Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 415.000 - Acute Inpatient Hospital Services
Section 415.404 - Provider Eligibility
Universal Citation: 130 MA Code of Regs 130.415
Current through Register 1531, September 27, 2024
Payment for the services described in 130 CMR 415.000 is made only to acute inpatient hospitals participating in MassHealth as of the date of service.
(A) In-state. To participate in MassHealth, an acute inpatient hospital located in Massachusetts must
(1) be licensed as a hospital by the
Massachusetts Department of Public Health;
(2) have a signed provider agreement that
specifies a payment methodology with the MassHealth agency; and
(3) participate in the Medicare
program.
(B) Out-of-state.
(1)
Out-of-state acute inpatient hospital services are covered only as provided in
130 CMR
450.109: Out-of-state
Services.
(2) To
participate in the MassHealth, an out-of-state acute inpatient hospital must
obtain a MassHealth provider number and meet the following criteria:
(a) be approved as an acute inpatient
hospital by the governing or licensing agency in its state;
(b) participate in the Medicare program;
and
(c) participate in that state's
Medicaid Program (or equivalent).
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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