Starting January 1, 2026, independent nurses (INs) who are seeking a prior authorization (PA) to work with a Community Case Management (CCM) member for the first time must submit a copy of a signed plan of care to the member’s CCM clinical manager in order to receive their PA for continuous skilled nursing (CSN) services. INs who have already been working with CCM members on an existing PA will not need to submit a signed plan of care for CCM’s review in order to have a new PA established with the same member.
If the member’s physician or ordering non-physician practitioner has not yet physically signed the plan of care, the IN must obtain a verbal order in accordance with 130 CMR 414.412(D) and submit with the unsigned plan of care documentation of the verbal order, which must include the following:
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- Nurse’s signature and date of verbal start of care;
- Name and address of the ordering prescriber clearly printed/typed on the verbal order documentation; and
- Indication that the prescriber has verbally approved the plan of care and the number of hours per week MassHealth/CCM has approved.
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Once a member’s CCM clinical manager has received a copy of the IN’s plan of care and has confirmed that it has been signed or contains the necessary documentation for a verbal order, the clinical manager will issue a PA for CSN services. If an IN cannot submit a copy of the plan of care or submits a plan of care that does not meet the requirements established under 130 CMR 414.412, the clinical manager will not issue a PA for the IN provider.
This change in process will go into effect on January 1, 2026.
If you have questions, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.