Important MassHealth Changes Start Jan 22, 2022

by | Jan 19, 2022 | Announcements, Insurance

The ASM is excited to announce some big changes with MassHealth which start this month!

  • MassHealth will cover acupuncture beginning Jan 22, 2022
  • Acupuncturists can sign-up to be Fee-For-Service providers and see members who are enrolled in the MassHealth administered plan (the blue card).
  • The MassHealth administered plans pay for medically necessary acupuncture for the treatment of pain and for acupuncturists to be able to bill for services. More details are below.

 

It Is A Win-Win

After lots of hard work, we are hopeful that these changes will positively impact the acupuncture profession as well as all the individuals who can receive treatments. More individuals will be eligible for services and acupuncturists will be able to provide services to more people and to receive adequate payment for those services.

Highlights Of How The ASM Has Been Working For You

  • The MassHealth statute was 1st re-written in 2014 and included acupuncture as a covered service when provided by acupuncturists and physicians.
  • However, the language used to define the provider types mirrored those used by Medicare and left out any mention of acupuncturists. Because of this, MassHealth did not permit acupuncturists to enroll as providers, but instead only reimbursed them through a supervising MD.
  • ASM reviewed the statute with an attorney and went to work making phone calls, sending letters, and providing testimony to legislative committees.
  • When this statute was reopened the department reached out to the ASM and we have participated in meetings over the last few years voicing important issues and needed changes.
  • A few of our recommendations included the need to cover evaluation and management (E&M) and to make that payable on the same date as acupuncture services.
  • We felt triumphant in November 2021 when we learned that MassHealth would soon allow “acupuncturist” as a new provider type starting on Jan 22, 2022.

 

View The Presentation

MassHealth held a provider enrollment webinar on November 17, 2021. Though it was not recorded, the ASM obtained a copy of the slide deck. It contains key information on how the program works, how to enroll, and more.
Download the presentation PDF here 

Presentation Topics

  1. Enrollment Options and Instructions/Tips for Completing Applications
  2. Provider Record Keeping Requirements
  3. Provider File Integrity
  4. MassHealth Plans Descriptions
  5. Provider Online Service Center
  6. MassHealth User ID/MMIS Access
  7. Billing and Service Requirements – please note the services covered
  8. Resources- please use these to refer your questions and get additional information


MassHealth Customer Support
Have Questions? Want A Provider Enrollment Packet?
Phone: 1-800-841-2900 or   Email: 

Key Coverage Details and Importance of Documentation

  • Treatment for pain is the only condition covered
  • Detoxification follows a different set of rules
  • 20 visits are covered per year. Additional visits need pre-authorization. One office visit (E&M) per member every four weeks. E&M may occur on the same date of service as acupuncture
  • If no clinical benefit is appreciated after four sessions, then the treatment plan must be re-evaluated.
  • Record keeping is now critical and must follow a protocol. In addition to the regular record keeping regulations, a report must be sent in writing to the patient’s primary care provider after the initial intake and following each evaluation. If you want more information on how to do this we recommend you take the Bulletproof Documentation class which is listed below.

Additional Resources

Make Your Documentation Bulletproof-Take Part In This Virtual Class!!

Doing the report writing is a new requirement for many acupuncturists and one that needs to be done correctly to get payment for services provided. The ASM and the Michigan Society of Acupuncturists have arranged to have Mori West offer a well needed virtual class – Bulletproof Documentation. It will help solidify your report writing regardless of how you feel about accepting MassHealth.  Get class details here 

MassHealth Customer Support
Need Help? Want An Enrollment Packet?
Phone: 1-800-841-2900 or   Email: