Provider Eligibility

(A) An organization seeking to participate in MassHealth as an ADH provider must (1) enter into a provider contract with the MassHealth agency; (2) be licensed by the Department of Public Health under 105 CMR 158.00 Licensure of Adult Day Health Programs; (3) accept MassHealth payments as payment in full for all ADH; (4) establish, maintain, and comply with written policies and procedures to comply with 130 CMR 404.000; (5) agree to periodic inspections, by the MassHealth agency or its designee, that assess the quality of member care and ensure compliance with 130 CMR 404.000. (6) agree to comply with all the provisions of 130 CMR 404.000, 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules, regulations, and sub- regulatory guidance; and (7) participate in any ADH provider orientation required by EOHHS. (B) The MassHealth agency requires documentation from applicants seeking to become ADH providers. All required application documentation must be submitted and approved in order to participate as an ADH provider in MassHealth. All required MassHealth application documentation will be specified by the MassHealth agency.