A member is eligible for services and benefits according to the
member's coverage type. Each coverage type is described below. Payment for the
covered services listed in 130 CMR 450.105 is subject to all conditions and
restrictions of MassHealth, including all applicable prerequisites for payment.
See individual program regulations for information on covered services and
specific service limitations, including age restrictions applicable to certain
services.
(A)
MassHealth
Standard.
(1)
Covered
Services. The following services are covered for MassHealth
Standard members (
see
130 CMR
505.002:
MassHealth Standard
and
130 CMR
519.002:
MassHealth
Standard).
(a) abortion
services;
(b) acupuncture
services;
(c) adult day health
services;
(d) adult foster care
services;
(e) ambulance
services;
(f) ambulatory surgery
services;
(g) audiologist
services;
(h) behavioral health
services;
(i) certified nurse
midwife services
(j) certified
nurse practitioner services;
(k)
certified registered nurse anesthetist services;
(l) Chapter 766: home assessments and
participation in team meetings;
(m)
chiropractor services;
(n) clinical
nurse specialist services;
(o)
community health center services;
(p) day habilitation services;
(q) dental services;
(r) durable medical equipment and
supplies;
(s) early intervention
services;
(t) family planning
services;
(u) hearing aid
services;
(v) home health
services;
(w) hospice
services;
(x) independent nurse
(private duty nursing) services;
(y) inpatient hospital services;
(z) laboratory services;
(aa) nursing facility services;
(bb) orthotic services;
(cc) outpatient hospital services;
(dd) oxygen and respiratory therapy
equipment;
(ee) personal care
services;
(ff) pharmacy
services;
(gg) physician
services;
(hh) physician assistant
services;
(ii) podiatrist
services;
(jj) prosthetic
services;
(kk) psychiatric clinical
nurse specialist services;
(ll)
rehabilitation services;
(mm) renal
dialysis services;
(nn) speech and
hearing services;
(oo) therapy
services: physical, occupational, and speech/language;
(pp) transportation services;
(qq) urgent care clinic services;
(rr) vision care; and
(ss) X-ray/radiology services.
(2)
Managed Care
Member Participation. MassHealth Standard members must enroll with
a MassHealth managed care provider unless excluded from enrollment with a
MassHealth managed care provider. (See
130 CMR 450.117, and
130 CMR 508.000: MassHealth: Managed Care Requirements.)
MassHealth members who are enrolled in the Kaileigh Mulligan Program, described
in
130 CMR
519.007(A): The
Kaileigh Mulligan Program, or who are enrolled in a home- and
community-based services waiver may choose to enroll in the PCC Plan or a
MassHealth-contracted MCO. Such members who do not choose to enroll in the PCC
Plan or a MassHealth-contracted MCO are enrolled with the MassHealth behavioral
health contractor. Such members may choose to receive all services on a
fee-for-service basis.
(3)
MCOs, Accountable Care Partnership Plans, SCOs, and
ICOs. For MassHealth Standard members who are enrolled in an MCO,
Accountable Care Partnership Plan, SCO, or ICO, 130 CMR 450.105(A)(3)(a) and
(b) apply.
(a) The MassHealth agency does not
pay a provider other than the MCO, Accountable Care Partnership Plan, SCO, or
ICO for any services that are covered by the MassHealth agency's contract with
the MCO, Accountable Care Partnership Plan, SCO, or ICO except for family
planning services that were not provided or arranged for by the MCO,
Accountable Care Partnership Plan, SCO, or ICO. It is the responsibility of the
provider to verify the scope of services covered by the MassHealth agency's
contract with the MCO, Accountable Care Partnership Plan, SCO, or
ICO.
(b) The MassHealth agency pays
providers other than the MCO, Accountable Care Partnership Plan, SCO, or ICO
for those services listed in 130 CMR 450.105(A)(1) that are not covered by the
MassHealth agency's contract with the MCO, Accountable Care Partnership Plan,
SCO, or ICO. Such payment is subject to all conditions and restrictions of
MassHealth, including all applicable prerequisites for
payment.
(4)
Behavioral Health Services.
(a) MassHealth Standard members enrolled in
the PCC Plan or a Primary Care ACO receive behavioral health services only
through the MassHealth behavioral health contractor. (See
130 CMR
450.124.)
(b) MassHealth Standard members enrolled in
an MCO, Accountable Care Partnership Plan, SCO, or ICO receive behavioral
health services only through the MCO, Accountable Care Partnership Plan, SCO,
or ICO. (See
130 CMR
450.117.)
