Back to Insights and Updates for ProvidersJune 2024

Payment Policy updates: skilled nursing facility care

Tufts Health One Care  |  Tufts Health Plan Senior Care Options

Point32Health is updating our Skilled Nursing Facility Payment Policies for Tufts Health Public Plans and Tufts Health Plan Senior Care Options, effective for dates of service beginning Aug. 1, 2024.

The updates are intended to provide additional clarity and guidance regarding documentation submission expectations for Tufts Health Plan Senior Care Options and Tufts Health One Care members.

As outlined in our Skilled Nursing Facility (SNF) Documentation Submission Guide, SNFs must complete and submit required documentation to MassHealth and/or Point32Health upon admission/discharge and during status changing events. This requirement includes the timely submission of a Status Change Form (SC-1) and Minimum Data Set (MDS) 3.0 for SCO and One Care members admitted for custodial care (i.e., short-term/non-skilled stay; member will be returning home).

Failure to submit required documentation in accordance with the guidance outlined in the Documentation Submission Guide and the updated Skilled Nursing Facility Payment Policies may result in a claim denial.

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