Orders

The MassHealth agency pays a psychologist for psychological assessment when the following conditions are met: (A) A qualified individual responsible for providing services to the member orders the psychological assessment. This ensures that the service is provided within the context of an overall service plan. A qualified individual includes a physician, psychologist, physician assistant, nurse practitioner, clinical nurse specialist, psychiatric clinical nurse specialist, or licensed independent clinical social worker who is either practicing independently, or as staff of a community health center, mental health center, or hospital. Any other individual or entity wishing to order psychological assessment (such as therapists or other staff at clinics, day habilitation centers, intermediate care facilities for individuals with intellectual disabilities, hospitals, schools, courts, group homes, or state agencies) must coordinate with a qualified individual to obtain the necessary order. (B) Upon request by the MassHealth agency, the provider must provide documentation that psychological assessment was initiated and provided in accordance with 130 CMR 411.410(A). The MassHealth agency may deny or recover payment if the provider fails to provide such documentation to the MassHealth agency when requested. (C) The MassHealth agency pays a psychologist for psychological assessment for the purposes of determining or redetermining eligibility for the EAEDC Program pursuant to 130 CMR 450.106: Emergency Aid to the Elderly, Disabled and Children Program, only if a physician or qualified individual on the staff of a community health center orders such assessment. (130 CMR 411.411 Reserved)