Provider Eligibility

Payment for the services described in 130 CMR 421.000 is made only to family planning agencies that are participating in MassHealth as of the date of service. The eligibility requirements for family planning agencies are as follows. (A) In State. (1) A family planning agency located in Massachusetts is eligible to participate in MassHealth only if it is certified by the MassHealth agency as a family planning agency, in accordance with the requirements specified in 130 CMR 421.404 through 421.427. (2) The family planning agency must fulfill one of the following licensing requirements. (a) Family planning services must be provided in a facility licensed as a clinic or hospital by the Massachusetts Department of Public Health. (b) Family planning services must be provided under the supervision of a physician licensed by the Massachusetts Board of Registration in Medicine. (3) A family planning agency may provide family planning services in one or more service delivery sites, which must be located in freestanding clinics, community health centers, hospital outpatient departments, or hospital-licensed health centers. (B) Out of State. A family planning agency located outside of Massachusetts is eligible to participate in MassHealth only if it meets the licensing requirements in its state, participates in that state's Medicaid program (or equivalent), and meets the requirements specified in 130 CMR 421.404 through 421.427.