Provider Eligibility: In-state

(A) In order to be eligible to receive payment from MassHealth, a potential provider must complete and submit an application to become an approved MassHealth provider, own, lease, or otherwise control by means of a written agreement vehicles required for the transportation services it seeks to provide, be a Medicare provider of any Medicare-covered services it seeks to provide, and be assigned a MassHealth provider number by the MassHealth agency. (B) The provider must ensure that applicants and employees whose positions entail the potential for unsupervised contact with MassHealth members, including, but not limited to drivers and attendants, provide written references and undergo a Criminal Offender Record Information (CORI) check before any contact with a MassHealth member. The provider must ensure that all new employees whose positions entail the potential for unsupervised contact with MassHealth members including, but not limited to, drivers and attendants, undergo a CORI check prior to employment. The provider must ensure that all existing employees whose positions entail the potential for unsupervised contact with MassHealth members including, but not limited to, drivers and attendants, undergo a CORI check annually to recertify their eligibility for their position. The CORI must be in compliance with guidelines that the Executive Office of Health and Human Services may issue. The CORI must remain on file at the transportation provider’s place of business. (C) The provider must ensure that it and its employees and contractors, as applicable, meet each of the requirements listed below. Providers must demonstrate compliance with the following requirements through an attestation or other method identified by EOHHS, in such form and at such frequency as designated by EOHHS through provider bulletins or other written guidance. (1) The provider and its employees and contractors (including drivers and attendants) are not excluded from participation in any federal health care program (as defined in section 1128B(f) of the Social Security Act) and is not listed on the exclusion list of the Office of the Inspector General of the Department of Health and Human Services (OIG). The provider must use the OIG’s List of Excluded Individuals/Entities to screen all employees and contractors to determine if the OIG has excluded them from participation in federal health care programs, both upon initial hiring or contracting and on an ongoing monthly basis. (2) Each individual driver has a valid driver’s license. (3) The provider has in place a process to address any violation of a state drug law by its employees and contractors. (4) The provider has in place a process to disclose to MassHealth the driving history, including any traffic violations, of each individual driver employed or contracted with by such provider. (D) Except where the MassHealth agency elects to limit or terminate provider agreements in accordance with 130 CMR 407.407 and 450.108: Selective Contracting in areas of the state or for modes of transportation for which a selective contract with a transportation broker is in effect, the MassHealth agency accepts and approves applications from providers that qualify and meet given regulations or licensure requirements as are adopted by the Massachusetts Department of Public Health, the MassHealth agency, or the Massachusetts Registry of Motor Vehicles for one or more of the following modes of transportation: wheelchair van, ambulance, or other licensed carriers.