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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 248 Rev. 04/01/24 MASSHEALTH FINANCIAL ELIGIBILITY Chapter 520 Page 520.033

(B) Expenses Used to Meet the Deductible. The MassHealth agency applies bills to meet the deductible in the following order: (1) Medicare and other health-insurance premiums credited prospectively for the cost of six months' coverage, deductibles, enrollment fees, or coinsurance charges incurred by the individual and the spouse; (2) expenses incurred by the individual and the spouse for necessary medical and remedial- care services that are recognized under state law but are not covered by MassHealth, including guardianship fees and related expenses as described in and allowed under 130 CMR 520.026(E)(3); and (3) expenses incurred by the individual, a family member, or financially responsible relative for necessary medical and remedial-care services that are covered by MassHealth.

(C) Expenses that Cannot be Used to Meet the Deductible. Expenses that may not be applied to meet the deductible include, but are not limited to, the following: (1) cosmetic surgery; (2) rest-home care; (3) weight-training equipment; (4) massage therapy; (5) special diets; and (6) room-and-board charges for individuals in residential programs.

520.033: Verification of Medical Expenses

(A) Medical expenses must be verified by a bill or written statement from a health-care provider with the exception of expenses for nonprescription drugs, which must be verified by a receipt from the provider of the drug. Any unpaid bill incurred before the deductible period must be verified by a bill dated within the six-month deductible period.

(B) Verifications must include all of the following information: (1) the name of the provider; (2) the type of service provided; (3) the name of the individual for whom the service was provided; (4) the amount charged for the service including the current balance; and (5) the date of service.