Provider Eligibility

The MassHealth agency makes payment for services, described in 130 CMR 436.000, only to eligible providers of radiation oncology services who are participating in MassHealth on the date of service. The participating provider is responsible for the quality of all services for which payment is claimed, the accuracy of such claims, and compliance with all regulations applicable to radiation oncology services under MassHealth. In order to claim payment, the participating provider must be the radiation oncology center that actually performed the service. A radiation oncology center must have one or more supervising physicians who are responsible for the personal, direct, or general supervision of the facility and its personnel in accordance with Medicare requirements at 42 CFR 410.323(b)(3), the operation and calibration of the equipment, and the quality of the testing performed. (A) In State. To be eligible to participate as a MassHealth provider, a radiation oncology center must (1) be located and doing business in the Commonwealth of Massachusetts; (2) operate under a clinic license issued by the Massachusetts Department of Public Health (DPH), in accordance with regulations at 105 CMR 140.000. (Providers operating as a satellite location under a Massachusetts DPH hospital license, or otherwise have Medicare provider-based status under 42 CFR 413.65, do not meet this requirement.); (3) obtain a current determination of need or acceptable substitute such as a physician’s exemption letter issued by the Massachusetts Department of Public Health, to provide radiation therapy services; (4) employ to perform, oversee, and direct all care provided at the center one or more physicians licensed by Commonwealth of Massachusetts as a radiation oncologist, nuclear medicine provider, or radiologist; (5) ensure that non-physician medical technicians providing services are licensed by the Commonwealth of Massachusetts to provide such services in accordance with regulations at 105 CMR 120.000; and (6) participate in the Medicare program as a radiation therapy provider. (B) Out of State. A radiation oncology center located outside of Massachusetts that does not otherwise meet the requirements of 130 CMR 436.404(A) may participate in MassHealth if it meets the requirements of 130 CMR 436.404(A)(6), 450.109, and the following: (1) employs to perform, oversee, and direct all care provided at the center one or more physicians licensed as a radiation oncologist, nuclear medicine provider, or radiologist in the same state the radiation oncology center is located and operating; (2) ensures that non-physician medical technicians providing services are licensed in the same state in which the radiation oncology center is located and operating; and (3) participates in the Medicare program as a radiation therapy provider.