1. (A) To participate in MassHealth, an out-of-state home health agency located within 50 miles of the Massachusetts border must

   1. (1) ensure that the agency and each participating branch is certified as a provider of home health services under the Medicare program;
   2. (2) participate in the Medicaid program in its state and meet all requirements within the Medicare Conditions of Participation for home health agency services;
   3. (3) provide home health services to a member who resides in a Massachusetts community near the border of the home health agency’s state;
   4. (4) obtain a MassHealth provider number before providing home health services; and
   5. (5) notify the MassHealth agency in writing within 14 days of any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract, including, but not limited to, change of ownership, change of address, change in status of Medicare Certification and/or reaccreditation, and additional home health agency branch office.

2. (B) To participate in MassHealth, an out-of-state home health agency located beyond 50 miles of the Massachusetts border must

   1. (1) be certified as a provider of home health services under the Medicare program by the Medicare-certifying agency in its state;
   2. (2) participate in the Medicaid program in its state;
   3. (3) obtain a MassHealth provider number before providing home health services;
   4. (4) provide services to a member in accordance with 130 CMR 450.109: Out-of-state Services;

   5. (5) notify the MassHealth agency in writing within 14 days of

      1. (a) any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract, including, but not limited to, change of ownership, change of address, change in status of Medicare Certification and/or reaccreditation, and additional home health agency participating branch office.

      2. (b) In addition, out-of-state providers also need to

         1. 1. accept MassHealth payments as payment in full for all home health services;
         2. 2. agree to comply with all the provisions of 130 CMR 403.000 and 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules and regulations; and
         3. 3. meet all provider participation requirements described in 130 CMR 403.000 and 450.000: Administrative and Billing Regulations.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-8

Provider Manual Series (130 CMR 403.000)

Transmittal Letter Date

Home Health Agency Manual

HHA-55 07/01/22