Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 425.000 - Psychiatric Inpatient Hospital Services
Section 425.405 - Provider Eligibility
Universal Citation: 130 MA Code of Regs 130.425
Current through Register 1531, September 27, 2024
Payment for the services described in 130 CMR 425.000 will be made only to psychiatric inpatient hospitals participating in MassHealth on the date of service.
(A) In State. To participate in MassHealth, an in-state psychiatric inpatient hospital must
(1) be a
state-operated psychiatric inpatient hospital; or
(2) be a private psychiatric inpatient
hospital meeting all of the following criteria:
(a) has a signed provider agreement that
specifies a payment methodology with the MassHealth agency;
(b) is licensed as a hospital by the
Massachusetts Department of Mental Health (DMH);
(c) is accredited by The Joint
Commission;
(d) participates in the
Medicare program.
(B) Out of State. To participate in MassHealth, an out-of-state private psychiatric inpatient hospital must
(1) obtain a MassHealth provider
number;
(2) be licensed by the
governing or licensing agency in its state;
(3) be accredited by The Joint
Commission;
(4) participate in that
state's Medicaid program; and
(5)
participate in the Medicare program.
See 130 CMR 425.410 for limitations on services covered when provided in an out-of-state psychiatric hospital.
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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