Provider Eligibility

An organization seeking to participate in MassHealth as a DH provider must (A) be located in Massachusetts; (B) enter into a contract with the MassHealth agency through submission of an application that includes all documentation specified by the MassHealth agency or its designee and be certified by the MassHealth agency or its designee in accordance with the requirements set forth in 130 CMR 419.000 and 130 CMR 450.000: Administrative and Billing Regulations to conduct a business in Massachusetts that delivers health and human services to individuals with ID/DD; (C) accept the MassHealth agency payments as payment in full for DH; (D) be in operation at least five business days a week, six hours per day; (E) collaborate with DDS in accordance with EOHHS guidelines, to ensure coordination of services to DDS clients; (F) be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) or the Council on Quality and Leadership; (G) meet all provider participation requirements described in 130 CMR 419.000 and 130 CMR 450.000: Administrative and Billing Regulations. (H) participate in any DH provider orientation required by EOHHS; (I) submit to the MassHealth agency or its designee a written description of DH offered by the DH provider and its service plan; and (J) agree to periodic review and inspection by the MassHealth agency or its designee that assess the quality of member care and ensure compliance with 130 CMR 419.000 and 130 CMR 450.000: Administrative and Billing Regulations.