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MassHealth Issues CSN Bulletin 26: Updates to CCA Supervision Requirements

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MassHealth Issues CSN Bulletin 26: Updates to CCA Supervision Requirements

Optional supervisory flexibilities introduced; core quality and oversight responsibilities remain unchanged.

MassHealth Issues CSN Bulletin 26: Updates to CCA Supervision Requirements
February 2026
MassHealth recently issued Continuous Skilled Nursing (CSN) Bulletin 26 (February 2026), which outlines revisions to supervision requirements for Complex Care Assistant (CCA) services. The bulletin introduces several optional flexibilities related to how and when supervisory visits may occur.
Key changes outlined in the bulletin include:
  • Elimination of the biweekly supervisory visit requirement
  • Allowing licensed practical nurses (LPNs) to conduct CCA supervisory visits
  • Permitting 60-day supervisory visits to occur without the CCA present
Important considerations
  • Responsibility to assess the quality and safety of CCA services continues, even when supervision occurs less frequently or without direct observation
  • Additional onsite observation is required if concerns related to care quality or safety are identified
  • Existing requirements related to documentation, training, and 12-month evaluations are unchanged
  • Accreditation standards, internal agency policies, and liability considerations may still necessitate more frequent or direct supervision
  • These provisions are optional flexibilities, not mandates—agencies should decide whether/how to apply them based on clinical judgment, organizational policy, and risk management.
HCA is monitoring how these changes are implemented and interpreted. We will share additional information if further guidance becomes available from MassHealth. Agencies with specific operational questions or concerns are welcome to reach out directly.
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