Provider Eligibility

Payment for the services described in 130 CMR 415.000 is made only to acute inpatient hospitals participating in MassHealth as of the date of service. (A) In-State. To participate in MassHealth, an acute inpatient hospital located in Massachusetts must (1) be licensed as a hospital by the Massachusetts Department of Public Health; (2) have a signed provider agreement that specifies a payment methodology with the MassHealth agency; and (3) participate in the Medicare program. (B) Out of State. (1) Out-of-state acute inpatient hospital services are covered only as provided in 130 CMR 450.109: Out-of-State Services. (2) To participate in MassHealth, an out-of-state acute inpatient hospital must obtain a MassHealth provider number and meet the following criteria: (a) be approved as an acute inpatient hospital by the governing or licensing agency in its state; (b) participate in the Medicare program; and (c) participate in that state's Medicaid Program (or equivalent).