Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 408.000 - Adult Foster Care Services
Section 408.527 - Withdrawal by a GAFC Provider from MassHealth

(1) A GAFC provider electing to withdraw from participation in MassHealth must send written notice to the MassHealth agency or its designee, of the provider's intention to withdraw from the GAFC program. The GAFC provider must send the withdrawal notice by certified or registered mail (return receipt requested) to the MassHealth agency or its designee, no fewer than 90 days before the effective date of withdrawal.

(2) In the instance of alleged emergency withdrawal, the GAFC provider must contact the MassHealth agency, or its designee, within one business day of the emergency withdrawal and follow-up, in writing, within three business days informing the MassHealth agency, or its designee, of the reasoning for such emergency withdrawal, and must provide proof in documentation or other form as the MassHealth agency may require. The GAFC provider must also notify all members and the MassHealth agency about the status of all members and any plans for relocation under 130 CMR 408.523.

(3) The GAFC provider must forward a list of all members currently receiving GAFC. The GAFC provider must notify the MassHealth agency in writing as members are placed in other programs or begin to receive alternative services, including the name of the new program or service and the members' start date in the new program or service.

(1) The GAFC provider must notify all members, authorized representatives of members and other funding sources in writing of the intended closing date no fewer than 90 days from the intended closing date, and specify the assistance to be provided to each member in identifying alternative services.

(2) On the same date on which the GAFC provider sends a withdrawal notice to the MassHealth agency, the provider must give notice, in hand, to all members to whom it is providing GAFC services and the member's authorized representatives, including those members who have been transferred to hospitals, or who are on medical or nonmedical leave of absence. The notice must advise that any member who is eligible for MassHealth on the effective date of the withdrawal must relocate to another GAFC provider participating in MassHealth to ensure continuation of MassHealth payment of services and must be determined eligible to continue to receive the services. A copy of this notice must be forwarded to the MassHealth agency. The notice must also state that the GAFC provider will work promptly and diligently to arrange for the relocation of members to MassHealth-participating GAFC providers or, if appropriate, to alternative community-service providers.

(1) A GAFC provider must not admit any new MassHealth members after the date on which the withdrawal notice was sent to MassHealth. Members of the GAFC program, for whom prior authorization was sought prior to the withdrawal notice being sent, who are then authorized for GAFC after the notice of withdrawal are not considered newly admitted members.

(2) A GAFC provider that withdraws from participation in MassHealth must assist members to whom it has been providing GAFC services to identify and locate another GAFC provider, and must continue to provide its current level of GAFC services until all members receiving services from the GAFC provider have been admitted with a new GAFC provider or another qualified MassHealth provider.

(3) A GAFC provider seeking to withdraw from the MassHealth program will work promptly and diligently to arrange for the relocation of members to MassHealth participating GAFC or other qualified MassHealth providers. For relocation requirements, see 130 CMR 408.523.