Submission of Bills to Meet the Deductible

(A) Criteria. To establish eligibility by meeting a deductible, the individual must submit verification of medical bills whose total equals or exceeds the deductible and that meet the following criteria. (1) The bill must not be subject to further payment by health insurance or other liable third- party coverage, including the Health Safety Net. (2) The bill must be for an allowable medical or remedial-care expense in accordance with 130 CMR 520.032(B). A remedial-care expense is a nonmedical support service made necessary by the medical condition of the individual or the spouse. (3) The bill must be unpaid and a current liability or, if paid, paid during the current six- month deductible period. (4) Any bill or portion of a bill used to meet a deductible may not be applied to any other deductible period. However, any portion of a bill not used to meet the current deductible may be used in a future deductible period. The MassHealth agency will not pay any bills or portions of bills that are used to meet the deductible. These bills remain the responsibility of the applicant. Page 520.033 (B) Expenses Used to Meet the Deductible. The MassHealth agency applies bills to meet the deductible in the following order: (1) Medicare and other health-insurance premiums credited prospectively for the cost of six months' coverage, deductibles, enrollment fees, or coinsurance charges incurred by the individual and the spouse; (2) expenses incurred by the individual and the spouse for necessary medical and remedial- care services that are recognized under state law but are not covered by MassHealth, including guardianship fees and related expenses as described in and allowed under 130 CMR 520.026(E)(3); and (3) expenses incurred by the individual, a family member, or financially responsible relative for necessary medical and remedial-care services that are covered by MassHealth. (C) Expenses that Cannot be Used to Meet the Deductible. Expenses that may not be applied to meet the deductible include, but are not limited to, the following: (1) cosmetic surgery; (2) rest-home care; (3) weight-training equipment; (4) massage therapy; (5) special diets; and (6) room-and-board charges for individuals in residential programs.