Service Limitations

(A) Services Provided When the Member Is in an Inpatient Setting. The MassHealth agency does not pay for services when a member is receiving inpatient or long-term-care services in an acute or chronic hospital, a psychiatric hospital, or a level II or level III nursing facility. The MassHealth agency also does not pay for services when the member resides in the facility in which services are provided. However, the MassHealth agency will pay for CSP services provided as part of support for transition between service settings, including connecting with the member as part of the member’s discharge planning from an inpatient or 24-hour diversionary setting and supporting them through the transition to accessing outpatient and community-based services and supports. (B) Housing Related Expenses. The MassHealth agency does not pay for costs related to housing move-in or fees related to eviction prevention. (C) Services Provided When the Member Is in the Custody of a Correctional Institution. The MassHealth agency does not pay for services when a member is in the custody of a correctional institution. The MassHealth agency also does not pay for services when the member is incarcerated or detained in a correctional institution in which services are provided. (D) Travel Time. The MassHealth agency pays for travel time that is to or from community- based locations, including the member’s home, and is specifically related to the engagement of a member in CSP services, or direct provision of CSP services. The MassHealth agency does not pay for any other travel time. (E) Transportation. CSP providers may provide referrals to community-based transportation resources. CSP providers may pay for a member’s transportation costs related to CSP services. The MassHealth agency does not reimburse CSP providers for transportation costs. (F) Funding Availability. Reimbursement for MassHealth services is subject to limitation based on the availability of full federal financial participation, and requirements for federal funding, pursuant to EOHHS’ Section 1115 Demonstration waiver and any other applicable federal statute, regulation, or payment limit. This page is reserved.