Provider Eligibility

(A) In State. Each center operated by a freestanding clinic or a satellite clinic is eligible to participate only if the center is (1) enrolled as a Medicare provider; (2) enrolled and actively participating with the MassHealth agency as a billing provider as evidenced by the issuance of a Provider Identification and Service Location (PIDSL) number for the provision of mental health center services at that location; and (3) licensed by the Massachusetts Department of Public Health (DPH). The MassHealth agency may waive the clinic licensure requirement for centers that are (a) operated by a local department of public health; and (b) comply with 130 CMR 429.404(A)(2). (B) Out of State. Each out-of-state center operated by a freestanding clinic or satellite clinic is eligible to participate only if the center (1) meets the following criteria: (a) if the center is required by its own state's law to be licensed, each center must be licensed by the appropriate state agency under whose jurisdiction it operates; (b) each center must participate in its own state's medical assistance program or its equivalent; and (c) each center must have a rate of reimbursement established by the appropriate rate setting regulatory body of its state. (2) is a Medicare-participating provider; (3) is enrolled by the MassHealth agency as a provider of mental health center services at that location; and (4) obtains a MassHealth PIDSL number. (C) Behavioral Health Urgent Care Provider Eligibility. To be designated as a behavioral health urgent care (BHUC) provider, a center must meet the eligibility requirements in 130 CMR 429.404(A) and the following criteria: (1) Comply with the regulations in 130 CMR 429.000; (2) Attest at a time and in a form determined by the MassHealth agency to being able to meet the following requirements: (a) Appointments. 1. Appointments for diagnostic evaluation services for new clients are available on the same or next day of clinic operation, when clinically indicated based on initial intake; 2. Appointments for all existing clients with an urgent behavioral health need are available on the same or next day of clinic operation; 3. Urgent psychopharmacology appointments and Medication for Addiction Treatment (MAT) evaluations are available within 72 hours of an initial diagnostic evaluation and based on a psychosocial assessment; and 4. All other treatment appointments including follow-up appointments are available within 14 days. (b) Hours. Meet the requirements in 130 CMR 429.434(D). (c) Language Capabilities. Maintain the ability to use two-way video communication for translation services, and/or have multilingual staff that align with the language needs of the communities served. (3) Multiple Clinics. The BHUC provider requirements must be met at the clinic location level. (D) Each center operated by a freestanding clinic or satellite clinic must meet the requirements in 130 CMR 429.000 to be enrolled by the MassHealth agency. (E) Payment for services described in 130 CMR 429.000 will be made only to mental health centers participating in MassHealth on the date of service.