Provider Enrollment Process

(A) A complete application for enrollment in the medical respite program must be submitted for each medical respite provider. The application submission must: (1) Identify all of the applicant’s proposed medical respite service locations; (2) Specify whether the applicant is also a CSP-HI provider or if it is partnering with a CSP- HI provider to meet the requirements of 130 CMR 458.404(D), and, if partnering, include the name(s) of the partnering CSP-HI provider and an attestation that the applicant will have an executed Memorandum of Understanding prior to initiating provision of medical respite services as required under 130 CMR 458.404(D); (3) Specify whether the applicant also employs a licensed medical provider for the provision of primary care services or if it is partnering with a licensed medical provider for the provision of primary care services to meet the requirements of 130 CMR 458.404(B), and, if partnering, include the name(s) of the partnering licensed medical provider and an attestation that the applicant will have an executed Memorandum of Understanding prior to initiating provision of medical respite services, as required under 130 CMR 458.404(B); (4) Include written permission to co-locate with a program funded by another state agency, as required under 130 CMR 458.404(E)(10), if any service location listed in the application meets the co-location conditions of 130 CMR 458.404(E)(10); and (5) Be accurate and complete, and submitted as directed by MassHealth. (B) The MassHealth agency may request additional information or perform a site inspection to evaluate the applicant’s compliance with all applicable MassHealth rules and regulations prior to enrollment. (C) Based on the information in the enrollment application, information known to the MassHealth agency about the applicant, and the findings from any site inspection deemed necessary, the MassHealth agency will determine whether the applicant is eligible for enrollment. In the event of an application listing multiple service locations, MassHealth will evaluate each identified service location for eligibility prior to enrollment. (D) The MassHealth agency will notify the applicant of its determination in writing. An application will not be considered complete until the applicant has responded to all MassHealth requests for additional information, and MassHealth has completed any site inspection it deems necessary. (E) If the MassHealth agency determines that the applicant or any of its service locations is not eligible for enrollment, the notice of determination will contain a statement of the reasons for that determination, such as incomplete application materials. (F) The enrollment is valid only for the entity and service location(s) specifically identified for enrollment in the notice of determination and is not transferable to other entities or other service locations or programs operated by the applicant. Any medical respite provider seeking to establish an additional service location that was not approved in the initial notice of determination must apply for the enrollment of the additional service location as directed by MassHealth, and MassHealth shall issue a new notice of determination with respect to the additional service location. In order to receive payment for services rendered at a particular service location, the service location must be specifically approved to render medical respite services in a written notice of determination.