130 C.M.R. 434.401
Commonwealth of Massachusetts Subchapter Number and Title Page
MassHealth
Table of Contents iv
Provider Manual Series
Transmittal Letter Date
Psychiatric Outpatient Hospital Manual
POH-4 12/26/08
4. PROGRAM REGULATIONS
434.401: Introduction.......................................................................................................... 4-1 434.402: Definitions ........................................................................................................... 4-1 434.403: Eligible Members ................................................................................................ 4-3 434.404: Exclusion of MassHealth Managed Care Members............................................. 4-3 434.405: Provider Eligibility .............................................................................................. 4-3 434.406: Nonreimbursable Services .................................................................................. 4-4 434.407: Payment................................................................................................................ 4-4 434.408: Certification ........................................................................................................ 4-5 434.409: Prior Authorization ............................................................................................. 4-5 434.410: Recordkeeping (Medical Records) Requirements ............................................... 4-6 434.411 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services ............. 4-7 (130 CMR 434.412 through 434.420 Reserved) 434.421: Psychiatric Day Treatment Program Services ..................................................... 4-8 (130 CMR 434.422 through 434.425 Reserved) 434.426: Mental Health Services: Staff Composition Requirements ................................ 4-9 434.427: Mental Health Services: Operating and Treatment Procedures ......................... 4-10 434.428: Mental Health Services: Utilization Review Plan .............................................. 4-11 434.429: Mental Health Services: Recordkeeping Requirements ..................................... 4-12 434.430: Mental Health Services: Service Limitations ..................................................... 4-13 434.431: Child and Adolescent Needs and Strengths (CANS) Data Reporting ................. 4-15
Commonwealth of Massachusetts Subchapter Number and Title Page
MassHealth 4. Program Regulations
4-1
Provider Manual Series (130 CMR 434.000)
Transmittal Letter Date
Psychiatric Outpatient Hospital Manual
POH-4 12/26/08
130 CMR 434.000 establishes the requirements for the provision of psychiatric hospital outpatient services under MassHealth. The MassHealth agency pays for outpatient visits and ancillary services (such as radiographic views, laboratory tests, and pharmacy items) that are medically necessary and appropriately provided. The quality of such services must meet professionally recognized standards of care. All psychiatric inpatient hospitals participating in MassHealth that provide psychiatric hospital outpatient services must comply with the MassHealth regulations, including but not limited to MassHealth regulations set forth in 130 CMR 434.000 and 450.000.