A home visit must be used to deliver episodic care in the member’s home when a health practitioner has determined that it is not advisable for the member to visit the CHC. The medical record must document the reasons for a home visit. A house-bound member with chronic medical and nursing care needs must be referred to a Medicare-certified home health agency.
SOURCE: MA 130 CMR 405.421, (Accessed Nov. 2022).
A CHC must provide on site the medical services specified in 130 CMR 405.408. It is not necessary that all of these services be available during all hours of the CHC’s operation, but all must be available to members on a regularly scheduled basis with sufficient frequency to ensure access to care and continuity of care. If the CHC does not serve patients of a particular age group, upon the prior written approval of the MassHealth agency, the CHC will not be required to provide pediatric or obstetrical/gynecological services or both (see 130 CMR 405.408(A) and (C)).
All of the services listed in 130 CMR 405.409 must be provided on site or, alternatively, through a referral network. For the purpose of 130 CMR 405.409, a service furnished by a practitioner other than an employee or contractor of the CHC for which the practitioner, rather than the CHC, claims payment is not considered to be “on site,” even if the service is provided on CHC premises. With the exception of audiology, electrocardiogram, laboratory, and radiology services, the CHC must notify the MassHealth agency, in writing, of each service listed in 130 CMR 405.409(A) through (N) that the CHC will provide on site. All services provided on site must be furnished by practitioners qualified to provide the service that are employees or contractors of the CHC. With the exceptions of audiology, electrocardiogram, laboratory, and radiology services provided on site (for which such services must be furnished and payment claimed by the CHC in accordance with applicable provisions set forth in 130 CMR 405.000 and Subchapter 6 of the Community Health Center Manual), all services set forth below that are provided on site must be furnished, and associated payment claimed by the CHC, in compliance with the applicable MassHealth regulations and subchapter 6 for each such service, including applicable fee schedules. See regulations for referral requirements.
SOURCE: MA 130 CMR 405.408 & 405.409, (Accessed Nov. 2022).