130 CMR, § 417.404

Current through Register 1536, December 6, 2024
Section 417.404 - Provider Eligibility
(A)In State. In order to qualify for participation in MassHealth as an in state psychiatric day treatment program, a psychiatric day treatment program must be located in Massachusetts and:
(1) Operate under a valid clinic license to provide mental health services issued by the Massachusetts Department of Public Health;
(2) Be in operation at least five days a week and provide services to members at least six hours per day but fewer than 24 hours on each of those days; and
(3) Meet all provider participation requirements as specified in 130 CMR 417.400 and 450.000: Administrative and Billing Regulations.
(B)Out of State.
(1) To participate in MassHealth, an out-of-state psychiatric day treatment program must obtain a MassHealth provider number and meet the following criteria:
(a) the clinic in which the psychiatric day treatment program operates must be appropriately licensed as required by the state agency of that state under whose jurisdiction it operates;
(b) if the program is required by its own state's law to also be licensed or certified as a day treatment program, the program must be licensed or certified by the appropriate state agency under whose jurisdiction it operates;
(c) the program participates in its state's Medicaid Program or the equivalent of that program;
(d) the program has a rate established by its state's appropriate rate setting regulatory body.
(2) Out-of-state psychiatric day treatment services are covered only as provided in 130 CMR 450.109: Out-of-state Services.

130 CMR, § 417.404

Amended by Mass Register Issue 1383, eff. 1/25/2019.