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6 130 CMR: DIVISION OF MEDICAL ASSISTANCE
Trans. by E.L. 259 Rev. 02/13/26
130 CMR 522.000: MASSHEALTH: OTHER DIVISION PROGRAMS
(E) Copayments. Members are not required to pay copayments for any covered services.
(F) Medical Coverage Date. Except as provided at 130 CMR 522.004(H), coverage begins on the date of the final eligibility determination. The time standards for determining and redetermining eligibility are described at 130 CMR 502.005: Time Standards for an Eligibility Determination and 502.007: Continuing Eligibility.
(G) Benefits Provided. Benefits provided are described at M.G.L. c. 118E, § 10F. Included benefits are (1) preventive pediatric care; (2) sick visits; (3) office visits, first-aid treatment, and follow-up care; (4) provision of smoking prevention educational information and materials to the parent, guardian, or person with whom the enrollee resides, as distributed by the Department of Public Health; (5) prescription drugs up to $200 per state fiscal year; (6) urgent care visits, not including emergency care in a hospital outpatient or emergency department; (7) outpatient surgery and anesthesia that are medically necessary for the treatment of inguinal hernia and ear tubes; (8) annual and medically necessary eye exams; (9) medically necessary mental-health outpatient services, including substance-use treatment services, not to exceed 20 visits per fiscal year; (10) durable medical equipment, up to $200 per state fiscal year, with an additional $300 per state fiscal year for equipment and supplies related to asthma, diabetes, and seizure disorders only; (11) dental health services, up to $750 per state fiscal year, including preventive dental care, provided that no funds will be expended for cosmetic or surgical dentistry; (12) auditory screening; (13) laboratory diagnostic services; and (14) radiologic diagnostic services.
(H) Enrollment Cap. The MassHealth agency may limit the number of children who can be enrolled in CMSP. When the MassHealth agency imposes such a limit, applicants will be placed on a waiting list when their eligibility has been determined. When the MassHealth agency is able to open enrollment for CMSP, the MassHealth agency will process the applications in the order in which they were placed on the waiting list.