130 CMR 408.404 - Provider Eligibility
(A) An organization
seeking to participate in MassHealth as an AFC provider must
(1) enter into a contract with the MassHealth
agency;
(2) maintain a business
office in Massachusetts and be duly authorized to conduct a business in
Massachusetts that delivers health and human services to elders or people with
disabilities. Such business offices must:
(a)
be available to members during regular, posted business hours;
(b) be physically accessible to members with
disabilities;
(c) have clear access
and space for storing of business records;
(d) have a sign visible from outside the
facility identifying the business name and hours that the business office is
open;
(e) have a publicly listed
business name, address, and local toll-free telephone number that is answered
by customer service staff during business hours and that has Telecommunication
Device for the Deaf/Teletype (TTY/TDD) transmission and reception capability;
provided, that during business hours, this number cannot be a pager, answering
service, voice message system, or cell phone; and
(f) maintain a 24-hour voice message
system;
(3) accept
MassHealth payments as payment in full for all AFC;
(4) establish, maintain, and comply with
written policies and procedures to comply with
130 CMR
408.000;
(5) agree to periodic inspections, by the
MassHealth agency or its designee, that assess the quality of member care and
ensure compliance with
130 CMR
408.000;
(6) agree to comply with all the provisions
of
130 CMR
408.000,
450.000:
Administrative and Billing Regulations, and all other
applicable MassHealth rules and regulations.
(7) participate in any AFC provider
orientation required by EOHHS;
(8)
meet all provider participation requirements described in
130 CMR
408.000 and
130 CMR 450.000:
Administrative and Billing Regulations;
(9) agree to pay AFC caregivers on a timely
basis for services provided at applicable compensation levels.
(10) be accredited by the National Committee
for Quality Assurance (NCQA), the Council on Accreditation (COA), the
Commission on Accreditation of Rehabilitation Facilities (CARF), or other
nationally recognized accreditation organizations determined acceptable by the
MassHealth agency. AFC providers must provide evidence of accreditation in
accordance with 130 CMR 408.404(A)(10) in the form and format as required by
the MassHealth agency; and
(11)
submit to the MassHealth agency or its designee a statement of fiscal soundness
attesting to the financial viability of the AFC provider supported by
documentation to demonstrate that the provider has adequate resources to
finance the provision of services in accordance with
130 CMR
408.000 in the form and format as required by the
MassHealth agency.
(B)
The MassHealth agency requires documentation from applicants seeking to become
AFC providers. All required application documentation must be submitted and
approved in order to participate as an AFC provider in MassHealth. All required
MassHealth application documentation will be specified by the MassHealth
agency.
Notes
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No prior version found.