Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 630.000 - Home- and Community-Based Services Waiver services
Section 630.408 - Nonpayable Services

Universal Citation: 130 MA Code of Regs 130.630

Current through Register 1531, September 27, 2024

(A) The MassHealth agency does not pay for any HCBS waiver services that are furnished before the development of the service plan or that are not included in a participant's service plan pursuant to 130 CMR 630.409(A).

(B) The MassHealth agency does not pay for HCBS waiver services that are provided to any individual other than the participant who is eligible to receive such services and for whom such services are approved in the service plan.

(C) The MassHealth agency does not pay an HCBS waiver provider for

(1) any service that is not listed as a covered service for the participant under 130 CMR 630.405;

(2) any service that is not authorized in the service plan;

(3) any service to a person who is a resident or inpatient of a hospital, nursing facility, ICF/IID, or any other medical facility subject to state licensure or certification, except for respite services, in accordance with 130 CMR 630.427, and transitional assistance, in accordance with 130 CMR 630.435;

(4) any service to a participant who is receiving a service from another home- and community-based waiver program;

(5) the cost of room and board, unless provided as part of respite care in accordance with 130 CMR 630.427;

(6) the cost of maintenance, upkeep, an improvement, or home accessibility adaptations to a residential habilitation site, group home, or other provider-owned and -operated residential setting;

(7) the cost of maintenance, upkeep, or an improvement to a participant's place of residence, except for home accessibility adaptations in accordance with 130 CMR 630.417, and transitional assistance in accordance with 130 CMR 630.435; and

(8) any service that is provided without the use of EVV as required by the MassHealth agency.

(D) The MassHealth agency does not pay for HCBS waiver services furnished by legally responsible individuals as defined in 130 CMR 630.402.

(E) The MassHealth agency does not pay for HCBS waiver services that are unsafe, inappropriate, or unnecessary for a participant. Each HCBS waiver provider is responsible for ensuring that the HCBS waiver services it provides are safe, appropriate, and necessary for the participant.

(F) The MassHealth agency does not pay for HCBS waiver services in excess of the units identified and authorized in the participant's service plan.

(G) The MassHealth agency does not pay for HCBS waiver services that duplicate care provided by another payment source or by a family member or legally responsible individual as defined in 130 CMR 630.402.

(H) Additional information about nonpayable services by service type is located as applicable in 130 CMR 630.410 through 630.437.

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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.