HCBS Waiver Conditions for Payment

(A) The MassHealth agency pays an HCBS waiver provider for the provision of waiver services in accordance with the applicable payment methodology and rate schedule established by EOHHS. (B) Payment for services is subject to the conditions, exclusions, and limitations set forth in 130 CMR 630.000 and 130 CMR 450.000: Administrative and Billing Regulations. (C) The MassHealth agency pays an HCBS waiver provider for a waiver service only if (1) the member was enrolled as a participant under one of the HCBS waivers on the date of service; (2) the service billed was appropriate and necessary; (3) the service billed was authorized and included in the service plan for the participant pursuant to 130 CMR 630.409(A); (4) the waiver services were provided by an HCBS waiver provider in accordance with the requirements of 130 CMR 630.000 and 130 CMR 450.000: Administrative and Billing Regulations: (5) any service delivered via telehealth is authorized under HCBS Waiver Provider Bulletin 23. EOHHS may publish updates or clarifications related to the provision of telehealth for HCBS Waiver Services by bulletin or other written issuance; and (6) the service is provided with the use of EVV as required by the MassHealth agency. The MassHealth agency may make clarifications on the meaning or application of this EVV requirement by bulletin or other written issuance, including to which programs, services, or providers the EVV requirement applies. (D) Additional conditions of payment for waiver services by service type are located as applicable in 130 CMR 630.410 through 630.437. (E) Self-directed Services. Participants who self-direct their services will submit timesheets to the fiscal intermediary (FI) for each worker who provided self-directed services through EVV as required by the MassHealth agency. The FI reviews the time sheets and verifies that they are in accordance with the participant’s service plan and that payment is permissible. The FI sends approved payments to the participant who is responsible for making payment to the worker for the self-directed services.