(c) MassHealth Standard members who are not
enrolled in an MCO, Accountable Care Partnership Plan, SCO, ICO, or with the
behavioral health contractor may receive behavioral health services from any
participating MassHealth provider of such services.
(d) MassHealth Standard members who are
younger than 21 years old and who are excluded from participating with a
MassHealth managed care provider under
130
CMR 508.002(A)(1) or (2)
must enroll with the MassHealth behavioral health contractor.
(e) MassHealth members who are enrolled in
the Kaileigh Mulligan Program, described in
130 CMR
519.007(A): The
Kaileigh Mulligan Program, may choose to enroll with a MassHealth
managed care provider. Such members who do not choose to enroll with a
MassHealth managed care provider are enrolled with the MassHealth behavioral
health contractor. Such members may choose to receive all services on a
fee-for-service basis.
(f)
MassHealth members who are receiving services from the Department of Children
and Families (DCF) or the Department of Youth Services (DYS) may choose to
enroll with a MassHealth managed care provider. Such members who do not choose
to enroll with a MassHealth managed care provider must enroll with the
MassHealth behavioral health contractor.
(g) MassHealth members who receive Title IV-E
adoption assistance, described in
130 CMR
522.003: Adoption Assistance and
Foster Care Maintenance, may choose to enroll with a MassHealth
managed care provider. Such members who do not choose to enroll with a
MassHealth managed care provider are enrolled with the MassHealth behavioral
health contractor. Such members may choose to receive all services on a
fee-for-service basis.
(h)
MassHealth members who participate in one of the Money Follows the Person home-
and community-based services waivers who are not enrolled with a MassHealth
managed care provider or not otherwise enrolled with the behavioral health
contractor must enroll with the behavioral health contractor.
(5)
Purchase of Health
Insurance. The MassHealth agency may purchase third-party health
insurance for MassHealth Standard members, with the exception of members
described at
130 CMR
505.002(F):
Individuals with Breast or Cervical Cancer, if the MassHealth
agency determines such premium payment is cost effective. Under such
circumstances, the MassHealth agency pays a provider only for those services
listed in 130 CMR 450.105(A)(1) that are not available through the member's
third-party health insurer.
(6)
Senior Care Organizations. MassHealth Standard members
65 years of age or older may voluntarily enroll in a senior care organization
(SCO) in accordance with the requirements under
130 CMR
508.008: Senior Care
Organizations. The MassHealth agency does not pay a provider other
than a SCO for any services that are provided to the MassHealth member while
the member is enrolled in a SCO.
(7)
Integrated Care
Organizations. MassHealth Standard members 21 through 64 years of
age who are enrolled in Medicare Parts A and B, are eligible for Medicare Part
D, and have no other health insurance that meets the basic benefit level
defined in
130 CMR
501.001: Definition of Terms
may voluntarily enroll in integrated care organization (ICO) in accordance with
the requirements at
130 CMR
508.007: Integrated Care
Organizations. While enrolled in an ICO, MassHealth members who turn
65 years of age and are eligible for MassHealth CommonHealth may remain in One
Care after 65 years of age. The MassHealth agency does not pay a provider other
than the ICO for any services that are provided by an ICO while the member is
enrolled in the ICO, except for family planning services that were not provided
or arranged for by the ICO. It is the responsibility of the provider of
services to determine if a MassHealth member is enrolled in an ICO. Upon
request, the ICO must inform providers and enrolled members of ICO covered
benefits. ICOs are responsible for providing enrolled members with the full
continuum of Medicare and MassHealth covered services.
(B)
MassHealth
CarePlus.
(1)
Covered
Services. The following services are covered for MassHealth
CarePlus members (
see
130 CMR
505.008:
MassHealth
CarePlus).
(a) abortion
services;
(b) acupuncture
services;
(c) ambulance
services;
(d) ambulatory surgery
services;
(e) audiologist
services;
(f) behavioral health
services;
(g) certified nurse
midwife services;
(h) certified
nurse practitioner services;
(i)
certified registered nurse anesthetist services;
(j) chiropractor services;
(k) clinical nurse specialist
services;
(l) community health
center services;
(m) dental
services;
(n) durable medical
equipment and supplies;
(o) family
planning services;
(p) hearing aid
services;
(q) home health
services;
(r) hospice
services;
(s) inpatient hospital
services;
(t) laboratory
services;
(u) nursing facility
services;
(v) orthotic
services;
(w) outpatient hospital
services;
(x) oxygen and
respiratory therapy equipment;
(y)
pharmacy services;
(z) physician
services;
(aa) physician assistant
services;
(bb) podiatrist
services;
(cc) prosthetic
services;
(dd) psychiatric clinical
nurse specialist services;
(ee)
rehabilitation services;
(ff) renal
dialysis services;
(gg) speech and
hearing services;
(hh) therapy
services: physical, occupational, and speech/language;
(ii) transportation services;
(jj) urgent care clinic services;
(kk) vision care; and
(ll) X-ray/radiology services.
