Back to Insights and Updates for ProvidersDecember 2023

MassHealth guidance and new performance specifications

Tufts Health Together - MassHealth MCO Plan and ACPPs

Based on requirements and guidance from MassHealth and the Massachusetts Executive Office of Health and Human Services (EOHHS), we’ve developed performance specifications specific to certain services, as identified below:

Youth detoxification and stabilization

In August, MassHealth released Managed Care Entity Bulletin 103 (found in the 2023 MassHealth provider bulletins section of MassHealth’s website), which outlines updated requirements for managed care organizations and Accountable Care Partnership Plans related to youth and transition-age youth detoxification and stabilization programs.

In support of these requirements, effective for dates of service beginning July 1, 2023 for Tufts Health Together – MassHealth MCO Plan and ACPPs, we will provide coverage for youth and transition-age youth detoxification and stabilization services at or above the rate listed in 101 CMR 418.00 (Payments for youth short-term stabilization and emergency placement services). Prior authorization is not required, and providers must bill for these services using the H0011-HV procedure code and modifier combination.

These programs provide acute treatment service and clinical support services levels of care in an integrated setting with additional staffing and service expectations specific to the needs of the youth (12 through 17 years of age) and transition-age youth (16 through 20 years of age) populations.

Point32Health has developed performance specifications for youth and transition-age youth detox and stabilization services, and our Tufts Health Plan Inpatient and Intermediate/Diversionary Behavioral Health (Mental Health & Substance Use Disorder) Facility Payment Policy has been updated to reflect these new requirements.

Community-based acute treatment services

Our newly developed 24-Hour Diversionary Services Community-Based Acute Treatment for Children and Adolescents (CBAT) with Intellectual Disabilities/ Autism Spectrum Disorders (ID/ASD) Performance Specifications reflect requirements from MassHealth pertaining to providers contracted for this level of care or service.

These new performance specifications are a subset of our existing Tufts Health Plan CBAT performance specifications. Applicable providers are expected to adhere to both, but where there is difference between the general CBAT performance specifications and these newly developed performance specifications specific to CBAT for children/adolescents with ID/ASD, the more specific performance specifications should take precedence.

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