Withdrawal of a DH Provider from MassHealth

A DH provider that intends to withdraw from MassHealth must satisfy all of the following obligations. (A) MassHealth Notification. (1) A DH provider electing to withdraw from participation in MassHealth must send written notice to the MassHealth agency, or its designee, and DDS of the provider’s intention to withdraw from participating as a MassHealth DH provider. The DH provider must send the withdrawal notice to the MassHealth agency or its designee, no fewer than 90 days before the effective date of withdrawal. (2) The DH provider must forward to the MassHealth agency or its designee a list of all members currently receiving DH. The DH provider must notify the MassHealth agency in writing as members are placed in other programs or begin to receive alternative services, including the name of the new program or service and each member’s start date in the new program or service. (B) Notification to Members and Authorized Representatives. (1) The DH provider must notify all members, authorized representatives of members and other funding sources in writing of the intended closing date no fewer than 90 days from the intended closing date, and specify the assistance to be provided to each member in identifying alternative services. (2) On or reasonably after the date on which the DH provider sends a withdrawal notice to the MassHealth agency or its designee, the provider must give notice to all members to whom it is providing DH along with notice to the members’ authorized representatives, including for those members who have been transferred to hospitals, or who are on medical or nonmedical leave of absence. The notice must advise that any member who is eligible for MassHealth on the effective date of the withdrawal must relocate to another DH provider participating in MassHealth to ensure continuation of MassHealth payment of DH services and must be determined eligible to continue to receive the services. A copy of this notice must be forwarded to the MassHealth agency or its designee. (3) The notice must also state that the DH provider will work promptly and diligently to arrange for the relocation of members to MassHealth-participating DH providers or, if appropriate, to alternative community-service providers. (C) Emergency Withdrawal. In the instance of emergency withdrawal, the DH provider must contact the MassHealth agency, or its designee, within one business day of the emergency withdrawal and follow up, in writing, within three business days informing the MassHealth agency, or its designee, of the reasoning for such emergency withdrawal, and must provide proof in documentation or other form as the MassHealth agency may require. The DH provider must also notify all members, member representatives, the MassHealth agency, and DDS coordinator, if applicable, about the status of all members and any plans for relocation. (D) Admission and Relocation Requirements. (1) A DH provider must not admit any new MassHealth members after the date on which the withdrawal notice is sent to the MassHealth agency or its designee. Members receiving DH from the DH provider, for whom PA was sought prior to the withdrawal notice being sent, who are then authorized for DH after the notice of withdrawal, are not considered newly admitted members. (2) Notwithstanding provision for emergency withdrawal, a DH provider that withdraws from participation in MassHealth must assist members to whom it has been providing DH to identify and locate another DH provider and must continue to provide its current level of DH until all members receiving services from the DH provider have been admitted with a new DH provider or another qualified MassHealth provider. (3) A DH provider seeking to withdraw from the MassHealth program must work promptly and diligently to arrange for the relocation of members to a MassHealth participating DH provider or other qualified MassHealth providers. (130 CMR 419.435 through 419.441 Reserved) This page is reserved.