Clinical Nurse Specialist (CNS) Services.

(A) General. 130 CMR 433.473 applies specifically to clinical nurse specialists. In general, however, subject to compliance with state and federal law, the requirements and limitations elsewhere in 130 CMR 433.000 that apply to a physician also apply to a clinical nurse specialist (CNS), such as service and payment limitations, recordkeeping and reporting requirements, and prior-authorization and other conditions of coverage. (B) Conditions of Payment. The MassHealth agency pays a CNS or group practice for CNS services when (1) the services are limited to the scope of practice authorized by state law or regulation (including but not limited to 244 CMR: Board of Registration in Nursing or of the state licensing agency of another state in which the services are provided); (2) the CNS or group practice is not an employee or contractor of the hospital or other facility in which the CNS services were performed, or is not otherwise paid by the hospital or facility for their services; (3) the CNS participates in MassHealth pursuant to the requirements of 130 CMR 433.473(C); and (4) for an out of state CNS the requirements of 130 CMR 433.403(C) are met. (C) Clinical Nurse Specialist Provider Eligibility. A CNS may enroll as a MassHealth provider. Any CNS applying to participate as a provider in MassHealth must submit documentation, satisfactory to the MassHealth agency that he or she (1) is licensed to practice as a CNS by the Massachusetts Board of Registration in Nursing or by the licensing agency of another state in which the CNS services are provided; and (2) is a member of a group practice or is in a solo private practice. (D) Consultation Between a Clinical Nurse Specialist and Physician. The MassHealth agency does not pay for a consultation between a CNS and a physician as a separate service. (130 CMR 433.474 through 433.484 Reserved) 4 Program Regulations Part 4. Additional Services