Current through Register 1531, September 27, 2024
(A)
In-state. Each center operated by a freestanding
clinic or a satellite clinic is eligible to participate only if the center is:
(1) enrolled as a Medicare
provider;
(2) enrolled and actively
participating with the MassHealth agency as a billing provider as evidenced by
the issuance of a Provider Identification and Service Location (PIDSL) number
for the provision of mental health center services at that location;
and
(3) licensed by the
Massachusetts Department of Public Health (DPH). The MassHealth agency may
waive the clinic licensure requirement for centers that are:
(a) operated by a local department of public
health; and
(b) comply with
130
CMR 429.404(A)(2).
(B)
Out-of-state. Each out-of-state center operated by a
freestanding clinic or satellite clinic is eligible to participate only if the
center:
(1) meets the following criteria:
(a) if the center is required by its own
state's law to be licensed, each center must be licensed by the appropriate
state agency under whose jurisdiction it operates;
(b) each center must participate in its own
state's medical assistance program or its equivalent;
(c) each center must have a rate of
reimbursement established by the appropriate rate setting regulatory body of
its state.
(2) is a
Medicare-participating provider;
(3) is enrolled by the MassHealth agency as a
provider of mental health center services at that location; and obtains a
MassHealth PIDSL number.
(C)
Behavioral Health Urgent Care
Provider Eligibility. To be designated as a Behavioral Health
Urgent Care provider, a center must meet the eligibility requirements set forth
in 130 CMR 429.404(A)
and the following criteria.
(1) Comply with the regulations in 130 CMR
429.000;
(2) Attest at a time and
in a form determined by the MassHealth agency to being able to meet the
following requirements:
(a)
Appointments.
1.
Appointments for diagnostic evaluation services for new clients are available
on the same or next day of clinic operation, when clinically indicated based on
initial intake;
2. Appointments for
all existing clients with an urgent behavioral health need are available on the
same or next day of clinic operation;
3. Urgent psychopharmacology appointments and
Medication for Addiction Treatment evaluation are available within 72 hours of
an initial diagnostic evaluation and based on a psychosocial assessment;
and
4. All other treatment
appointments including follow-up appointments are available within 14 calendar
days.
(b)
Hours. Meet the requirements as set forth
in130 CMR
429.434(D)
(3)
Multiple
Clinics. The Behavioral Health Urgent Care provider requirements
shall be met at the clinic location level.
(D) Each center operated by a freestanding
clinic or satellite clinic must meet the requirements listed in 130 CMR 429.000
in order to be enrolled by the MassHealth agency.
(E) Payment for services described in 130 CMR
429.000 will be made only to mental health centers participating in MassHealth
on the date of service.
