Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 417.000 - Psychiatric Day Treatment Program Manual
Section 417.404 - Provider Eligibility
Universal Citation: 130 MA Code of Regs 130.417
Current through Register 1531, September 27, 2024
(A) In State. In order to qualify for participation in MassHealth as an in state psychiatric day treatment program, a psychiatric day treatment program must be located in Massachusetts and:
(1)
Operate under a valid clinic license to provide mental health services issued
by the Massachusetts Department of Public Health;
(2) Be in operation at least five days a week
and provide services to members at least six hours per day but fewer than 24
hours on each of those days; and
(3) Meet all provider participation
requirements as specified in 130 CMR 417.400 and 450.000:
Administrative and Billing Regulations.
(B) Out of State.
(1) To participate in MassHealth, an
out-of-state psychiatric day treatment program must obtain a MassHealth
provider number and meet the following criteria:
(a) the clinic in which the psychiatric day
treatment program operates must be appropriately licensed as required by the
state agency of that state under whose jurisdiction it operates;
(b) if the program is required by its own
state's law to also be licensed or certified as a day treatment program, the
program must be licensed or certified by the appropriate state agency under
whose jurisdiction it operates;
(c)
the program participates in its state's Medicaid Program or the equivalent of
that program;
(d) the program has a
rate established by its state's appropriate rate setting regulatory
body.
(2) Out-of-state
psychiatric day treatment services are covered only as provided in
130 CMR
450.109: Out-of-state
Services.
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