1. (A) The MassHealth agency pays the speech and hearing centers for no more than one individual

treatment and one group therapy session per member per day.

1. (B) The MassHealth agency does not pay for a treatment claimed for the same date of service as a comprehensive evaluation, since the evaluation fee includes payment for both a written report and for any treatment provided at the time of the evaluation.
2. (C) The MassHealth agency pays speech and hearing centers for providing therapy services in a

Medicare-certified long-term-care facility only in the following circumstances.

1. (1) The member is not covered under Medicare Part A or B.
2. (2) The member is covered under Medicare, the facility has submitted the claim to Medicare, and Medicare has denied payment.

1. (D) The MassHealth agency pays for the establishment of a maintenance program and the training of the member, member’s family, or other persons to carry it out, as part of a regular treatment visit, not as a separate service.

   1. (1) The MassHealth agency does not pay for performance of a maintenance program, except as provided in 130 CMR 413.418(D)(2).
   2. (2) In certain instances, the specialized knowledge and judgment of a licensed therapist may be required to perform services that are part of a maintenance program, to ensure safety or effectiveness that may otherwise be compromised due to the member’s medical condition. At the time the decision is made that the services must be performed by a licensed therapist, all information that supports the medical necessity for performance of such services by a licensed therapist, rather than a non-therapist, must be documented in the medical record.

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

4-7

Provider Manual Series (130 CMR 413.000)

SPEECH AND HEARING CENTER TRANSMITTAL LETTER DATE

MANUAL

SHC-16 07/01/05