Check Prior Authorization (410.408)

See 130 CMR 410.408: Prior Authorization is listed in the table of contents for outpatient hospital services; providers must consult that section for any prior authorization requirements that apply to outpatient hospital services.

Program Regulations Index (410.431–410.446)

This excerpt is an index of program regulation section headings (for example, 410.431–410.446) and page references; it does not itself specify authorization procedures or provider actions.

Therapist Services TOC Entries (410.451–410.453)

Therapist Services (410.451–410.453) appear in the table of contents with entries for covered services, service limitations, and recordkeeping; consult those specific sections for service coverage and documentation requirements.

• 410.451: Therapist Services: Covered Services
• 410.452: Therapist Services: Service Limitations
• 410.453: Therapist Services: Recordkeeping Requirements

Program Regulations — Table of Contents

This window contains table-of-contents entries for multiple regulation headings under 130 CMR 410 but contains no procedural details or authorization rules; providers should read the full regulation text for any operational requirements.

Program Regulation Headings and Reserved Sections (410.443–410.453)

The table of contents lists program regulation headings including 410.443–410.453 and notes several reserved sections; it identifies service areas (Adult Day Health, Adult Foster Care, Psychiatric Day Treatment, Dental Services, Therapist Services) but does not include authorization details.

• Includes headings for Adult Day Health, Adult Foster Care, Psychiatric Day Treatment, Dental Services, Therapist Services
• Notes reserved ranges (130 CMR 410.447–410.450, 410.454)

Laboratory Services TOC (410.455–410.459)

Laboratory services sections (410.455–410.459) are listed in the table of contents with entries for introduction, payment, request for services, recordkeeping, and specimen referral; consult the full sections for any ordering, payment, or submission requirements.

• 410.455: Laboratory Services: Introduction
• 410.456: Laboratory Services: Payment
• 410.457: Laboratory Services: Request for Services
• 410.459: Laboratory Services: Specimen Referral

Pharmacy Services TOC (410.461; 410.468)

Pharmacy services entries appear in the table of contents (e.g., 410.461 and 410.468) including drugs dispensed in pharmacies, hospital-based pharmacies, and Participation in the 340B Drug Pricing Program; the TOC lists headings only—refer to the full text for billing or 340B participation rules.

• 410.461: Pharmacy Services: Drugs Dispensed in Pharmacies (including hospital-based pharmacies)
• 410.468: Participation in the 340B Drug Pricing Program

TOC Entries — No Authorization Rules Present

This fragment of the table of contents provides section numbers and titles only and does not include authorization, billing, or procedural rules; providers must consult the corresponding regulation sections for actionable requirements.

Mental Health Services TOC — Index Only

The table of contents shows mental health services headings but contains no authorization, billing, or documentation instructions in this excerpt; consult the full text of the listed sections for requirements.

TOC: Mental Health Services (410.471–410.480)

Mental health regulation sections 410.471 through 410.480 are listed in the TOC (including introduction, noncovered services, definitions, staffing, treatment procedures, utilization review, and recordkeeping); providers should review these sections for utilization review and documentation obligations.

• 410.471–410.480: Mental Health Services headings
• 410.477: Utilization Review Plan listed (see full text for utilization procedures)

Utilization Review Reference (410.477)

Utilization review is listed in the TOC under Mental Health Services (410.477: Utilization Review Plan), which indicates utilization review/prior authorization processes are addressed in that section; consult 410.477 for specific utilization review or prior authorization procedures.

• 410.477: Mental Health Services: Utilization Review Plan

TOC Fragment — No Authorization Details

This TOC fragment lists section headings (for example, mental health and related services) but does not provide details on prior authorization, billing, or documentation requirements; providers must read the full regulation sections for operational guidance.

Utilization Review and Service Limitations Referenced

The TOC references utilization review (410.477) and service limitations (410.479) for mental health services but does not include the procedural details in this excerpt; providers should consult those sections for any limits or review processes.

• 410.477: Utilization Review Plan
• 410.479: Service Limitations

Program Regulations — TOC Overview

The program regulations table of contents lists many topics (definitions, staffing, treatment procedures, utilization review plan, recordkeeping, service limitations, CANS data reporting, and vision care services); the TOC itself does not contain detailed provider obligations.

• Includes CANS Data Reporting (410.480) and Vision Care Services (410.481)
• Lists recordkeeping and utilization review headings

Utilization Review Plan Listed (410.477)

The TOC shows the Utilization Review Plan is covered under 410.477; providers should review that specific section when determining whether prior authorization or utilization review applies.

• See 410.477: Mental Health Services: Utilization Review Plan

Payment Requires Medical Necessity (130 CMR 450.204)

MassHealth pays for outpatient hospital visits and ancillary services that are medically necessary and appropriately provided, as defined at 130 CMR 450.204; services must meet professionally recognized standards of care.

• Payment limited to medically necessary, appropriately provided services (see 130 CMR 450.204)
• Quality must meet professionally recognized standards of care

Verify Member Eligibility Before Providing Services

Outpatient hospital services are covered only when provided to eligible MassHealth members (and specified EAEDC recipients); verify member eligibility and coverage type per 130 CMR 450.107 before delivering services.

• Verify MassHealth member eligibility and coverage type (see 130 CMR 450.107)
• EAEDC recipients have coverage rules referenced in 130 CMR 450.106

Consult Definitions (410.402)

Definitions used in 130 CMR 410.000 are located in 410.402; consult that section for precise term meanings referenced throughout the regulations.

• See 410.402: Definitions