Utilization Management Program and Mental Health and Substance Use Disorder Admission

Screening Requirements (A) Utilization Management Program. The MassHealth agency pays for procedures and acute hospital stays that are subject to the acute hospital Utilization Management Program only if the applicable requirements of the program as described in 130 CMR 450.207: Utilization Management Program for Acute Inpatient Hospitals through 450.209: Utilization Management: Prepayment Review for Acute Inpatient Hospitals are satisfied. Appendices A and D of the Acute Outpatient Hospital Manual contain the name, address, and telephone number of the contact organization for the Utilization Management Program and describes the information that must be provided during the review process. (B) Mental Health and Substance Use Disorder Admissions. The MassHealth agency will pay for mental health and substance use disorder services provided in an acute inpatient setting only if the admitting provider has satisfied the screening requirements established by MassHealth policy, bulletin, or other issuance.