Abortion Services: Out-of-state Abortions

The MassHealth agency will pay for an abortion performed in an out-of-state facility only if the abortion meets the conditions specified in 130 CMR 410.434 and if prior authorization is requested and received from the MassHealth agency. 4. Program Regulations (A) The member, the referring provider, or a referral agency may request prior authorization from the MassHealth agency in writing. The request must be made in accordance with the instructions for requesting prior authorization for abortion services in Subchapter 5 of the Outpatient Hospital Manual. (B) If the MassHealth agency authorizes the abortion, it will issue a prior authorization number directly to the out-of-state facility. The facility must enter the prior authorization number on the claim form when requesting payment from the MassHealth agency. (C) Out-of-state abortion services will be authorized only when such services are not available in a Massachusetts facility. (D) Prior authorization is not required for abortion services provided in the situations described in 130 CMR 410.404(B)(1).