Section 417.410 - Nonreimbursable ServicesThe MassHealth agency does not pay psychiatric day treatment providers for:
(A)Vocational Rehabilitative Services. The MassHealth agency does not pay for any vocational rehabilitative services that may include, but are not limited to, activities which have a primary focus of producing goods or performing services. However, certain prevocational activities, such as time management groups and career planning groups to prepare members for less intensive services, may be considered part of the hourly rate.(B)Educational Services. The MassHealth agency does not pay for educational services, such as traditional academic and special classroom services.(C)Functional Maintenance Programs. The MassHealth agency does not pay for functional maintenance programs.(D)Research and Experimental Treatment. The MassHealth agency does not pay for research or experimental treatment.(E)Meals. The MassHealth agency does not pay for meals as part of psychiatric day treatment.(F)Services Included as Part of Treatment Sessions. The MassHealth agency does not pay for the following services separately, since the fee for treatment sessions includes the cost of these services:(1) telephone contacts of any duration with or related to members;(2) any consultations about members with outside agencies;(3) information and referral;(4) patient registration;(6) individual service planning; or(G)Duplicative Services. The MassHealth Agency does not pay for psychiatric day treatment services when such services are duplicative of other services the member is receiving.(H) Services provided when the member is in an inpatient setting. The MassHealth agency does not pay for psychiatric day treatment services when a member is receiving inpatient or long-term-care services in an acute or chronic hospital, a psychiatric hospital, or a level II or level in nursing facility. The MassHealth Agency also does not pay for psychiatric day Treatment services when the member resides in the facility in which psychiatric day treatment services are provided.(I)Individual Therapy or Medication Evaluation. The MassHealth agency does not pay for individual therapy or medical evaluations provided by the psychiatric day treatment program.(J)Group Therapy. The MassHealth agency does not pay for group therapy as a separate service provided by a psychiatric day treatment program.Amended by Mass Register Issue 1383, eff. 1/25/2019.