Are there time limits that apply to decisions?
MassHealth is required to respond to appropriately completed and submitted requests for PA within the following time periods, in accordance with 130 CMR 450.303(A): • independent nursing — within 14 calendar days after the date the PA unit receives the request; • DME — within 15 calendar days after the date the PA unit receives the request; • for all other services (excluding pharmacy and transportation) — within 21 days after the date the PA unit receives the request. If a PA is deferred, the adjudication clock stops. Both the provider and member are notified that the PA has been deferred. When the provider submits the additional information to MassHealth, the clock starts again from where it left off.
