The MassHealth agency pays for procedures and hospital stays that are subject to the Utilization Management Program only if the requirements of the program, as described in 130 CMR 450.207: Utilization Management Program for Acute Inpatient Hospitals through 450.209: Utilization Management: Prepayment for Acute Inpatient Hospitals, are satisfied. Appendix E of the Acute Inpatient Hospital Manual describes the information that must be provided as part of the review process.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-4a

Provider Manual Series (130 CMR 415.000)

Transmittal Letter Date

Acute Inpatient Hospital Manual

AIH-52 01/02/15