Provider Eligibility

Payment for the services described in 130 CMR 434.000 will be made only to the outpatient department of a psychiatric hospital participating in MassHealth on the date of service. (A) In State. To participate in MassHealth, psychiatric inpatient hospitals located in Massachusetts must (1) operate under a psychiatric inpatient hospital license issued by the Massachusetts Department of Mental Health; (2) have a signed provider contract with the MassHealth agency that specifies the conditions of participation in MassHealth; and (3) participate in the Medicare program. (B) Out of State. To participate in MassHealth, an out-of-state psychiatric inpatient hospital must obtain a MassHealth provider number and meet the following criteria: (1) operate under a hospital license from or be approved as a hospital by the governing or licensing agency in its state; (2) participate in the Medicare program; and (3) participate in that state's medical assistance program (or the equivalent).