Important Update About Laboratory Drug Testing
MassHealth does not pay for drug testing, such as drug screening or urine screening, for residential monitoring or other non-medically necessary purposes.
“The MassHealth agency does not pay for the following services: […] (4) tests performed only for purposes of civil, criminal, administrative, or social service agency investigations, proceedings, or monitoring activities; (5) tests performed for residential monitoring purposes; […] (9) test that are not medically necessary as defined in 130 CMR 450.204: Medical Necessity; …” 130 CMR 401.411: Noncovered Services and Payment Limitations.” You can read more about MassHealth regulations at Mass.gov.
For more about drug testing, see the BSAS Practice Guidance on Drug Screening as a Treatment Tool.
In the last several years, Massachusetts has passed new laws about clinical laboratories. Sober homes cannot have drug tests processed by labs who share an owner in common with the sober house. Sober homes cannot accept any compensation, whether in cash or in kind, in exchange for having their residents’ drug tests processed by a particular lab. There are civil and criminal penalties for violating these laws.
Beginning in July 2014, the Commonwealth implemented a new law aimed at eliminating inappropriate self-referral arrangements between clinical laboratories and sober houses under common ownership. The law, amending and adding to M.G.L. ch. 111D, affecting §§ 1, 8, 8A, 13, 14 [see links below] prohibits individuals with a direct or indirect ownership interest in a clinical laboratory from sending specimens or making referrals for services to that laboratory. It also imposes similar obligations on clinical laboratories by prohibiting them from seeking or testing specimens referred by individuals with a direct or indirect ownership interest in the laboratory. The law allows for civil or criminal penalties, or both, for violations, including civil penalties of up to $100,000 for each referral or for engaging in a scheme to violate the law. Like the false claims and anti-kickback penalties, the law includes sentencing options of state prison for not more than 5 years, or house of correction for not more than 2 ½ years, a fine of up to $10,000, or both imprisonment and a fine. You can read more about the clinical laboratory anti-self-referral law, and the Medicaid Anti-Kickback Statute (M.G.L. c. 118E, § 41) at: https://oig.hhs.gov/fraud/docs/safeharborregulations/072991.htm