Nonpayable Circumstances

The MassHealth agency does not pay a therapist for services provided under any of the following circumstances. (A) The therapist provided the service in an inpatient or long-term care facility and is paid by the inpatient or long-term care facility to provide that service, whether or not the cost of the service is included in the MassHealth agency’s or other payer’s rate of payment for that facility. (B) The therapist receives compensation from the state, county, or municipality, unless they are supplementing their income by providing services during off-duty hours. (C) Under comparable circumstances, the therapist does not customarily bill private patients who do not have health insurance.