(2)
Managed Care
Member Participation. MassHealth CarePlus members must enroll with
a MassHealth managed care provider in accordance with
130 CMR
508.001: MassHealth Member
Participation in Managed Care. (See also
130 CMR
450.117.)
(3)
MCOs and Accountable Care
Partnership Plans. For MassHealth CarePlus members who are
enrolled in an MCO or Accountable Care Partnership Plan, the following rules
apply.
(a) The MassHealth agency does not pay
a provider other than the MCO or Accountable Care Partnership Plan for any
services that are covered by the MassHealth agency's contract with the MCO or
Accountable Care Partnership Plan, except for family planning services that
were not provided or arranged for by the MCO or Accountable Care Partnership
Plan. It is the responsibility of the provider to verify the scope of services
covered by the MassHealth agency's contract with the MCO or Accountable Care
Partnership Plan.
(b) The
MassHealth agency pays providers other than the MCO or Accountable Care
Partnership Plan for those services listed in 130 CMR 450.105(B)(1) that are
not covered by the MassHealth agency's contract with the MCO or Accountable
Care Partnership Plan. Such payment is subject to all conditions and
restrictions of MassHealth, including all applicable prerequisites for
payment.
(4)
Behavioral Health Services.
(a) MassHealth CarePlus members enrolled in
the PCC Plan or Primary Care ACO receive behavioral health services only
through the MassHealth behavioral health contractor. (See
130 CMR
450.124.)
(b) MassHealth CarePlus members enrolled in
an MCO or Accountable Care Partnership Plan receive behavioral health services
only through the MCO or Accountable Care Partnership Plan.
(See
130 CMR
450.117.)
(c) MassHealth CarePlus members who are not
enrolled in an MCO, Accountable Care Partnership Plan, or with the behavioral
health contractor may receive behavioral health services from any participating
MassHealth provider of such services.
(5)
Purchase of Health
Insurance. The MassHealth agency may purchase third-party health
insurance for MassHealth CarePlus members, with the exception of members
described at
130 CMR
505.002(F):
Individuals with Breast or Cervical Cancer, if the MassHealth
agency determines such premium payment is cost effective. Under such
circumstances, the MassHealth agency pays a provider only for those services
listed in 130 CMR 450.105(B)(1) that are not available through the member's
third-party health insurer.
(C)
MassHealth
Buy-In.
(1) For a MassHealth
Buy-In member who is 65 years of age or older or is institutionalized
(see
130 CMR 519.011
: MassHealth Buy-In), the MassHealth agency pays all of the
member's Medicare Part B premium. The MassHealth agency does not pay for any
other benefit for these members.
(2) MassHealth Buy-In members are responsible
for payment of copayments, coinsurance, and deductibles. MassHealth Buy-In
members are also responsible for payment for any services that are not covered
by the member's insurance.
(3) The
MassHealth agency does not pay providers directly for any services provided to
any MassHealth Buy-In member, and therefore does not issue a MassHealth card to
MassHealth Buy-In members.
(4)
MassHealth Buy-In members are excluded from participation with any MassHealth
managed care provider pursuant to
130
CMR 508.002: MassHealth Members
Excluded from Participation in Managed Care.
(D)
MassHealth Senior
Buy-In.
(1)
Covered
Services. For MassHealth Senior Buy-In members
(see
130
CMR 519.010: MassHealth Senior
Buy-In), the MassHealth agency pays the member's Medicare Part B
premiums, and where applicable, Medicare Part A premiums. The MassHealth agency
also pays for coinsurance and deductibles under Medicare Parts A and
B.
(2)
Managed Care
Member Participation. MassHealth Senior Buy-In members are
excluded from participation with a MassHealth managed care provider pursuant to
130
CMR 508.002: MassHealth Members
Excluded from Participation in Managed Care.
(E)
MassHealth
CommonHealth.
