- (A) Research and Experimental Treatment. The MassHealth agency does not pay for research or experimental treatment.
- (B) Travel Time for Outreach. Travel time to and from an outreach visit, including a member's home, place of residence, or an appropriate, mutually agreed-upon community-based location, is not a reimbursable service.
- (C) Nonmedical Programs. The MassHealth agency does not pay for diagnostic and treatment services that are provided as an integral part of a planned and comprehensive program that is organized to provide primarily nonmedical or other nonreimbursable services. Such programs include residential programs, day activity programs, drop-in centers, and educational programs.
Commonwealth of Massachusetts Subchapter Number and Title Page
MassHealth 4. Program Regulations
4-6
Provider Manual Series (130 CMR 464.000)
Transmittal Letter Date
Program of Assertive Community
Treatment Manual
PACT-1 11/1/2025
- (D) Referrals. A provider to whom a member is referred must bill the MassHealth agency directly for any services rendered as a result of the referral, not through the PACT provider. To receive payment for referral services, the rendering provider must be a participating provider in MassHealth on the date of service.