Medical Services Required on Site or by Referral

All of the services listed in 130 CMR 405.409 must be provided on site or, alternatively, through a referral network. For the purpose of 130 CMR 405.409, a service furnished by a practitioner other than an employee or contractor of the CHC for which the practitioner, rather than the CHC, claims payment is not considered to be “on site,” even if the service is provided on CHC premises. With the exception of audiology, electrocardiogram, laboratory, and radiology services, the CHC must notify the MassHealth agency, in writing, of each service listed in 130 CMR 405.409(A) through (N) that the CHC will provide on site. All services provided on site must be furnished by practitioners qualified to provide the service that are employees or contractors of the CHC. With the exceptions of audiology, electrocardiogram, laboratory, and radiology services provided on site (for which such services must be furnished and payment claimed by the CHC in accordance with applicable provisions set forth in 130 CMR 405.000 and Subchapter 6 of the Community Health Center Manual), all services set forth below that are provided on site must be furnished, and associated payment claimed by the CHC, in compliance with the applicable MassHealth regulations and Subchapter 6 for each such service, including applicable fee schedules. All services listed in 130 CMR 405.409(A) through (N) that are provided by referral must be based on written agreements between the CHC and each referral provider to ensure continuity of care, exchange of relevant health information such as test results and records, and avoidance of service duplication. Each referral provider must be a participating provider in MassHealth, and payment for the services provided by the referral provider must be claimed by the referral provider in compliance with the applicable MassHealth regulations for such service. All referrals must include follow-up to ensure that the referral process is successfully completed. Services that must be provided on site or through the referral network are the following: (A) audiology services; (B) chiropractor services; (C) dental services; (D) electrocardiogram (EKG) services; (E) laboratory services; (F) medical specialty services such as, but not limited to, cardiology and neurology; (G) mental health services, including psychological testing; (H) occupational therapy services; (I) pharmacy services; (J) physical therapy services; (K) podiatry services; (L) radiology services; (M) speech/language therapy services; and (N) vision care services. (130 CMR 405.410 Reserved)