Section 408.438 - Withdrawal by an Adult Foster Care Provider from MassHealthAn AFC provider that intends to withdraw from MassHealth must satisfy all of the following obligations.
(A)MassHealth Notification.(1) An AFC provider electing to withdraw from participation in MassHealth must send written notice to the MassHealth agency, or its designee, of the provider's intention to withdraw from the AFC program. The AFC provider must send the withdrawal notice by certified or registered mail (return receipt requested) to the MassHealth agency or its designee, no fewer than 90 days before the effective date of withdrawal.(2) In the instance of alleged emergency withdrawal, the AFC provider must contact the MassHealth agency, or its designee, within one business day of the emergency withdrawal and follow up in writing within three business days, informing the MassHealth agency or its designee of the reasoning for such emergency withdrawal, and must provide proof in documentation or other form as the MassHealth agency may require. The AFC provider must also notify all members and the MassHealth agency about the status of all members and any plans for relocation under 130 CMR 408.432.(3) The AFC provider must forward a list of all members currently receiving AFC. The AFC provider must notify the MassHealth agency in writing as members are placed in other programs or begin to receive alternative services, including the name of the new program or service and the members' start date in the new program or service.(B)Notification to Member and Authorized Representatives. (1) The AFC provider must notify all members, authorized representatives of members, and other funding sources in writing of the intended closing date no fewer than 90 days from the intended closing date and specify the assistance to be provided to each member in identifying alternative services.(2) On the same date on which the AFC provider sends a withdrawal notice to the MassHealth agency, the provider must give notice, in hand, to all members to whom it is providing AFC services and the member's authorized representatives, including those members who have been transferred to hospitals, or who are on medical or nonmedical leave of absence. The notice must advise that any member who is eligible for MassHealth on the effective date of the withdrawal must relocate to another AFC provider participating in MassHealth to ensure continuation of MassHealth payment of services and must be determined eligible to continue to receive the services. A copy of this notice must be forwarded to the MassHealth agency. The notice must also state that the AFC provider will work promptly and diligently to arrange for the relocation of members to MassHealth-participating AFC providers or, if appropriate, to alternative community-service providers.(C)Admission and Relocation Requirements. (1) An AFC provider must not admit any new MassHealth members after the date on which the withdrawal notice was sent to the MassHealth Provider Enrollment Center. Members of the AFC program, for whom prior authorization was sought prior to the withdrawal notice being sent, who are then authorized for AFC after the notice of withdrawal are not considered newly admitted members.(2) An AFC provider that withdraws from participation in MassHealth must assist members to whom it has been providing AFC services to identify and locate another AFC provider, and must continue to provide its current level of AFC services until all members receiving services from the AFC provider have been admitted with a new AFC provider or another qualified MassHealth provider.(3) An AFC provider seeking to withdraw from the MassHealth program will work promptly and diligently to arrange for the relocation of members to MassHealth-participating AFC or other qualified MassHealth providers. For relocation requirements, see130 CMR 408.432.Amended by Mass Register Issue 1338, eff. 5/5/2017.Amended by Mass Register Issue 1472, eff. 7/1/2022.Amended by Mass Register Issue 1520, eff. 4/26/2024.