MedicaidDocumentationHigh impact
Nursing Facility Bulletin 191: Additional member specific criterion required to bill for the Substance Use Disorder (SUD) Add-on
MassHealth·MA · Psychiatry·Specialty Services
Effective date
Oct 1, 2024
We identified it
Jun 18, 2026
Summary
MassHealth nursing facilities billing for the SUD add-on must now ensure members receive at least one specific SUD service (opioid counseling, medication management, or other SUD counseling) during the same month as the billing period. Failure to provide these services will result in add-on payment recoupment as overpayments.
Action Required
Immediately: Nursing facilities must verify that each member receiving SUD add-on billing has documented receipt of at least one qualifying SUD service (opioid counseling, medication management, or other SUD counseling) within the same billing month. Update billing workflows to cross-reference service delivery with add-on claims. Ensure medication management aligns with DPH September 12, 2022 memorandum. Claims without corresponding services are subject to recoupment as overpayments.