130 C.M.R. 403.401 – Introduction

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

Provider Manual Series (130 CMR 403.000)

Transmittal Letter Date

Home Health Agency Manual

HHA-55 07/01/22

4. PROGRAM REGULATIONS: 130 CMR 403.000: Home Health Agency

403.401: Introduction ......................................................................................................................... 4-1 403.402: Definitions........................................................................................................................... 4-1 (130 CMR 403.403 Reserved) ........................................................................................................... 4-6 403.404: Eligible Members ............................................................................................................... 4-6 403.405: Provider Eligibility: In-state............................................................................................... 4-6 403.406: Provider Eligibility: Out-of-state ....................................................................................... 4-7 403.407: Services Provided Under Contract ...................................................................................... 4-8 403.408: Administrative Requirements .............................................................................................. 4-8 403.409: Clinical Eligibility Criteria for Home Health Services ....................................................... 4-9 403.410: Prior Authorization Requirements .................................................................................. 4-10 403.411: Notice of Approval or Denial of Prior Authorization ...................................................... 4-12 403.412: Scope of Home Health Services ....................................................................................... 4-12 403.413: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services ................. 4-12 (130 CMR 403.414 Reserved) 403.415: Nursing Services ........................................................................................................... 4-13 403.416: Home Health Aide Services ............................................................................................. 4-14 403.417: Physical, Occupational, and Speech/Language Therapy ................................................ 4-15 403.418: Medical Supplies .............................................................................................................. 4-17 403.419: Provider Responsibilities ................................................................................................. 4-17 403.420: Plan-of-care Requirements ............................................................................................... 4-21 403.421: Quality Management and Utilization Review ................................................................. 4-23 403.422: Transfers and Discharge Planning ................................................................................. 4-24 403.423: Conditions of Payment .................................................................................................... 4-25 403.424: Intermittent or Part-time Requirement ............................................................................. 4-27 (130 CMR 403.425 through 403.427 Reserved) 403.428: Maximum Allowable Fees ............................................................................................... 4-28 403.429: Denial of Services and Administrative Review ............................................................... 4-28 403.430: Prohibited Marketing Activities ...................................................................................... 4-28