Section 415.404 - Provider EligibilityPayment for the services described in 130 CMR 415.000 is made only to acute inpatient hospitals participating in MassHealth as of the date of service.
(A)In-state. To participate in MassHealth, an acute inpatient hospital located in Massachusetts must (1) be licensed as a hospital by the Massachusetts Department of Public Health;(2) have a signed provider agreement that specifies a payment methodology with the MassHealth agency; and(3) participate in the Medicare program.(B)Out-of-state. (1) Out-of-state acute inpatient hospital services are covered only as provided in 130 CMR 450.109: Out-of-state Services.(2) To participate in the MassHealth, an out-of-state acute inpatient hospital must obtain a MassHealth provider number and meet the following criteria: (a) be approved as an acute inpatient hospital by the governing or licensing agency in its state;(b) participate in the Medicare program; and(c) participate in that state's Medicaid Program (or equivalent).Amended by Mass Register Issue 1270, eff. 9/26/2014.Amended by Mass Register Issue S1277, eff. 1/2/2015.