Provider Eligibility: Notification of Potential Changes in Eligibility

(A) The provider must notify the MassHealth agency in writing, within 14 calendar days of receipt, of any written communication or electronic notification from an issuing federal or state agency, board, quasi-public board department (other than the MassHealth agency) or another state’s Medicaid program that expresses an intention, conditionally or otherwise, to alter, revoke, void, suspend, or deny the issuance, renewal, or extension of any license, certificate, or other statement of qualification that constitutes a provider eligibility criterion, or take any action of the nature set forth in 130 CMR 450.212(A)(6). (B) The provider must notify the MassHealth agency in writing, within 14 calendar days of sending to an issuing agency, of any communication that expresses an intention or desire to register as an inactive practitioner, resign, surrender, terminate, or substantially modify the conditions of any such license, certificate, or other statement of qualification that constitutes a provider eligibility criterion. (C) Without limiting the generality of 130 CMR 450.215(A), the provider must notify the MassHealth agency in accordance with 130 CMR 450.215(A) and (B) whenever the provider (1) has received notice of denial of Medicare or Medicaid certification from the Massachusetts Department of Public Health; (2) has received notice of a denial of an application for renewal of a license; (3) has filed application with the Department of Public Health to convert from nursing facility to rest home status; (4) has received an order to show cause from a board of registration; (5) becomes subject to any action of the nature set forth in 130 CMR 450.212(A)(6); or (6) has been terminated or suspended from participation in Medicare or another state’s Medicaid program.