The Massachusetts Executive Office of Health and Human Services has reinstated referral requirements for services covered under the MassHealth Primary Care Clinician (PCC) Plan and Primary Care Accountable Care Organizations (ACOs), effective August 1, 2025.

The change, outlined in All Provider Bulletin 403 (May 2025) and reaffirmed in an August 2025 Mass.gov message, ends the pandemic-era suspension of referral requirements that had been in place since March 2020. The reinstatement applies to a range of covered services, including home health therapy such as physical therapy (PT), occupational therapy (OT), and speech therapy (ST).

MassHealth states that the reinstatement is intended to ensure care coordination and proper authorization through members’ primary care providers. Under the updated policy, PCC Plan and Primary Care ACO members must obtain a referral from their primary care provider before receiving these services, unless the service qualifies under existing exemptions.

Key Facts:

• Effective Date: August 1, 2025
• Plans Affected: Primary Care Clinician (PCC) Plan and Primary Care Accountable Care Organizations (ACOs)
• Bulletin Reference: All Provider Bulletin 403 — Ending the Suspension of PCC Plan and Primary Care ACO Referrals and Updating Referral Requirements for Urgent Care Services
• Services Requiring Referral: Includes home health therapy (PT, OT, ST) and other listed outpatient services
• Source: MassHealth All Provider Bulletin 403 (PDF)

For full details and a complete list of services requiring referral, providers should review Bulletin 403 and related provider education materials available on the MassHealth website.