130 CMR, § 403.406

Current through Register 1536, December 6, 2024

Section 403.406 - Provider Eligibility: Out of State

(A) To participate in MassHealth, an out-of-state home health agency located within 50 miles of the Massachusetts border must

(1) ensure that the agency and each participating branch is certified as a provider of home health services under the Medicare program;

(2) participate in the Medicaid program in its state and meet all requirements within the Medicare Conditions of Participation for home health agency services;

(3) provide home health services to a member who resides in a Massachusetts community near the border of the home health agency's state;

(4) obtain a MassHealth provider number before providing home health services; and

(5) notify the MassHealth agency in writing within 14 days of any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract including, but not limited to, change of ownership, change of address, change in status of Medicare Certification and/or reaccreditation, and additional home health agency branch office.

(B) To participate in MassHealth, an out-of-state home health agency located beyond 50 miles of the Massachusetts border must

(1) be certified as a provider of home health services under the Medicare program by the Medicare-certifying agency in its state;

(2) participate in the Medicaid program in its state;

(3) obtain a MassHealth provider number before providing home health services;

(4) provide services to a member in accordance with 130 CMR 450.109: Out-of-state Services;

(5) notify the MassHealth agency in writing within 14 days of

(a) any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract including, but not limited to, change of ownership, change of address, change in status of Medicare Certification and/or reaccreditation, and additional home health agency participating branch office.

(b) In addition, out-of-state providers also need to

1. accept MassHealth payments as payment in full for all home health services;

2. agree to comply with all the provisions of 130 CMR 403.000 and 130 CMR 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules and regulations; and

3. meet all provider participation requirements described in 130 CMR 403.000 and 130 CMR 450.000: Administrative and Billing Regulations.

130 CMR, § 403.406

Amended by Mass Register Issue 1319, eff. 8/12/2016.

Amended by Mass Register Issue 1343, eff. 7/14/2017.

Amended by Mass Register Issue 1472, eff. 7/1/2022.