Quality Management, Utilization Review, and Reporting Requirements

(A) A CSN agency must participate in any quality management and program integrity processes as required by the MassHealth agency and EOHHS including making any requested data available and providing access to visit the CSN agency’s place of business upon request by the MassHealth agency or its designee. (B) A CSN agency must submit requested documentation to the MassHealth agency or its designee for purposes of utilization review and provider review and audit, within the MassHealth agency’s or its designee’s time specifications. The CSN agency must provide the MassHealth agency or its designee with any supporting documentation the MassHealth agency or its designee requests, in accordance with M.G.L. c. 118E, § 38 and 130 CMR 450.000: Administrative and Billing Regulations. (C) A CSN agency must provide the MassHealth agency or its designee any requested documentation for purposes of a member’s medical necessity review for CSN agency services. The requested documentation must be submitted to the MassHealth agency or its designee within the MassHealth agency’s or its designee’s time specifications.