MassHealth Announces Key Updates Affecting Home Health Agencies

MassHealth used its November 18 stakeholder meeting to roll out a series of operational changes that home health agencies will need to prepare for in the coming months. The briefing touched on Electronic Visit Verification (EVV) enforcement, ongoing telehealth allowances, overdue fiscal filings, and upcoming eligibility changes for several major MassHealth programs.

EVV remains the most pressing focus, with MassHealth confirming that follow-up letters were sent November 10 to providers who disputed their initial non-compliance notice. Agencies must now reach 30% auto-verified visit compliance by December 5, 2025, with soft edits already appearing on Remittance Advices. A second checkpoint—requiring 40% auto-verification—will run from July 1, 2025 through March 31, 2026. Hard edits remain slated for July 2026.

In welcome news to many providers, telehealth flexibilities have been extended, allowing prescriber face-to-face encounters to continue via telehealth through January 30, 2026. Encounters on or after October 1, 2025 remain allowable, and certain home health telehealth provisions will also continue under federal extensions.

MassHealth also issued a reminder that Fiscal Soundness Attestations remain outstanding for agencies that have not yet submitted. CHIA reinforced its FY2024 requirements as well, following its October 31 warning notice. A complete submission must include the FY2024 NSR, financial statements, and the CMS-178 Medicare Cost Report, with separate filings required for agencies delivering both home health and CSN services. Exemptions are granted only after formal CHIA approval.

Looking ahead to January 1, 2026, eligibility changes for Senior Care Options (SCO) members will take effect. Members must have Medicare Parts A and B and MassHealth Standard to remain in an SCO plan—letters to affected members have already been mailed. At the same time, agencies should prepare for new ACO transitions, detailed in Provider Bulletin 410, with member notifications issued on October 31.

These updates collectively mark a period of substantial operational change for home health providers statewide. Agencies are encouraged to review the full briefing and begin planning for compliance across these multiple fronts.