1. (A) The MassHealth agency pays only for those treatments and evaluations for which the speech

and hearing center has obtained written referral from a licensed physician or licensed nurse practitioner. The referral must include the following information:

1. (1) a complete diagnosis of the member;
2. (2) the date of onset of the disability for which therapy is recommended;
3. (3) a statement of previous treatment, if any;
4. (4) the date of the member's last physical examination;
5. (5) the reason for the referral;
6. (6) the date of the referral; and
7. (7) the physician's or nurse practitioner’s signature and address.

1. (B) A referral from the physician or nurse practitioner does not authorize payment. The speech

therapy or aural rehabilitation prescribed by the physician pursuant to the comprehensive evaluation described in 130 CMR 413.416(A) must constitute appropriate and effective treatment, within accepted medical standards, for the member's condition.