What types of policy changes does MassHealth issue?

MassHealth regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does MassHealth update its policies?

MassHealth typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many MassHealth policy changes are tracked here?

This page currently tracks 50 documented MassHealth policy changes. New items are added as they are identified.

What should I do when MassHealth changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

MassHealth Policy Changes 2026 | Prior Auth & Coverage Updates

MassHealth Policy Changes & Prior Auth Updates

We track 50 documented policy changes from MassHealth across MA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original MassHealth notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new MassHealth updates automatically.

Medium impact

Psychiatric Inpatient Hospital Bulletin 28: Discharge Planning to Support Certain Family Assistance Members in Need of Long-Term Services and Supports

MassHealth·Effective May 1, 2025

MassHealth created a new Family Assistance LTSS Pathway effective May 1, 2025, allowing Family Assistance members who require long-term services and supports after psychiatric hospitalization to upgrade to MassHealth Standard or CommonHealth coverage. Psychiatric inpatient hospitals must now conduct specific clinical assessments (MDS-HC and NF Level of Care Form) and assist with application paperwork for qualifying members who need community LTSS or long-term facility care.

Nursing Facility Bulletin 191: Additional member specific criterion required to bill for the Substance Use Disorder (SUD) Add-on

Dental Bulletin 51: Delayed Start Date for New Dental Third-Party Administrator

All Provider Bulletin 399: New MassHealth Member Card

Continuous Skilled Nursing Agency Bulletin 23: Revision to Continuous Skilled Nursing Agency Eligibility Requirements at 130 CMR 438.404(A)

Nursing Facility Bulletin 190: Updates to Transition to CMS OBRA MDS 3.0 Assessments for Nursing Facility Fee-for-Service Payments

Managed Care Entity Bulletin 123: Primary Care Sub-Capitation Tier Requirement Updates

Dental Bulletin 52: New Anticipated Start Date for New Dental Third-Party Administrator

All Provider Bulletin 400: Changes in Exclusion of Designated 340B Drugs for MassHealth Coverage

Managed Care Entity Bulletin 125: Cell and Gene Therapy Adjudicated Payment Amount per Discharge and Adjudicated Payment per Episode of Care Carve-Out

Managed Care Entity Bulletin 126: Accountable Care Organizations—Primary Care Provider Additions and Removals Effective January 1, 2026

Managed Care Entity Bulletin 127: Accountable Care Partnership Plans—Service Area Additions and Removals Effective January 1, 2026

Community Health Center Bulletin 123: Updated Application for Health and Dental Coverage and Help Paying Costs (ACA-3)

Acute Outpatient Hospital Bulletin 41: Cell and Gene Therapy Adjudicated Payment Amount per Discharge and Adjudicated Payment per Episode of Care Carve-Out

Acute Inpatient Hospital Bulletin 199: Updated Application for Health and Dental Coverage and Help Paying Costs (ACA-3)

Acute Inpatient Hospital Bulletin 201: Cell and Gene Therapy Adjudicated Payment Amount per Discharge and Adjudicated Payment per Episode of Care Carve-Out

Community Health Center Bulletin 124: Updated Application for Seniors and People Needing Long-Term-Care Services (SACA-2)

Acute Inpatient Hospital Bulletin 200: Updated Application for Seniors and People Needing Long-Term-Care Services (SACA-2)

All Provider Bulletin 401: Medicaid Management Information System and Provider Online Service Center Migration to Amazon Web Services

Managed Care Entity Bulletin 124: Medicaid Management Information System and Provider Online Service Center Migration to Amazon Web Services

Dental Bulletin 53: Dental Third-party Administrator Transition

All Provider Bulletin 402: Third-Party Liability Billing Requirements for Health Reimbursement Arrangements and Similar Instruments

Nursing Facility Bulletin 192: Update to Requirement for Appropriate Agreements between High-SUD Nursing Facilities and Opioid Treatment Programs

Indian Health Services Provider Bulletin 1: Updates to MassHealth Indian Health Services Facilities Billing

Managed Care Entity Bulletin 128: Ending the Suspension of Referrals and Updating Referral Requirements for Urgent Care Services

Managed Care Entity Bulletin 129: Important Information About the MassHealth Standardized Encounter Data Program (SENDPro) Project

Indian Health Services Provider Bulletin 2: Billing for Pharmacy Services Rendered by Indian Health Services Facilities

All Provider Bulletin 403: Ending the Suspension of Primary Care Clinician Plan & Primary Care ACO Referrals and Updating Referral Requirements for Urgent Care Services

Acute Inpatient Hospital Bulletin 202: Greenhouse Gas Emissions Reporting Requirements

Home Health Agency Bulletin 94: Electronic Visit Verification Registration and Compliance for Home Health Agency Services

Acute Outpatient Hospital Bulletin 42: Correction of Cell and Gene Therapy Adjudicated Payment Amount per Discharge and Adjudicated Payment per Episode of Care Carve-Out

Acute Inpatient Hospital Bulletin 203: Correction of Cell and Gene Therapy Adjudicated Payment Amount per Discharge and Adjudicated Payment per Episode of Care Carve-Out

Adult Foster Care Bulletin 33: Electronic Visit Verification Registration and Compliance for Group Adult Foster Care Services

Psychiatric Inpatient Hospital Bulletin 28: Discharge Planning to Support Certain Family Assistance Members in Need of Long-Term Services and Supports

Nursing Facility Bulletin 193: Discharge and Transition Planning to Support Certain Family Assistance Members in Need of Long-Term Services and Supports

Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 104: Discharge and Transition Planning to Support Certain Family Assistance Members in Need of Long-Term Services and Supports

Acute Inpatient Hospital Bulletin 204: Discharge Planning to Support Certain Family Assistance Members in Need of Long-Term Services and Supports

Personal Care Attendant Bulletin 17: Primary Care Provider Summary Form Requirement for Personal Care Attendant Complex Care

Managed Care Entity Bulletin 131: SCO Medicaid Only Transition to MassHealth Fee-for-Service (FFS)

Independent Nurse Bulletin 21: New Independent Nurse Provider Orientation and Training Requirement

Hearing Instrument Specialist Bulletin 14: Hearing Aid History Search in Provider Online Service Center - Reminder

HCBS Waiver Provider Bulletin 24: Electronic Visit Verification Registration and Compliance for Certain Waiver Services

Audiologist Bulletin 7: Hearing Aid History Search in Provider Online Service Center - Reminder

All Provider Bulletin 404: Administrative and Billing Regulations – Reinforcing Sanctioning Process for ”Past Due” Cost Reports

Acute Outpatient Hospital Bulletin 43: Hearing Aid History Search in Provider Online Service Center - Reminder

Managed Care Entity Bulletin 130: Clarification on Payment for Psychiatric Inpatient Hospital Stays and Use of Administratively Necessary Days

Nursing Facility Bulletin 194: Additional Updates to Transition to CMS OBRA MDS 3.0 Assessments for Nursing Facility Fee-for-Service Payments

Adult Foster Care Bulletin 34: Updated Guidance Related to Adult Foster Care and Group Adult Foster Care Admission and Monthly Visit Requirements

Adult Day Health Bulletin 39: Cessation/Discontinuation of Adult Day Health Admission and Re-engagement Services

Durable Medical Equipment Bulletin 40: Reporting Requirements for All Providers Using Assistive Technology Professionals and Filing Claims for Corrective Mobility System Repairs

All Provider Bulletin 405: Perinatal Depression Screening and Depression Screening for Infant Caregivers