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Repricing of Claims with the ARPA Temporary Rate Increase for AAC Codes that Require a Prior Authorization

January 3, 2022

On July 19, 2021, the Executive Office of Health and Human Services (EOHHS) issued 101 CMR 447.00: Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act (ARPA), which includes a temporary 10% rate add-on for Durable Medical Equipment and Oxygen & Respiratory Therapy (DME/OXY) providers for dates of service from July 1, 2021 to June 30, 2022.

MassHealth is adjusting prior authorizations (PAs) that require PA pricing that have effective dates that span July 1, 2021 through June 30, 2022. These adjustments will incorporate the temporary 10% ARPA rate increase as applicable.

Claims associated with the adjusted PAs will be systematically adjusted for dates of service on or after July 1, 2021, in stages, through the next couple of months.

Systematic adjustments will pay up to the billed amount on the claim. Providers can adjust any claims in need of additional payments if the paid amount does not match the approved PA allowed amount.

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com