Authorization of In‑Home, Member‑Specific Training Time for CSN Agency Nurses Newly Assigned to a Member's Care
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Amends MassHealth prior authorization process to proactively authorize CSN training time units and define coverage, billing, and documentation rules for in‑home, member‑specific training when a CSN agency nurse is newly assigned to a CCM member.
MassHealth will proactively authorize 40 hours (160 units) of CSN training time on the agency's prior authorization and allow requests for additional units under specified conditions.
CSN agencies may bill up to eight hours (32 units) of in-home, member-specific training per new nurse within the first six weeks of that nurse's first shift with the member.
Claims for in-home, member-specific training must include modifier U6 with the appropriate procedure code.
Coverage and Authorization Criteria
CSN training time coverage criteria
Covered when ALL of the following are met:
ALL of the following
- Agencies may bill up to eight hours (32 units) of CSN training time per new nurse for in-home, member-specific training.
- Training units for a given nurse must be applied during the first six weeks after that nurse's first shift working with the member.
- Training units may only be used to train a nurse to serve a specific member and not for general education or competency testing unrelated to the member's care.
- Verbal consent from the member and/or their natural caregiver or legal guardian is required for a new agency nurse to receive in-home, member-specific training.
ALL of the following
- The agency has already appropriately used the initial 40 hours (160 units) for in-home, member-specific training for nurses who are or were new to the member's case and serve the member.
- Any additional units requested will not be used to provide more than eight hours (32 units) of CSN training time per nurse.
- Any additional units requested will not be used after the first six weeks of a nurse's first shift on the member's case.
- The agency may request additional units by emailing commcase@umassmed.edu with documentation showing the required conditions are met, specifying number of units to add to each modifier line on the PA, the number of nurses to be trained, and the rationale for training additional nurses.
- Agencies may request no more than 160 additional training time units at a time.
Billing, Modifiers, and Limits
| U6 (modifier) | Modifier required to identify in-home, member-specific training time when submitting claims |
Provider Actions and Authorization Process
Request additional CSN training time units (proactive PA of 160 units; request process for more)
MassHealth or its designee will proactively authorize 40 hours (160 units) of CSN training time and will establish the units on the CSN agency's prior authorization. Agencies that require additional CSN training time units during the same PA period must request a modification and may request no more than 160 additional training time units at a time by emailing commcase@umassmed.edu with documentation showing required conditions are met and specifying units per modifier line and number of nurses to be trained.
- Additional units may only be requested after the initially authorized 160 units have been appropriately used for in-home, member-specific training for nurses new to the member's case.
- Additional units cannot be used to provide more than eight hours (32 units) of training per nurse.
- Additional units cannot be used after the first six weeks of a nurse's first shift on the member's case.
- Request email must include documentation that the conditions are met, the number of units to add to each modifier line on the PA, the number of nurses to be trained, and the rationale for training additional nurses.
Key Definitions
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