Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 434.000 - Psychiatric Hospital Outpatient Services
Section 434.407 - Payment
Universal Citation: 130 MA Code of Regs 130.434
Current through Register 1531, September 27, 2024
(A) Payment for psychiatric hospital outpatient services in Massachusetts will be made at the rate for services established in the signed provider contract with the MassHealth agency, subject to the limitations set forth in 130 CMR 434.407.
(B) For purposes of making payments, the following limitations apply.
(1) The
MassHealth agency will not pay for psychiatric hospital outpatient services
provided to a member who is an inpatient at the same or a different hospital on
the same day.
(2) If a member
receives psychiatric hospital outpatient services at one facility and, later on
the same day, is admitted as an inpatient to another facility, the MassHealth
agency will pay both hospitals for services.
(3) When a member is admitted to inpatient
status through the emergency room or outpatient department, the MassHealth
agency will pay for only the inpatient stay. The MassHealth agency will not pay
for services furnished in the emergency room or outpatient department on the
admitting day.
(C) Payment for out-of-state psychiatric hospital outpatient services will be made in accordance with the MassHealth (or equivalent) fee schedule of that state.
(D) Payment for out-of-state psychiatric hospital outpatient services provided to an eligible Massachusetts member may be made only in the following instances:
(1) emergency psychiatric hospital outpatient
services are provided to a member;
(2) psychiatric hospital outpatient services
are provided to a member who lives in a community near the border of
Connecticut, Maine, New Hampshire, New York, Rhode Island, or Vermont and for
whom the out-of-state hospital is nearer than one in Massachusetts providing
equivalent medical services;
(3)
prior authorization has been obtained from the MassHealth agency for
nonemergency outpatient services provided to a member by the out-of-state
psychiatric inpatient hospital that is more than 50 miles from the
Massachusetts border.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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