Provider Eligibility

Payment for the services described in 130 CMR 425.000 will be made only to psychiatric inpatient hospitals participating in MassHealth on the date of service. (A) In State. To participate in MassHealth, an in-state psychiatric inpatient hospital must (1) be a state-operated psychiatric inpatient hospital; or (2) be a private psychiatric inpatient hospital meeting all of the following criteria: (a) has a signed provider agreement that specifies a payment methodology with the MassHealth agency; and (b) is licensed as a hospital by the Massachusetts Department of Mental Health (DMH); (c) is accredited by the Joint Commission; (d) participates in the Medicare program. (B) Out of State. To participate in MassHealth, an out-of-state private psychiatric inpatient hospital must (1) obtain a MassHealth provider number; (2) be licensed by the governing or licensing agency in its state; (3) be accredited by the Joint Commission; (4) participate in that state's Medicaid program; and (5) participate in the Medicare program. See 130 CMR 425.410: Service Limitations for limitations on services covered when provided in an out-of-state psychiatric hospital. (B) Out of State. To participate in MassHealth, an out-of-state private psychiatric inpatient hospital must (1) obtain a MassHealth provider number; (2) be licensed by the governing or licensing agency in its state; (3) be accredited by the Joint Commission; (4) participate in that state's Medicaid program; and (5) participate in the Medicare program. See 130 CMR 425.410: Service Limitations for limitations on services covered when provided in an out-of-state psychiatric hospital.