Special Provisions

Preferred Provider Agreements (1) A purchaser may apply for approval of a Preferred Provider Agreement under which the governmental unit will purchase specialized services at a reimbursement rate that reflects the particular requirements of the services to be provided. (2) In order for EOHHS to approve the Agreement, the Agreement must (a) Identify the clinical needs of the purchaser’s clients; (b) Establish specific criteria for evaluating provider qualifications to meet the clinical needs of the purchaser’s clients; (c) Specify the purchaser’s role in managing the services provided to its clients, including but not limited to prior authorizations; (d) Specify the provider's duties in complying with the administrative requirements established by the purchasing agency; (e) Demonstrate that the rates to be paid are reasonable and reflect the additional services to be provided; and (f) If the governmental unit is a state agency, the agency must demonstrate that the provisions of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services relative to the procurement and form of the Agreement have been satisfied. (3) If the governmental unit has adopted formal procedures for contracting with providers under Preferred Provider Agreements, and the procedures satisfy the criteria set forth in 101 CMR 329.06(2), the governmental unit may request approval of its formal procedures rather than approval of the individual agreements. The governmental unit must supply to EOHHS the services for which Preferred Provider Agreements will be executed and the range of rates to be paid.