Provider Eligibility

To participate in MassHealth as a MassHealth CSN agency provider, an agency must (A) be accredited or certified as (1) a provider of home health services by a CMS-approved accrediting organization including one of the following: Accreditation Association for Ambulatory Health Care, Accreditation Commission for Health Care, Community Health Accreditation Partner, the Joint Commission on Accreditation of Healthcare Organizations, and meet all requirements of the CMS-approved accrediting organization; or (2) a provider of home care services by the Accreditation Commission for Health Care and meet all requirements of this accrediting organization; or (3) a provider of home health services under the Medicare program by the Massachusetts Department of Public Health and meet all requirements within the Medicare Conditions of Participation for home health agency services; (B) obtain a MassHealth provider number before providing CSN agency services; (C) participate in, and be in compliance with, other MassHealth enrollment requirements that may include, but are not limited to, provider site visit requirements; (D) accept MassHealth payments as payment in full for all CSN agency services; (E) agree to comply with all the provisions of 130 CMR 438.000 and 130 CMR 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules and regulations; (F) meet all provider participation requirements described at 130 CMR 438.000 and 130 CMR 450.000: Administrative and Billing Regulations; (G) agree to periodic inspections, by the MassHealth agency or its designee, that assess the quality of member care and ensure compliance with 130 CMR 438.000; (H) participate in any CSN agency provider orientation required by the EOHHS; (I) submit to the MassHealth agency or its designee a statement of fiscal soundness attesting to the financial viability of the CSN agency provider supported by documentation to demonstrate that the provider has adequate resources to finance the provision of services in accordance with 130 CMR 438.000 and as specified in 130 CMR 438.415(E); (J) notify the MassHealth agency in writing within 14 days of any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract including, but not limited to, change of ownership, change of address, change in status of accreditation and/or reaccreditation or Medicare certification, and additional CSN agency branch office; and (K) An out-of-state provider must also (1) provide services to a member in accordance with 130 CMR 450.109: Out-of-state Services; and (2) participate in the Medicaid program in its state. (130 CMR 438.405 through 438.407 Reserved)