On March 20, 2020, as part of MassHealth’s COVID-19 response, the Executive Office of Health and Human Services suspended referral requirements for MassHealth-covered services, including orthotics and prosthetics, for the Primary Care Accountable Care Organizations (ACO) and the Primary Care Clinician (PCC) Plan.
Effective for claims with dates of service on and after August 1, 2025, MassHealth will reinstate referral requirements for orthotics and prosthetics services provided to members in the PCC plan or a Primary Care ACO, as outlined in 130 CMR 450.118(J): Referral for Services and 130 CMR 450.119(I): Referral for Services.
For more information, please review All Provider Bulletin 403: Ending the Suspension of Primary Care Clinician Plan & Primary Care ACO Referrals and Updating Referral Requirements for Urgent Care Services: https://www.mass.gov/lists/403-through-300.
If you have questions regarding this guidance, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.