Provider Eligibility: Out of State

(A) To participate in MassHealth, an out-of-state home health agency located within 50 miles of the Massachusetts border must (1) ensure that the agency and each participating branch is certified as a provider of home health services under the Medicare program; (2) participate in the Medicaid program in its state and meet all requirements within the Medicare Conditions of Participation for home health agency services; (3) provide home health services to a member who resides in a Massachusetts community near the border of the home health agency’s state; (4) obtain a MassHealth provider number before providing home health services; and (5) notify the MassHealth agency in writing within 14 days of any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract, including, but not limited to, change of ownership, change of address, change in status of Medicare Certification and/or reaccreditation, and additional home health agency branch office. (B) To participate in MassHealth, an out-of-state home health agency located beyond 50 miles of the Massachusetts border must (1) be certified as a provider of home health services under the Medicare program by the Medicare-certifying agency in its state; (2) participate in the Medicaid program in its state; (3) obtain a MassHealth provider number before providing home health services; (4) provide services to a member in accordance with 130 CMR 450.109: Out-of-state Services; (5) notify the MassHealth agency in writing within 14 days of (a) any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract, including, but not limited to, change of ownership, change of address, change in status of Medicare Certification and/or reaccreditation, and additional home health agency participating branch office. (b) In addition, out-of-state providers also need to 1. accept MassHealth payments as payment in full for all home health services; 2. agree to comply with all the provisions of 130 CMR 403.000 and 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules and regulations; and 3. meet all provider participation requirements described in 130 CMR 403.000 and 450.000: Administrative and Billing Regulations.