1. (A) MassHealth covers services provided in another state to a MassHealth member, subject to all applicable limitations, including service coverage, prior authorization, and provider enrollment, only in the following circumstances:

   1. (1) medical services are needed because of a medical emergency;
   2. (2) medical services are needed and the member’s health would be endangered if the member were required to travel to Massachusetts;
   3. (3) it is the general practice for members in a particular locality to use medical resources in another state; or
   4. (4) the MassHealth agency determines on the basis of medical advice that the needed medical services, or necessary supplementary resources, are more readily available in the other state.
2. (B) MassHealth does not cover services provided outside the United States and its territories.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Introduction

1-20

Provider Manual Series (130 CMR 450.000)

Transmittal Letter Date

All Provider Manuals

ALL-224 12/18/17