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Retroactive Payments for Continuous Skilled Nursing Claims

July 9, 2018

MassHealth published amendments to 101 CMR 350.00: Home Health Rates, including two fee schedules increasing the reimbursement rates for independent nurses and home health agencies providing Continuous Skilled Nursing (CSN) services. These amendments were published on May 4, 2018; however, each fee schedule has an effective date prior to May 4, 2018. The first fee schedule has an effective date of February 23, 2018, and includes an increase to independent nurse and agency rates. The second fee schedule has an effective date of April 1, 2018, and includes an increase to agency rates.

Since 101 CMR 350.00 was published after the fee schedules' effective dates, MassHealth is retroactively applying the rate increases to CSN claims submitted for services rendered between February 23, 2018 to March 31, 2018, and April 1, 2018 to May 3, 2018, respectively. CSN providers do not need to resubmit claims in order to get reimbursed according to the new fee schedules.

In the upcoming weeks, CSN providers should expect to see these retroactive payments applied to all submitted claims, within the timeframes mentioned above, if the CSN provider did not bill according to the February 23rd and April 1st fee schedules, respectively.

If you have any questions, please contact the MassHealth LTSS Provider Service Center at 1-844-368-5184 or email support@masshealthltss.com.