(1)
Covered Services. The following services are covered
for MassHealth CommonHealth members (
see
130 CMR
505.004:
MassHealth
CommonHealth and
130 CMR
519.012:
MassHealth
CommonHealth).
(a) abortion
services;
(b) acupuncture
services;
(c) adult day health
services;
(d) adult foster care
services;
(e) ambulance
services;
(f) ambulatory surgery
services;
(g) audiologist
services;
(h) behavioral health
services;
(i) certified nurse
midwife services;
(j) certified
nurse practitioner services;
(k)
certified registered nurse anesthetist services;
(l) Chapter 766: home assessments and
participation in team meetings;
(m)
chiropractor services;
(n) clinical
nurse specialist services;
(o)
community health center services;
(p) day habilitation services;
(q) dental services;
(r) durable medical equipment and
supplies;
(s) early intervention
services;
(t) family planning
services;
(u) hearing aid
services;
(v) home health
services;
(w) hospice
services;
(x) independent nurse
(private duty nursing) services;
(y) inpatient hospital services;
(z) laboratory services;
(aa) nursing facility services;
(bb) orthotic services;
(cc) outpatient hospital services;
(dd) oxygen and respiratory therapy
equipment;
(ee) personal care
services;
(ff) pharmacy
services;
(gg) physician
services;
(hh) physician assistant
services;
(ii) podiatrist
services;
(jj) prosthetic
services;
(kk) psychiatric clinical
nurse specialist services;
(ll)
rehabilitation services;
(mm) renal
dialysis services;
(nn) speech and
hearing services;
(oo) therapy
services: physical, occupational, and speech/language;
(pp) transportation services;
(qq) urgent care clinic services;
(rr) vision care; and
(ss) X-ray/radiology services.
(2)
Managed Care
Member Participation. MassHealth CommonHealth members must enroll
with a MassHealth managed care provider or ICO, unless excluded from
participation in a MassHealth managed care provider. (See
130 CMR 450.117, and
130 CMR 508.000: Managed Care Requirements.)
(3)
MCOs, Accountable Care
Partnership Plans, and ICOs. For MassHealth CommonHealth members
who are enrolled in an MCO, Accountable Care Partnership Plan, or ICO, 130 CMR
450.105(E)(3)(a) and (b) apply.
(a) The
MassHealth agency does not pay a provider other than the MCO, Accountable Care
Partnership Plan, or ICO for any services that are covered by the MassHealth
agency's contract with the MCO, Accountable Care Partnership Plan, or ICO,
except for family planning services that were not provided or arranged for by
the MCO, Accountable Care Partnership Plan, or ICO. It is the responsibility of
the provider to verify the scope of services covered by the MassHealth agency's
contract with the MCO, Accountable Care Partnership Plan, or ICO.
(b) The MassHealth agency pays providers
other than the MCO, Accountable Care Partnership Plan, or ICO for those
services listed in 130 CMR 450.105(E)(1) that are not covered by the MassHealth
agency's contract with the MCO, Accountable Care Partnership Plan, or ICO. Such
payment is subject to all conditions and restrictions of MassHealth, including
all applicable prerequisites for payment.
(4)
Behavioral Health
Services.
(a) MassHealth
CommonHealth members enrolled in the PCC Plan or a Primary Care ACO receive
behavioral health services only through the MassHealth behavioral health
contractor. (See
130 CMR
450.124.)
(b) MassHealth CommonHealth members enrolled
in an MCO, Accountable Care Partnership Plan, or ICO receive behavioral health
services only through the MCO, Accountable Care Partnership Plan, or ICO.
(See
130 CMR
450.117.)
(c) MassHealth CommonHealth members who are
not enrolled in an MCO, Accountable Care Partnership Plan, or ICO, or with the
behavioral health contractor may receive behavioral health services from any
participating MassHealth provider of such services.
(d) MassHealth CommonHealth members who are
younger than 21 years of age and who are excluded from participation in a
MassHealth managed care provider or ICO under
130
CMR 508.002(A)(1) or (2)
must enroll with the MassHealth behavioral health contractor.
(5)
Purchase of Health
Insurance. The MassHealth agency may purchase third-party health
insurance for any MassHealth CommonHealth member if the MassHealth agency
determines such premium payment is cost-effective. Under such circumstances,
the MassHealth agency pays a provider only for those services listed in 130 CMR
450.105(E)(1) that are not available through the member's third-party health
insurer.
