Transitional Living Program: Prior Authorization

A provider of transitional living services must obtain prior authorization from the MassHealth agency as a prerequisite to payment for transitional living services. Prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment, such as member eligibility or resort to health insurance payment. All requests for prior authorization for transitional living services must be submitted on MassHealth forms in accordance with the billing instructions in Subchapter 5 of the Personal Care Manual. A completed assessment, evaluation, and service agreement prepared in accordance with 130 CMR 422.438 and 422.439 that are signed by both the member and the program’s director must be submitted to the MassHealth agency with a request for prior authorization.