Section 322.05 - Add-on and Supplemental Payment Provisions(1)Providers Eligible for Add-on Payment. (a) To be eligible for Corrective Mobility System Repair add-on payments, as defined in 130 CMR 409.402, a provider must be: 1. a MassHealth enrolled DME provider; and2. in compliance with the conditions of payment set forth in 101 CMR 322.05(1)(b).(b)Conditions of Payment. Add-on payments will be made only 1. for Corrective Mobility System Repairs. For purposes of 101 CMR 322.05, Maintenance Repairs, as defined in 130 CMR 409.402, are not Corrective Mobility System Repairs and would not qualify for an add-on payment;2. under federally approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the Secretary of Health and Human Services;3. to providers that meet service standards as defined by EOHHS via administrative bulletin or other written issuance, including standards related to timely service and turnaround times;4. to providers that demonstrate compliance with other conditions of payment as described by EOHHS via administrative bulletin or other written issuance; and5. to providers that comply with all applicable requirements of 130 CMR 409.000: Durable Medical Equipment Services.(c)Compliance with Conditions of Payment.1. EOHHS may audit compliance with conditions of payment.2. EOHHS may, via administrative bulletin or other written issuance, establish standards governing various conditions of payment including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.(d)Timing of Payment. Add-on payments will be made at the same time as payment for the billable code is made pursuant to 101 CMR 322.06.(e)Corrective Mobility System Repair Add-on Payment Documentation. 1. MassHealth will pay DME providers an add-on payment of $1,000.00 per eligible mobility system repair when the mobility system repair is performed within the time period established by EOHHS via administrative bulletin or other written issuance to providers for qualifying mobility system repairs.2. The mobility system must be thoroughly evaluated using a safety and performance evaluation or industry equivalent evaluation, and any qualifying repair must include any additional items that may not have been identified by the member at the time of the intake for the repair. The completed evaluation must be kept in the member's file.3. To receive an add-on payment, providers must comply with pre-payment and post-payment reporting requirements established by EOHHS, in addition to compliance with any administrative bulletin or other written issuance described in 101 CMR 322.05(1)(b)3.(f)Add-on Payment Reinvestment. 80% of the add-on payment must be reinvested to improve the provider's timeliness of mobility system repairs.(2)Supplemental Payments for Services Provided to Dual Eligible Members. Supplemental payments apply to certain patient lift systems (HCPCS codes E0639 and E0640) or other designated services for MassHealth members who are eligible for both Medicare and MassHealth services (dual eligible members). (a)Provider Eligibility. To be eligible to receive a supplemental payment for certain patient lift systems (HCPCS E0640 and E0639) or other designated services, a provider must be:1. a MassHealth enrolled DME provider; and2. in compliance with the conditions of payment set forth in 101 CMR 322.05(2)(b).(b)Conditions of Payment. Supplemental payments will be made only under federally approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the Secretary of Health and Human Services, for providers that:1. comply with other conditions of payment as described by EOHHS via administrative bulletin or other written issuance, including reconciliation of the total Medicare and total MassHealth payments; and2. comply with all applicable requirements of 130 CMR 409.000: Durable Medical Equipment Services.(c)Compliance with Conditions of Payment.1. EOHHS may audit compliance with conditions of payment.2. EOHHS may, via administrative bulletin or other written issuance, establish standards governing various conditions of payment including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.(d)Payment Methodology. The supplemental payment is calculated based on the MassHealth allowed amount (AAC+ the applicable markup defined in 101 CMR 322.02) minus the total Medicare allowed amount for the full rental period.Adopted by Mass Register Issue 1532, eff. 10/1/2024 (EMERGENCY).Amended by Mass Register Issue 1538, eff. 10/1/2024 (EMERGENCY).