Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth Table of Contents

iv

Provider Manual Series (130 CMR 427.000)

Transmittal Letter Date

Oxygen and Respiratory Therapy

Equipment Manual

OXY-35 04/28/23

4. Program Regulations

130 CMR 427.000: Oxygen and Respiratory Therapy Equipment

427.401: Introduction ............................................................................................................ 4-1 427.402: Definitions ............................................................................................................. 4-1 427.403: Eligible Members ................................................................................................... 4-3 427.404: Provider Eligibility ................................................................................................ 4-3 427.405: Services Provided by Out-of-State Providers .......................................................... 4-4 427.406: Reimbursable Services ........................................................................................... 4-4 427.407: Nonreimbursable Services ..................................................................................... 4-4 427.408: Prescription Requirements ..................................................................................... 4-5 427.409: Prior Authorization ................................................................................................ 4-6 427.410: Purchases Requiring Prior Authorization ............................................................... 4-7 427.411: Rentals Requiring Prior Authorization ................................................................... 4-7 (130 CMR 427.412 through 427.419 Reserved) 427.420: Adjusted Acquisition Cost ..................................................................................... 4-8 427.421: Rates of Payment .................................................................................................... 4-8 427.422: Individual Consideration ........................................................................................ 4-8 427.423: Purchase of Oxygen and Respiratory Therapy Equipment ..................................... 4-9 427.424: Rental of Oxygen and Respiratory Therapy Equipment ......................................... 4-10 427.425: Purchase of Oxygen and Respiratory Therapy Equipment Rented

by the Division ................................................................................................. 4-11

427.426: Repair of Oxygen and Respiratory Therapy Equipment Purchased

by the Division ................................................................................................. 4-11

427.427: Medicare Coverage ................................................................................................ 4-12 427.428: Oxygen and Respiratory Therapy Equipment for Institutionalized Recipients ........ 4-13 427.429: Provider Responsibility .......................................................................................... 4-13 427.430: Recordkeeping Requirements ................................................................................ 4-13 (130 CMR 427.431 through 427.439 Reserved) 427.440: Clinical Requirements: Introduction ...................................................................... 4-15 427.441: Clinical Requirements: Oxygen Therapy Equipment ............................................ 4-15 427.442: Clinical Requirements: Respiratory Therapy Equipment — Apnea Monitor ......... 4-17 427.443: Clinical Requirements: Respiratory Therapy Equipment — Oximetry .................. 4-18

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series (130 CMR 427.000)

Transmittal Letter Date

Oxygen and Respiratory Therapy

Equipment Manual

OXY-35 04/28/23