Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 403.000 - Home Health Agency
Section 403.406 - Provider Eligibility: Out of State
Universal Citation: 130 MA Code of Regs 130.403
Current through Register 1531, September 27, 2024
(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.
3. meet all provider participation
requirements described in 130 CMR 403.000 and 130 CMR 450.000:
Administrative and Billing Regulations.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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