General Laws of Massachusetts - Chapter 118E Division of Medical Assistance - Section 19 Prior approval of medical services; methods; rules and regulations; posttreatment examinations

Section 19. The division shall establish methods of approving services to be performed as a prerequisite to extending medical assistance. Said methods of prior approval may include, but need not be limited to: (1) in the case of restorative dentistry, or dentures, examination of proposed recipients or of diagnostic information regarding proposed recipients by dental consultants of the department; (2) in the case of orthodontic services, procedures which assure that medical assistance will be provided only for severe handicapping malocclusions; and (3) in the case of transportation to obtain medical care, a statement from the attending physician certifying that such transportation is necessary due to a physical disability.

Assistance under this chapter for nursing services for persons twenty years of age or under may be available only after a medical review team under the supervision or with the approval of the department of public health, in cooperation with the division and the departments of mental health and developmental services, approves such services for such persons. The department of public health, in cooperation with the division and such other departments, shall promulgate rules and regulations for such services, and any person or facility offering such services shall receive prior certification from the department of public health.

The division shall establish methods of random posttreatment examination of recipients of medical care or services under this chapter in order to assure that the care or services for which the division is billed were actually performed as described.

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Last modified: September 11, 2015