MassHealth’s Office of Long-Term Services and Supports (OLTSS) recently hosted a Quality Forum for Home Health Agencies, led in collaboration with Optum. The session focused on helping agencies strengthen operations, improve documentation practices, and understand new tools available through the LTSS Provider Portal.

Three key topics were discussed:

• Prior Authorization Best Practices – MassHealth reviewed common reasons for prior authorization (PA) deferrals and shared reminders on required documentation, including plans of care, visit notes, and timelines for submission.
• Program Integrity and Audit Updates – The presentation outlined current audit activities, including desk and onsite reviews, and emphasized maintaining complete records for face-to-face encounters, supervisory visits, and staff credentialing.
• New Provider Operations Activity Report – A new data tool is now available to help agencies compare their performance to the statewide HHA network. The report provides each agency’s claims approval rate, PA deferral rate, and provider inquiry rate, along with their most frequent claim edit and deferral reasons.

Agencies can request their individualized HHA Provider Operations Activity Report by emailing support@masshealthltss.com including the Provider Name and PID/SL(s). Reports are issued within two business days via secure email.

This new report, based on 2024 data, is intended to support continuous improvement and enhance communication between MassHealth and the home health provider community. You can view the full slide deck from the forum [here] for additional details and resources shared during the presentation.