Staffing Requirements

(A) Rendering providers working within facilities may provide covered services. (B) Rendering providers must (1) be licensed, registered, certified, or otherwise appropriately credentialed or recognized practitioners under Massachusetts state scope of practice statutes; and (2) have the necessary experience and receive appropriate training, as applicable to a given carceral facility. (C) ORP providers must be enrolled in MassHealth, pursuant to 130 CMR 450.000 and regulations governing the ORP provider’s provider type. ORP providers may enroll in MassHealth as a non-billing provider as described in 130 CMR 450.212(E) or as a billing provider. (1) The following types of providers are ORP providers: certified nurse midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, dentist, licensed independent clinical social worker, optometrist, pharmacist (if authorized to prescribe), physician, physician assistant, podiatrist, psychiatric clinical nurse specialist, or psychologist. (2) Claims for services listed in 130 CMR 449.413(C)(2) require an order, referral, or prescription from a MassHealth-enrolled ORP provider. Claims for the following services listed in 130 CMR 449.413(C)(2)(a) through (q) that do not have an order, referral, or prescription from a MassHealth-enrolled ORP provider will be denied. (a) any service that requires a Primary Care Clinician referral (see 130 CMR 450.118(J)); (b) any service that requires a Primary Care ACO Participating Primary Care Provider referral (see 130 CMR 450.119(I)); (c) Adult Day Health; (d) Adult Foster Care; (e) Continuous Skilled Nursing; (f) Durable Medical Equipment; (g) Eyeglasses; (h) Group Adult Foster Care; (i) Home Health; (j) Independent Nurse; (k) Labs and Diagnostic Tests; (l) Medications; (m) Orthotics; (n) Oxygen/Respiratory Equipment; (o) Prosthetics; (p) Psychological Testing; and (q) Therapy (Physical, Occupational, or Speech and Language). (D) Case Manager Qualifications. The case manager must have, or work under the supervision of an individual with, at minimum, a bachelor’s degree in a related field or two years of professional or paraprofessional experience in human services, criminal justice, social work, social casework, guidance, vocational counseling, employment counseling, educational counseling or correctional facility work.