Medical Policy Update (October 2024)

Posted on October 8, 2024

Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. 

CAR-T Therapy 

• Effective 10/1/2024 

• CAR-T therapies will be reviewed by Prime Therapeutics (formerly Magellan Rx) for Commercial and Medicare Advantage lines of business.   

• Health New England will continue to review all other associated CAR-T services such as inpatient admissions and out-of-network services. 

• Health New England will continue to review for MassHealth. 

Medical Necessity and Experimental and Investigational 

• Annual Review  

• Effective 11/1/2024 

• Medicaid definition of Medical Necessity updated 

• References updated 

• Formatting changes 

Musculoskeletal Surgery: Arthroplasty   

• Change of Effective Date from October 1, 2024, to November 1, 2024 

Categories: Provider Newsletter