In accordance with 42 CFR 431.52(b), the MassHealth agency pays for out-of-state speech and hearing center services only in the following circumstances.

1. (A) Services are needed and the member’s health would be endangered if the member were required to travel to his or her state of residence.
2. (B) The MassHealth agency determines, on the basis of medical advice, that the needed services, or necessary supplementary resources, are more readily available in another state.
3. (C) As a general practice, members in a particular locality use medical resources in another state.

Commonwealth of Massachusetts SUBCHAPTER NUMBER AND TITLE PAGE Division of Medical Assistance 4 PROGRAM REGULATIONS

4-4

Provider Manual Series (130 CMR 413.000)

SPEECH AND HEARING CENTER TRANSMITTAL LETTER DATE

MANUAL

SHC-16 07/01/05