Authorization of In-Home, Member-Specific Training Time for CSN Agency Nurses Newly Assigned to a Member’s Care
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Governs prior authorization, allowable units, billing modifiers, documentation, and conditions of payment for Continuous Skilled Nursing (CSN) in-home, member-specific training when a CSN agency nurse is newly assigned to a MassHealth CCM member.
MassHealth will proactively authorize 40 hours (160 units) of CSN training time and establish the units on the CSN agency’s prior authorization.
CSN agencies may bill up to eight hours (32 units) of CSN training time per nurse during the first six weeks after that nurse’s first shift with the member.
Claims for in-home, member-specific training must include modifier U6 along with the appropriate procedure code and modifier if applicable.
Coverage criteria for CSN training time
CSN training time coverage criteria
Covered when ALL of the following are met:
ALL of the following
ALL of the following
- Training units may only be used for in-home, member-specific training of nurses who are new to the member’s care and not for general training or competency testing.
ALL of the following
- Agencies may bill up to eight hours (32 units) of CSN training time per nurse; these units must be applied during the first six weeks after the nurse’s first shift with the member.
ALL of the following
- The member and/or their natural caregiver or legal guardian must provide verbal consent for a new agency nurse to receive in-home, member-specific training; agencies must document any in-home, member-specific training in the member’s medical record.
ALL of the following
- 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 (PA).
ALL of the following
- Additional CSN training time units may be requested only after the initial 160 units have been appropriately used; additional units must not be used to provide more than eight hours per nurse nor after the first six weeks of a nurse’s first shift.
- To request additional units, agencies must email commcase@umassmed.edu with documentation showing the initial allocation was used, specify the number of units to add to each modifier line on the PA, the number of nurses to be trained, and the rationale; agencies may request no more than 160 additional training time units per request.
ALL of the following
- Claims for in-home, member-specific training must include modifier U6 along with the appropriate procedure code and modifier if applicable; rates follow CSN rates under 101 CMR 361.00 and the CSN manual.
ALL of the following
- Agencies that do not follow the requirements in this bulletin may be subject to sanctions under 130 CMR 450.238 or overpayment provisions under 130 CMR 450.235.
Billing, modifiers, and unit limits
| U6 | Modifier required on claims for in-home, member-specific CSN training time |
Prior authorization and requesting additional units
Prior authorization: 160 units (40 hours) proactively set on PA
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 (PA). CSN agencies that require additional CSN training time units during the same PA period must request a PA modification and include required documentation and rationale in the request email to commcase@umassmed.edu.
- 160 units (40 hours) will be set on the CSN agency’s PA.
- Requests for additional units must be submitted as a PA modification and include documentation showing required conditions are met, units to add per modifier line, number of nurses to be trained, and rationale.
- Email requests to commcase@umassmed.edu.
When and how to request additional CSN training units
Additional CSN training time units may only be requested after the initial 160 units have been appropriately used and are subject to per-nurse and timing limits; requests may be for up to 160 additional units per modification and must include documentation that the conditions are met.
- Additional units must not be used to provide more than eight hours (32 units) of CSN training time per nurse.
- Additional units must not be used after the first six weeks of a nurse’s first shift on a member’s case.
- A single modification request may ask for no more than 160 additional units.
Key definitions
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