The MassHealth Therapy Team has been working with a Therapy Stakeholder Providers Group from across the Commonwealth to update regulations, increase provider rates, and reduce administrative burden. The shared goal is to increase the number of providers willing to accept MassHealth beneficiaries and to strengthen members’ access to high-quality care.

The MassHealth Therapy Provider Team has made significant progress toward these goals and continues to explore additional incentives to encourage provider participation in the MassHealth Program. Through strong, coordinated advocacy, MassHealth announced a historic increase in provider rates effective June 2025. These rates are intended to remain in effect for two years. In Spring 2026, the next rate review cycle will begin, with new rates targeted to go into effect in June 2027. For those who benefit from these rate increases, providers and MassHealth members alike, thank-you letters to your local legislators are strongly encouraged and greatly appreciated.

We also know that administrative burden is effectively lost revenue and time for therapy providers. MassHealth is actively working to increase the number of visits allowed prior to requiring Prior Authorization (PA) from 20 to 30 or 35, aligning with speech-language pathology guidelines. In addition, they are exploring the elimination of PA requirements for children. The MassHealth Therapy Provider Team continues to seek concrete feedback on how to reduce these burdens.

If your administrative or billing team has suggestions regarding the PA process, especially ideas to streamline or eliminate duplicative documentation, please send your input to MAOT Reimbursement Co-Representative Sherry Fenton at sherlynf@gmail.com.

Your feedback plays a critical role in shaping meaningful, provider-centered change.

Below is the agenda for the November 26, 2025, Therapy Stakeholders Meeting. As you can see, the good work continues, and we have much to be grateful for as we go into this Thanksgiving and Holiday Season.

Ongoing Discussion on Proposed Program Regulation (130 CMR 432.000: Therapist Manual) changes:

• Adding Speech-Language Pathologist Provisional Licensee/Speech Language Clinical Fellow (SLP PL)
• PA for Pediatric and Adult Members
• Calendar Year versus 12-Month Period
• Evaluations before Prior Authorization (PA)

Application Update and Bulletin SLP PL:

• Bulletin being issued around December 1st to align with Application System Update to begin enrolling SLP PLs.
• Senior Care Option to MassHealth Fee-for-Service Policy Change:
• Eligibility changes for SCO members (must have both Medicare Parts A and B as well as MassHealth Standard to remain in a SCO).
• Policy effective January 1, 2026.
• Working to ensure continuity of care for members.
• Letters have been issued to members.

Discussion on Managing Administrative Requirements:

• Update: CORI checks discontinued for PTs linked to group practices, system change to add additional service locations in the works.
• Additional suggestions on managing administrative requirements.
• Prior Authorization adjudication streamlined.

101 CMR 339: Rates for Restorative Services:

• Per legislation, restorative rates are reviewed every two years, and the next review will be for Fiscal Year 2027

Your voice counts!

Please share your questions and reimbursement experiences with your MAOT Reimbursement Representatives,

Sherlyn Fenton at sherlynf@gmail.com and

Sue Steinbacher at sjhenry8@gmail.com