Section 427.404 - Provider Eligibility(A)Participating Provider Requirement. Payment for the services described in 130 CMR 427.000 is made to oxygen and respiratory therapy equipment providers and repair service providers who are participating in MassHealth; to providers also enrolled as MassHealth participating durable medical equipment and supplies (DME) providers, orthotic services providers, or prosthetic services providers who meet all program-specific requirements; and to MassHealth-enrolled pharmacy providers who have been assigned an oxygen and respiratory therapy equipment specialty in accordance with 130 CMR 427.404(B). Participating oxygen and respiratory therapy equipment providers must be accredited by an accrediting body that is acceptable to the Centers for Medicare & Medicaid Services. Applicants must meet the requirements in 130 CMR 450.000: Administrative and Billing Regulations, as well as the requirements in 130 CMR 427.000. Participating oxygen and respiratory therapy equipment providers must continue to meet provider eligibility participation requirements throughout the period of their provider contract with the MassHealth agency.(B)Pharmacy Providers Assigned Oxygen and Respiratory Therapy Equipment Specialty. Applicants or providers enrolled as a MassHealth pharmacy provider under 130 CMR 406.000: Pharmacy Services may qualify to provide oxygen and respiratory therapy equipment services if the following conditions are met: (1) the applicant or provider meets all other conditions under 130 CMR 427.000 to provide oxygen and respiratory therapy equipment and supplies; and(2) the MassHealth agency has assigned a specialty of oxygen and respiratory therapy equipment to the applicant's or provider's existing provider number for pharmacy services.(C)In State.(1) A provider located in Massachusetts must engage in the business of supplying oxygen and respiratory therapy equipment to the public and must meet all state and local requirements for engaging in such business.(2) A provider located in Massachusetts must employ a minimum of one respiratory care practitioner licensed by the Commonwealth of Massachusetts.(3) A provider who furnishes services to recipients in Massachusetts and whose main office is located out of state must have a servicing facility in Massachusetts.(D)Out of State. A provider located outside of Massachusetts is eligible to participate in MassHealth only if it participates in the Medicaid program (or equivalent) of the state in which it primarily conducts business and meets the requirements in 130 CMR 427.404(A).
Amended by Mass Register Issue 1494, eff. 4/28/2023.