Out-of-State Abortions

(A) A facility located outside of Massachusetts is eligible to receive reimbursement for abortion services provided to Massachusetts recipients only if it is licensed by the governing or licensing agency in its state to perform abortions. An out-of-state facility must obtain a Massachusetts Medical Assistance provider number before it may receive such reimbursement from the MassHealth agency. (B) The MassHealth agency will pay for a nonemergency abortion performed in an out-of-state facility only if it is a payable abortion and if prior authorization has been requested from and granted by the MassHealth agency. (1) The recipient or a referral agency may request prior authorization by telephone or in writing. The request should be made to: MassHealth, Prior Authorization Unit, ATTN: Prior Authorization, 100 Hancock Street, 6th Floor, Quincy, MA, 02171 Tel.: (800) 862-8341. The facility may also make the prior authorization request. (2) If the MassHealth agency grants a prior authorization request, it will issue a prior authorization number directly to the out-of-state facility. In order to receive payment for an out-of-state abortion which requires prior authorization, the facility must enter the approved prior authorization number on the claim form. (3) The MassHealth agency will grant a prior authorization request only when the abortion service needed by the recipient is not available in a Massachusetts facility. Abortion Clinic Manual (C) Consistent with regulations governing other aspects of MassHealth, the MassHealth agency grants an exception to the prior authorization requirement for recipients who live in communities near the borders of the states of Connecticut, New Hampshire, New York, Rhode Island, or Vermont. Such recipients may seek abortion services at facilities in these states when the location of the out-of-state facility is closer to the recipient's residence than the nearest Massachusetts abortion facility which provides equivalent services and which is eligible to participate in MassHealth.