Title 130 CMR 450.000 - Administrative and Billing Regulations
- Section 450.101 - Definitions
- Section 450.102 - Purpose of 130 CMR 400.000 through 499.000
- Section 450.103 - Promulgation of 130 CMR
- Section 450.105 - Coverage Types
- Section 450.106 - Emergency Aid to the Elderly, Disabled and Children Program
- Section 450.107 - Eligible Members and the MassHealth Card
- Section 450.108 - Selective Contracting
- Section 450.109 - Out-of-state Services
- Section 450.110 - Hospital-determined Presumptive Eligibility
- Section 450.112 - Advance Directives
- Section 450.117 - Managed Care
- Section 450.118 - Primary Care Clinician (PCC) Plan
- Section 450.119 - Primary Care ACOs
- Section 450.123 - Managed Care Compliance with Mental Health Parity
- Section 450.124 - Behavioral Health Services
- Section 450.130 - Copayments Required by the MassHealth Agency
- Section 450.140 - Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services
- Section 450.141 - EPSDT Services: Definitions
- Section 450.142 - EPSDT Services: Medical Protocol and Periodicity Schedule and Dental Protocol and Periodicity Schedule
- Section 450.143 - EPSDT Services: Description of Medical Protocol and Periodicity Schedule Visits (EPSDT Visits)
- Section 450.144 - EPSDT Services: Diagnosis and Treatment
- Section 450.145 - EPSDT Services: Claims for Visits
- Section 450.146 - EPSDT Services: Claims for Laboratory Services, Audiometric Hearing Tests, Vision Tests, and Behavioral Health Screening (Physician, Physician Assistant, Certified Nurse Practitioner, Certified Nurse Midwife, Certified Clinical Nurse Specialist, and Community Health Center Providers Only)
- Section 450.148 - EPSDT Services: Payment for Transportation
- Section 450.149 - EPSDT Services: Recordkeeping Requirements
- Section 450.150 - Preventive Pediatric Health-care Screening and Diagnosis (PPHSD) Services for Certain MassHealth Members
- Section 450.200 - Conflict Between Regulations and Contracts
- Section 450.201 - Choice of Provider
- Section 450.202 - Nondiscrimination
- Section 450.203 - Payment in Full
- Section 450.204 - Medical Necessity
- Section 450.205 - Recordkeeping and Disclosure
- Section 450.206 - Determination of Compliance with Medical Standards
- Section 450.207 - Utilization Management Program for Acute Inpatient Hospitals
- Section 450.208 - Utilization Management: Admission Screening for Acute Inpatient Hospitals
- Section 450.209 - Utilization Management: Prepayment Review for Acute Inpatient Hospitals
- Section 450.210 - Pay-for-performance Payments: MassHealth Agency Review
- Section 450.211 - Medicaid Electronic Health Records Incentive Payment Program
- Section 450.212 - Provider Eligibility: Eligibility Criteria
- Section 450.213 - Provider Eligibility: Termination of Participation for Ineligibility
- Section 450.214 - Provider Eligibility: Suspension of Participation Pursuant to United States Department of Health and Human Services Order
- Section 450.215 - Provider Eligibility: Notification of Potential Changes in Eligibility
- Section 450.216 - Provider Eligibility: Limitations on Participation
- Section 450.217 - Provider Eligibility: Ineligibility of Suspended Providers
- Section 450.221 - Provider Contract: Definitions
- Section 450.222 - Provider Contract: Application for Contract
- Section 450.223 - Provider Contract: Execution of Contract
- Section 450.224 - Provider Contract: Exclusion and Ineligibility of Convicted Parties
- Section 450.226 - Provider Contract: Issuance of Provider ID/Service Location Numbers
- Section 450.227 - Provider Contract: Termination or Disapproval
- Section 450.231 - General Conditions of Payment
- Section 450.232 - Rates of Payment to In-state Providers
- Section 450.233 - Rates of Payment to Out-of-state Providers
- Section 450.234 - Rates of Payment to Chronic Disease, Rehabilitation, or Similar Hospitals with Both Out-of-state Inpatient Facilities and In-state Outpatient Facilities
- Section 450.235 - Overpayments
- Section 450.236 - Overpayments: Calculation by Sampling
- Section 450.237 - Overpayments: Determination
- Section 450.238 - Sanctions: General
- Section 450.239 - Sanctions: Calculation of Administrative Fine
- Section 450.240 - Sanctions: Determination
- Section 450.241 - Hearings: Claim for an Adjudicatory Hearing
- Section 450.242 - Hearings: Stay of Suspension or Termination or Provider Service Restriction
- Section 450.243 - Hearings: Consideration of a Claim for an Adjudicatory Hearing
- Section 450.244 - Hearings: Authority of the Hearing Officer
- Section 450.245 - Hearings: Burden of Proof
- Section 450.246 - Hearings: Procedure
- Section 450.247 - Hearings: Hearing Officer's Decision
- Section 450.248 - Medicaid Director's Decision
- Section 450.249 - Withholding of Payments
- Section 450.259 - Overpayments Attributable to Rate Adjustments
- Section 450.260 - Monies Owed by Providers
- Section 450.261 - Member and Provider Fraud
- Section 450.271 - Individual Consideration
- Section 450.275 - Teaching Physicians: Documentation Requirements
- Section 450.301 - Claims
- Section 450.302 - Claim Submission
- Section 450.303 - Prior Authorization
- Section 450.304 - Claim Submission: Signature Requirement
- Section 450.307 - Unacceptable Billing Practices
- Section 450.309 - Time Limitation on Submission of Claims: General Requirements
- Section 450.313 - Time Limitation on Submission of Claims: Claims for Members with Health Insurance
- Section 450.314 - Final Deadline for Submission of Claims
- Section 450.316 - Third-party Liability: Requirements
- Section 450.317 - Third-party Liability: Payment Limitations on Other Health Insurance Claim Submissions
- Section 450.318 - Third-party Liability: Payment Limitations on Medicare Crossover Claim Submissions
- Section 450.321 - Third-party Liability: Waivers
- Section 450.323 - Appeals of Erroneously Denied or Underpaid Claims
- Section 450.324 - Payment of Claims
- Section 450.331 - Billing Agencies