130 C.M.R. 484.001 – Definition of Payable Abortions

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Abortion Clinic Services Manual

ABR-19 06/10/22

4. PROGRAM REGULATIONS

484.001: Definition of Payable Abortions ............................................................................ 4-1 484.002: Assurance of Recipient Rights................................................................................ 4-1 484.003: Participation by MassHealth Agency Staff ............................................................. 4-1 484.004: Provider Certification Requirements....................................................................... 4-1 484.005: Reimbursable Abortion-related Services ............................................................... 4-2 484.006: Report Requirement................................................................................................ 4-2 484.007: Out-of-State Abortions............................................................................................ 4-3 484.008: Reimbursement for Services ................................................................................... 4-4 484.009: Billing ..................................................................................................................... 4-4

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-1

Provider Manual Series (130 CMR 484.000)

Transmittal Letter Date

Abortion Clinic Services Manual

ABR-19 06/10/22

(A) The MassHealth agency pays for abortion services performed in a Department of Public Health licensed clinic when provided to MassHealth recipients (categories of assistance 0, 1, 2, 3, 5, 6, 7, and 8) if all of the following conditions are met:
1. (1) the abortion is a medically necessary abortion, or the abortion is performed upon a victim of rape or incest when such rape or incest has been reported to a law enforcement agency or public health service within 60 days of the incident;
2. (2) the abortion is performed in accordance with law; and
3. (3) the abortion claim is made in accordance with 130 CMR 484.000.
(B) For the purposes of 130 CMR 484.000, a medically necessary abortion is one which, according to the medical judgment of a licensed physician, or, consistent with c. 112, s. 12M and the time limitations established therein a physician assistant, certified nurse practitioner, or certified nurse midwife, is necessary in light of all factors affecting the pregnant individual’s health.
(C) Unless otherwise indicated, all abortions referred to in 130 CMR 484.000 are payable abortions as defined in 130 CMR 484.001(A) and (B).
(D) For information on reimbursable services for recipients of the Emergency Aid to the Elderly, Disabled and Children Program (category of assistance 4), see 130 CMR 450.106: Emergency Aid to the Elderly, Disabled and Children Program.