Current through Register 1531, September 27, 2024
A DH provider that intends to withdraw from MassHealth must
satisfy all of the following obligations.
(A)
MassHealth
Notification.
(1) A DH provider
electing to withdraw from participation in MassHealth must send written notice
to the MassHealth agency, or its designee, and DDS of the provider's intention
to withdraw from participating as a MassHealth DH provider. The DH 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) The DH provider must forward to the
MassHealth agency or its designee a list of all members currently receiving DH.
The DH 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 each member's start date in the new
program or service.
(B)
Notification to Members and Authorized
Representatives.
(1) The DH
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 or reasonably after the date on which
the DH provider sends a withdrawal notice to the MassHealth agency or its
designee, the provider must give notice to all members to whom it is providing
DH along with notice to the members' authorized representatives, including for
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 DH provider participating in MassHealth to ensure continuation of
MassHealth payment of DH services and must be determined eligible to continue
to receive the services. A copy of this notice must be forwarded to the
MassHealth agency or its designee.
(3) The notice must also state that the DH
provider will work promptly and diligently to arrange for the relocation of
members to MassHealth-participating DH providers or, if appropriate, to
alternative community-service providers.
(C)
Emergency
Withdrawal. In the instance of emergency withdrawal, the DH
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 DH
provider must also notify all members, member representatives, the MassHealth
agency, and DDS coordinator, if applicable, about the status of all members and
any plans for relocation
(D)
Admission and Relocation Requirements.
(1) A DH provider must not admit any new
MassHealth members after the date on which the withdrawal notice is sent to the
MassHealth agency or its designee. Members receiving DH from the DH provider,
for whom PA was sought prior to the withdrawal notice being sent, who are then
authorized for DH after the notice of withdrawal, are not considered newly
admitted members.
(2)
Notwithstanding provision for emergency withdrawal, a DH provider that
withdraws from participation in MassHealth must assist members to whom it has
been providing DH to identify and locate another DH provider and must continue
to provide its current level of DH until all members receiving services from
the DH provider have been admitted with a new DH provider or another qualified
MassHealth provider.
(3) A DH
provider seeking to withdraw from the MassHealth program must work promptly and
diligently to arrange for the relocation of members to a MassHealth
participating DH provider or other qualified MassHealth
providers.
