Nonreimbursable Services

(A) Nonmedical Services. The MassHealth agency does not pay community behavioral health centers for nonmedical services. These services include, but are not limited to, the following: (1) vocational rehabilitation services; (2) sheltered workshops (a program of vocational counseling and training in which participants receive paid work experience or other supervised employment); (3) educational services; (4) recreational services (play therapy, the use of play activities with a child in an identified treatment setting as an alternative to strictly verbal expression of conflicts and feelings, is not considered a recreational service and is reimbursable); and (5) life enrichment services (ego enhancing services such as workshops or educational courses provided to functioning persons). (B) Nonmedical Programs. The MassHealth agency does not pay for diagnostic and treatment services that are provided as an integral part of a planned and comprehensive program that is organized to provide primarily nonmedical or other nonreimbursable services. Such programs include residential programs, day activity programs, drop-in centers, and educational programs. (C) Research and Experimental Treatment. The MassHealth agency does not pay for research or experimental treatment. (D) Referrals. A provider to whom a member is referred must bill the MassHealth agency directly for any services rendered as a result of the referral, not through the community behavioral health center. In order to receive payment for referral services, the rendering provider must be a participating provider in MassHealth on the date of service. (See 130 CMR 448.412(A)(7)).