Services Provided Under Contract

(A) Introduction. A home health agency may provide home health services directly or through contractual arrangements made by the home health agency. Whether the services are provided directly or through contracts, the home health agency is responsible for submitting claims for services and for meeting the requirements in 130 CMR 403.000 and all other applicable state and federal requirements. A home health agency may provide services through contracts in the following situations: (1) when a home health agency, in order to be approved to participate in MassHealth, makes arrangements with another agency or organization to provide the nursing, home health aide, or other therapeutic services that it does not provide directly; or (2) when a home health agency that is already approved for participation in MassHealth makes arrangements with others to provide services it does not provide. (B) Contract Requirements. (1) If the home health agency contracts with another provider participating in MassHealth (e.g., hospital, nursing facility, another home health agency, or hospice), a written contract must document the services to be provided and the corresponding financial arrangements. (2) If the home health agency contracts with a provider that does not participate in MassHealth, the written contract must include (a) a description of the services to be provided; (b) the duration of the agreement and how frequently it is to be reviewed; (c) a description of how personnel are supervised; (d) a statement that the contracting organization will provide its services in accordance with the plan of care established by the member's physician in conjunction with the home health agency's staff; (e) a description of the contracting organization's standards for personnel, including qualifications, functions, supervision, and in-service training; (f) a description of the method of determining reasonable costs and payments by the home health agency for the specific services to be provided by the contracting organization; and (g) an assurance that the contracting organization will comply with Title VI of the Civil Rights Act and all relevant MassHealth provider requirements.