Point32Health covers medically necessary home- and community-based services (HCBS), including adult day health (ADH), adult foster care (AFC), and personal care attendant (PCA) services, in accordance with members’ benefits and applicable state regulations.
We’ve updated Point32Health’s Home- and Community-Based Services Payment Policy to clarify and reinforce the claim submission process for certain ADH providers. Effective for dates of service beginning March 1, 2025, if you are an ADH provider and providing services within the ASAP’s service area, please submit claims for your services directly to the ASAP indicated on the Adult Day Health Referral form—rather than to Point32Health. ADH providers who participate with Tufts Health Senior Care Options but are not contracted with an ASAP, or caring for members outside the contracted ASAP area, may continue to submit claims directly to Point32Health for approved services.
If you are an ADH provider, be sure to follow the appropriate claim submission process. Please keep in mind that if you bill incorrectly, your claim may be denied.
For additional information, refer to the Home- and Community-Based Services Payment Policy.