Amended Guidelines for Medical Necessity Determination for Home Health Services
October 21, 2024
Effective November 2024, MassHealth amended the Guidelines for Medical Necessity Determination (Guidelines). These Guidelines identify the clinical information that MassHealth uses to determine medical necessity of home health agency services. Information located in these Guidelines include, but are not limited to, clinical coverage, prior authorization documentation requirements, clinical documentation guidelines, and submission requirements for home health services.
MassHealth has amended these Guidelines to reflect changes previously made to 130 CMR 403.000: Home Health Agency Manual, which governs the delivery of intermittent home health services (skilled nursing, medication administration, therapies, and home health aide services). Providers should refer to these regulations for further information:
- Guidelines for Medical Necessity Determination: https://tinyurl.com/2p9fzzjt (Guidelines)
- 130 CMR 403.000: Home Health Agency Manual: https://tinyurl.com/mr45w7xz
If you have any questions regarding this guidance, please contact the LTSS Provider Service Center at support@masshealthltss.com or call (844) 368-5184.