Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 484.000 - Abortion Clinic Services
Section 484.007 - Out-of-state Abortions

Universal Citation: 130 MA Code of Regs 130.484

Current through Register 1531, September 27, 2024

(A) A facility located outside of Massachusetts is eligible to receive reimbursement for abortion services provided to Massachusetts recipients only if it is licensed by the governing or licensing agency in its state to perform abortions. An out-of-state facility must obtain a Massachusetts Medical Assistance provider number before it may receive such reimbursement from the MassHealth agency.

(B) The MassHealth agency will pay for a non-emergency abortion performed in an out-of-state facility only if it is a payable abortion and if prior authorization has been requested from and granted by the MassHealth agency.

(1) The recipient or a referral agency may request prior authorization by telephone or in writing. The request should be made to: MassHealth, Prior Authorization Unit, ATTN: Prior Authorization, 100 Hancock Street, 6th Floor, Quincy, MA, 02171 (800) 862-8341. The facility may also make the prior authorization request.

(2) If the MassHealth agency grants a prior authorization request, it will issue a prior authorization number directly to the out of-state facility. In order to receive payment for an out-of-state abortion which requires prior authorization, the facility must enter the approved prior authorization number on the claim form.

(3) The MassHealth agency will grant a prior authorization request only when the abortion service needed by the recipient is not available in a Massachusetts facility.

(C) Consistent with regulations governing other aspects of MassHealth, the MassHealth agency grants an exception to the prior authorization requirement for recipients who live in communities near the borders of the states of Connecticut, New Hampshire, New York, Rhode Island, or Vermont. Such recipients may seek abortion services at facilities in these states when the location of the out of state facility is closer to the recipient's residence than the nearest Massachusetts abortion facility which provides equivalent services and which is eligible to participate in MassHealth.

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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