Utilization Management Program

The MassHealth agency pays for procedures and hospital stays that are subject to the Utilization Management Program only if the requirements of the program, as described in 130 CMR 450.207: Utilization Management Program for Acute Inpatient Hospitals through 450.209: Utilization Management: Prepayment for Acute Inpatient Hospitals, are satisfied. Appendix E of the Acute Inpatient Hospital Manual describes the information that must be provided as part of the review process.     4. Program Regulations 4-4a