Provider Eligibility

(A) In State. In order to qualify for participation in MassHealth as an in state psychiatric day treatment program, a psychiatric day treatment program must be located in Massachusetts and: (1) Operate under a valid clinic license to provide mental health services issued by the Massachusetts Department of Public Health; (2) Be in operation at least five days a week and provide services to members at least six hours per day but fewer than 24 hours on each of those days; and; (3) Meet all provider participation requirements as specified in 130 CMR 417.400 and 450.000: Administrative and Billing Regulations. (B) Out of State. (1) To participate in MassHealth, an out-of-state psychiatric day treatment program must obtain a MassHealth provider number and meet the following criteria: (a) the clinic in which the psychiatric day treatment program operates must be appropriately licensed as required by the state agency of that state under whose jurisdiction it operates; (b) if the program is required by its own state’s law to also be licensed or certified as a day treatment program, the program must be licensed or certified by the appropriate state agency under whose jurisdiction it operates; (c) the program participates in its state's Medicaid Program or the equivalent of that program; (d) the program has a rate established by its state's appropriate rate setting regulatory body. (2) Out-of-state psychiatric day treatment services are covered only as provided in 130 CMR 450.109: Out-of-State Services. (130 CMR 417.405 Reserved)