated referral for evaluation and referral for treatment, if applicable;

(B) the written comprehensive evaluation report (see 130 CMR 413.416(A) );

(C) the name, address, and telephone number of the member's primary care physician; and

(D) at least weekly documentation of the following:
(1) the date or dates of which speech therapy or aural rehabilitation was provided;

(2) the specific therapeutic procedures and methods used;

(3) the member's response to treatment;

(4) any changes in the member's condition;

(5) the problems encountered or changes in the treatment plan or goals, if any;

(6) the location where the service was provided, if different from that in the evaluation report;

(7) the amount of time spent in treatment; and

(8) the speech therapist's signature.

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