Continuous Skilled Nursing Agency Bulletin 22 — Authorization of In-Home, Member-Specific CSN Training Time
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Establishes authorization, billing, payment rates, documentation, and prior authorization procedures for in-home, member-specific training time for CSN agency nurses newly assigned to MassHealth CCM members; affects MassHealth-participating CSN agencies and their nurses.
Adds authorization and reimbursement rules for in-home, member-specific CSN training time and clarifies rates of reimbursement for that training time.
Coverage Criteria for CSN Training Time
Coverage criteria for CSN training time
Conditions under which CSN training time units may be used and when additional units may be requested:
Permitted training arrangements
- Another nurse from the same agency provides the in-home, member-specific training.
- A nurse employed by another MassHealth-enrolled CSN agency or a MassHealth-enrolled independent nurse provides the training.
- The member's natural caregiver and/or family trains the nurse on the member's care.
Billing Modifiers and Limits
| U6 | Modifier indicating in-home, member-specific CSN training time |
| UJ | Modifier that must not be billed in combination with U6 |
Prior Authorization and Requesting Additional Units
Prior Authorization and PA Modifications for CSN Training Time
MassHealth proactively authorizes 40 hours (160 units) of CSN training time on the CSN agency’s prior authorization (PA). Agencies that require more units during the same PA period must request a PA modification; additional units may only be requested after the initial 40 hours have been appropriately used, will not be used to provide more than eight hours of training per nurse, and will not be used after the first six weeks following a nurse’s first shift on the member’s case.
- Proactive authorization: 40 hours (160 units) set on the agency’s PA
- Additional units allowed only if initial 40 hours were used
- Additional units cannot exceed 8 hours (32 units) per nurse
- Additional units cannot be used after six weeks from a nurse’s first shift
How to Request Additional Units
To request additional CSN training time units, email commcase@umassmed.edu and include documentation that the initial 40 hours were used and that requests meet the bulletin’s conditions. The request must state 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 up to 160 additional units per request.
- Send request email to: commcase@umassmed.edu
- Attach documentation showing the initial 40 hours were used and that requested units comply with limits (≤8 hours per nurse; within 6-week window)
- Specify units to add per modifier line, number of nurses to be trained, and rationale
- Maximum 160 additional training time units per request
Definitions Related to CSN Training Time
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