Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 450.000 - Administrative and Billing Regulations
Section 450.109 - Out-of-state Services
Universal Citation: 130 MA Code of Regs 130.450
Current through Register 1531, September 27, 2024
(A) MassHealth covers services provided in another state to a MassHealth member, subject to all applicable limitations, including service coverage, prior authorization, and provider enrollment, only in the following circumstances:
(1) medical services are needed because of a
medical emergency;
(2) medical
services are needed and the member's health would be endangered if the member
were required to travel to Massachusetts;
(3) it is the general practice for members in
a particular locality to use medical resources in another state; or
(4) the MassHealth agency determines on the
basis of medical advice, that the needed medical services, or necessary
supplementary resources, are more readily available in the other
state.
(B) MassHealth does not cover services provided outside the United States and its territories.
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