Authorization of In-Home, Member-Specific Training Time for CSN Agency Nurses Newly Assigned to a Member’s Care - Amended
Customize your policy alerts
Sign up for all masshealth policy alerts
Know when masshealth releases new policies or updates existing guidance.
Monitor payer policy activity
Defines authorization, billing, payment rates, documentation, and conditions for MassHealth coverage of in-home, member-specific CSN training time when a CSN agency nurse is newly assigned to a MassHealth Community Case Management (CCM) member.
This bulletin supersedes and replaces CSN Agency Bulletin 19 and clarifies rates of reimbursement for CSN training time.
Coverage Criteria for CSN Training Time
Coverage criteria for CSN training time
Conditions under which CSN training time units are covered and payable:
Billing, Modifiers, and Unit Limits
| U6 | Modifier required to indicate in-home, member-specific training time for CSN agency nurses |
| UJ | Modifier that must not be billed together with U6 (claims with both UJ and U6 will not be paid) |
Prior Authorization and Request Process
Prior authorization and PA modification for CSN training time
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 PA. Agencies requiring additional units during the same PA period must request a modification to the PA. Additional units may be requested only after the allocated 40 hours have been appropriately used for in‑home, member‑specific training of nurses new to the member’s case; additional units may not be used to provide more than eight hours of CSN training time per nurse and may not be used after the first six weeks of a nurse’s first shift on a member’s case. CSN agencies may request no more than 160 additional training time units at a time. All reimbursement rules in the Continuous Skilled Nursing Agency Manual apply.
- 40 hours (160 units) proactively authorized and established on the agency PA
- Must request PA modification to add units during same PA period
- Additional units permitted only after initial allocation is used
- Per‑nurse limit for training time remains 8 hours (32 units)
- Additional units not permitted after first six weeks of a nurse’s first shift
- Max 160 additional units per request
How to request additional CSN training units
To request additional CSN training time units, CSN agencies must email commcase@umassmed.edu and include documentation showing the agency has met all required conditions for requesting additional units, 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.
- Send request to commcase@umassmed.edu
- Attach documentation demonstrating the initial 40 hours were appropriately used and that per‑nurse and timing limits will be met
- Specify units to add to each modifier line on the PA, number of nurses, and rationale
- Requests limited to no more than 160 additional units at a time
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.