Provider Eligibility

(A) An organization seeking to participate in MassHealth as an AFC provider must (1) enter into a contract with the MassHealth agency; (2) maintain a business office in Massachusetts and be duly authorized to conduct a business in Massachusetts that delivers health and human services to elders or people with disabilities. Such business offices must: (a) be available to members during regular, posted business hours; (b) be physically accessible to members with disabilities; (c) have clear access and space for storing of business records; (d) have a sign visible from outside the facility identifying the business name and hours that the business office is open; (e) have a publicly listed business name, address, and local toll-free telephone number that is answered by customer service staff during business hours and that has Telecommunication Device for the Deaf/Teletype (TTY/TDD) transmission and reception capability; provided, that during business hours, this number cannot be a pager, answering service, voice message system, or cell phone; and (f) maintain a 24-hour voice message system; (3) accept MassHealth payments as payment in full for all AFC; (4) establish, maintain, and comply with written policies and procedures to comply with 130 CMR 408.000; (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 408.000; (6) agree to comply with all the provisions of 130 CMR 408.000, 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules and regulations. (7) participate in any AFC provider orientation required by EOHHS; (8) meet all provider participation requirements described in 130 CMR 408.000 and 130 CMR 450.000: Administrative and Billing Regulations; (9) agree to pay AFC caregivers on a timely basis for services provided at applicable compensation levels; (10) be accredited by the National Committee for Quality Assurance (NCQA), the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or other nationally recognized accreditation organizations determined acceptable by the MassHealth agency. AFC providers must provide evidence of accreditation in accordance with 130 CMR 408.404(A)(10) in the form and format as required by the MassHealth agency; (11) submit to the MassHealth agency or its designee a statement of fiscal soundness attesting to the financial viability of the AFC provider supported by documentation to demonstrate that the provider has adequate resources to finance the provision of services in accordance with 130 CMR 408.000 in the form and format as required by the MassHealth agency; and (12) provide evidence in the form and format required by the MassHealth agency that the organization is actively billing for and serving at least eight individuals at the time of accreditation and re-accreditation. (B) The MassHealth agency requires documentation from applicants seeking to become AFC providers. All required application documentation must be submitted and approved in order to participate as an AFC provider in MassHealth. All required MassHealth application documentation will be specified by the MassHealth agency. (130 CMR 408.405 through 408.414 Reserved)