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New MassHealth policies for March and ConnectorCare deadlines

1. New Home Health Agency Prior Authorization requirements. MassHealth has issued a transmittal letter & a provider bulletin with the following changes taking effect March 1:

  • PA is now required for home nursing for more than 30 visits in 90 day period, & more than 240 units of home health aide services in 90 day period. 130 CMR 403.413
  • Change in physician referral policy -physician must be independent of HHA & must actually see patient. 130 CMR 403.410 & 419.  (Related changes in federal HHA rules about face to face requirement, 81 Fed. Reg 5530, Feb 2, 2016).
  • Requiring referral to ASAP (Aging Service Access Points) for patients 60 & over 130 CMR 403.411

These were filed as emergency regulations. There will be a later notice about a comment period.

Provider Bulletin:

Transmittal letter:

2. New Opioid Prior Authorization requirements.

The MassHealth Drug List has been amended effective March 7, 2016 to require prior authorization for opioids at lower doses than previously required and for methadone at all doses. This is part of a state-wide initiative to address opioid overdoses & deaths. However, for some people experiencing severe pain, the change may present access problems especially during the transition before all prescribers are aware of the new requirements.

Remember PA decisions should be made in 24 hours (130 CMR450.303(A), and pharmacies should provide at least a 72 hour supply for a prescribed drug even without PA in an emergency. 130 CMR 406.422(C)--(federal law allows for an exception from the emergency rule for some drugs but not for opioids, see 42 USC 1396r-8(d)(5)).


3. Enrollment deadlines for ConnectorCare

People notified that HSN will end March 31 have until March 31 to enroll in ConnectorCare (must enroll by March 23 to have ConnectorCare for April 1; if they enroll March 24-31, will not have ConnectorCare until May 1 but HSN should continue until May 1)

For people found eligible for ConnectorCare after Jan. 31, 2016, they will receive reminder that HSN will end if they do not enroll in ConnectorCare by deadline.

People found eligible for ConnnectorCare during open enrollment (through Jan 31, 2016) and still within 60 days of date on eligibility notice have until 60th day to enroll. (For example, applied & found eligible Jan 29, 2016, have until March 29, 2016 to enroll).SOME PEOPLE WHO TRIED TO ENROLL IN EARLY FEB. MAY HAVE BEEN TOLD IT"S TOO LATE because open enrollment ended Jan 31 --this was incorrect! This was fixed Feb 12 to allow for enrolling online. If misinformed person needs more time, she may qualify for an administrative Special Enrollment Period based on incorrect info from Connector.

4. New Federal Poverty Level.

Earlier in the week, Neil sent out the FPLs that took effect in MassHealth on March 1, and a heads-up that some people on Social Security who were slightly over income ceiling for MassHealth in 2015 may now be eligible in 2016 (because there was no COLA in Social Security in 2016). FPL Tables are posted here: /content/masshealth-income-guidelines

The Connector does not update its guidelines until the next open enrollment period for 2017 coverage.