(6)
Integrated
Care Organizations. MassHealth CommonHealth members 21 through 64
years of age who are enrolled in Medicare Parts A and B, are eligible for
Medicare Part D, and have no other health insurance that meets the basic
benefit level defined in
130 CMR
501.001: Definition of
Terms, may voluntarily enroll in an integrated care organization (ICO)
in accordance with the requirements at
130 CMR
508.007: Integrated Care
Organizations; while enrolled in an ICO, MassHealth members who turn
65 years of age and are eligible for MassHealth CommonHealth may remain in One
Care after 65 years of age. The MassHealth agency does not pay a provider other
than the ICO for any services that are provided by an ICO while the member is
enrolled in the ICO, except for family planning services that were not provided
or arranged for by the ICO. It is the responsibility of the provider of
services to determine if a MassHealth member is enrolled in an ICO. Upon
request, the ICO must inform providers and enrolled members of ICO covered
benefits. ICOs are responsible for providing enrolled members with the full
continuum of Medicare and MassHealth covered services.
(F)
MassHealth
Limited.
(1)
Covered
Services. For MassHealth Limited members (
see
130 CMR
505.006:
MassHealth Limited
and
130 CMR
519.009:
MassHealth
Limited), the MassHealth agency pays only for the treatment of a
medical condition (including labor and delivery) that manifests itself by acute
symptoms of sufficient severity that the absence of immediate medical attention
reasonably could be expected to result in
(a)
placing the member's health in serious jeopardy;
(b) serious impairment to bodily functions;
or
(c) serious dysfunction of any
bodily organ or part.
(2)
Organ Transplants. Pursuant to
42 U.S.C.
1396b(v)(2), the MassHealth
agency does not pay for an organ transplant procedure, or for care and services
related to that procedure, for MassHealth Limited members, regardless of
whether such procedure would otherwise meet the requirements of 130 CMR
450.105(F)(1).
(3)
Managed Care Member Participation. MassHealth Limited
members are excluded from participation in managed care pursuant to
130
CMR 508.002: MassHealth Members
Excluded from Participation in Managed Care.
(G)
MassHealth Family
Assistance.
(1)
Premium Assistance. The MassHealth agency provides
benefits for MassHealth Family Assistance members who meet the eligibility
requirements of
130 CMR 505.005(B),
(C) or (D).
(a) For MassHealth Family Assistance members
who meet the eligibility requirements of
130 CMR 505.005(B)
and (C), the only benefit the MassHealth
agency provides is partial payment of the member's employer-sponsored health
insurance, except as provided in 130 CMR 450.105(H).
(b) For MassHealth Family Assistance members
who meet the eligibility requirements of
130 CMR
505.005(B):
Eligibility Requirements for Children with Modified Adjusted Gross
Income of the MassHealth MAGI Household Greater than 150 and Less than or Equal
to 300% of the Federal Poverty Level, the MassHealth agency provides
dental services as described in 130 CMR 420.000: Dental
Services.
(c) For
MassHealth Family Assistance members who meet the eligibility requirements of
130 CMR
505.005(D):
Eligibility Requirements for Adults and Young Adults Aged 19 and 20 Who
Are Nonqualified PRUCOLs with Modified Adjusted Gross Income of the MassHealth
MAGI Household at or below 300% of the Federal Poverty Level, the
MassHealth agency issues a MassHealth card and provides
1. full payment of the member's private
health insurance premium; and
2.
coverage of any services listed in 130 CMR 450.105(H) not covered by the
member's private health insurance. Coverage includes payment of copayments,
coinsurance, and deductibles required by the member's private health
insurance.
(2)
Payment of Copayments, Coinsurance, and Deductibles for Certain
Children Who Receive Premium Assistance.
(a) For children who meet the requirements of
130 CMR
505.005(B):
Eligibility Requirements for Children with Modified Adjusted Gross
Income of the MassHealth MAGI Household Greater than 150 and Less than or Equal
to 300% of the Federal Poverty Level, the MassHealth agency pays
providers directly, or reimburses the member, for
1. copayments, coinsurance, and deductibles
relating to well-baby and well-child care; and
2. copayments, coinsurance, and deductibles
for services covered under the member's employer-sponsored health insurance
once the member's family has incurred and paid copayments, coinsurance, and
deductibles for eligible members that equal or exceed 5% of the family group's
annual gross income.
(b)
Providers should check the Eligibility Verification System (EVS) to determine
whether the MassHealth agency will pay a provider directly for a copayment,
coinsurance, or deductible for a specific MassHealth Family Assistance
member.
(3)
Covered Services for Members Who Are Not Receiving Premium
Assistance. For MassHealth Family Assistance members who meet the
eligibility requirements of
130 CMR 505.005(B),
(E), (F), or (G), the following services are
covered:
(a) abortion services;
(b) acupuncture services;
(c) ambulance services (emergency
only);
(d) ambulatory surgery
services;
(e) audiologist
services;
(f) behavioral health
services;
(g) certified nurse
midwife services;
(h) certified
nurse practitioner services;
(i)
certified registered nurse anesthetist services;
(j) Chapter 766: home assessments and
participation in team meetings;
(k)
chiropractor services;
(l) clinical
nurse specialist services;
(m)
community health center services;
(n) dental services;
(o) durable medical equipment and
supplies;
(p) early intervention
services;
(q) family planning
services;
(r) hearing aid
services;
(s) home health
services;
(t) hospice
services;
(u) inpatient hospital
services;
(v) laboratory
services;
(w) nurse midwife
services;
(x) nurse practitioner
services;
(y) orthotic
services;
(z) outpatient hospital
services;
(aa) oxygen and
respiratory therapy equipment;
(bb)
pharmacy services;
(cc) physician
services;
(dd) physician assistant
services;
(ee) podiatrist
services;
(ff) prosthetic
services;
(gg) psychiatric clinical
nurse specialist services;
(hh)
rehabilitation services;
(ii) renal
dialysis services;
(jj) speech and
hearing services;
(kk) therapy
services: physical, occupational, and speech/language;
(ll) urgent care clinic services;
(mm) vision care; and
(nn) X-ray/radiology services.
(4)
Managed Care
Participation.
(a) MassHealth
Family Assistance members who meet the eligibility requirements of
130 CMR
505.005(e):
Eligibility Requirement for HIV-positive Individuals Who Are Citizens
or Qualified Noncitizens with Modified Adjusted Gross Income of the Masshealth
MAGI Household Greater than 133 and Less than or Equal to 200% of the Federal
Poverty Level, must enroll with a MassHealth managed care provider.
(See 130 CMR
450.117.)
(b) MassHealth Family Assistance members who
meet the eligibility requirements of
130 CMR
505.005(F):
Eligibility Requirement for Disabled Adults Who Are Qualified
Noncitizens Barred, Nonqualified Individuals Lawfully Present, and Nonqualified
Prucols with Modified Adjusted Gross Income of the Masshealth Disabled Adult
Household at or below 100% of the Federal Poverty Level, must enroll
with the PCC Plan. (See
130 CMR
450.118.)
(5)
MCOs and Accountable Care
Partnership Plans. For MassHealth Family Assistance members who
are enrolled in an MCO or Accountable Care Partnership Plan, 130 CMR
450.105(G)(5)(a) and (b) apply.
(a) The
MassHealth agency does not pay a provider other than the MCO or Accountable
Care Partnership Plan for any services that are covered by the MassHealth
agency's contract with the MCO or Accountable Care Partnership Plan, except for
family planning services that were not provided or arranged for by the MCO or
Accountable Care Partnership Plan. It is the responsibility of the provider to
verify the scope of services covered by the MassHealth agency's contract with
the MCO or Accountable Care Partnership Plan.
(b) The MassHealth agency pays providers
other than the MCO or Accountable Care Partnership Plan for those services
listed in 130 CMR 450.105(H) that are not covered by the MassHealth agency's
contract with the MCO or Accountable Care Partnership Plan. Such payment is
subject to all conditions and restrictions of MassHealth, including all
applicable prerequisites for payment.
(6)
Behavioral Health
Services.
(a) MassHealth Family
Assistance members enrolled in the PCC Plan or a Primary Care ACO receive
behavioral health services only through the MassHealth behavioral health
contractor. (See
130 CMR
450.124.)
(b) MassHealth Family Assistance members
enrolled in an MCO or Accountable Care Partnership Plan receive behavioral
health services only through the MCO or Accountable Care Partnership Plan.
(See
130 CMR
450.117.)
(c) MassHealth Family Assistance members who
are not receiving premium assistance, and are not enrolled in an MCO,
Accountable Care Partnership Plan, or with the MassHealth behavioral health
contractor may receive behavioral health services from any participating
MassHealth provider of such services.
(H)
Children's Medical Security
Plan. Children determined to be eligible for the Children's
Medical Security Plan (CMSP) receive benefits described in
130 CMR
522.004(G): Benefits
Provided.