Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Adult Day Health Manual

ADH-26 07/27/18

4. Program Regulations

404.401: Statement of Purpose ............................................................................................... 4-1 404.402: Definitions ............................................................................................................... 4-1 404.403: Eligible Members .................................................................................................... 4-3 404.404: Provider Eligibility .................................................................................................. 4-4 404.405: Clinical Eligibility Criteria ....................................................................................... 4-4 404.406: Clinical Assessment and Prior Authorization .......................................................... 4-6

(130 CMR 404.407 through 404.409 Reserved) 404.410: ADH Administrative Reporting Requirements ....................................................... 4-8 404.411: Withdrawal by an ADH Provider from MassHealth ............................................... 4-8 404.412: Quality Management ............................................................................................... 4-9 404.413: Transportation Services ........................................................................................... 4-10 404.414: Conditions of Payment ............................................................................................ 4-11 404.415: Noncovered Days .................................................................................................... 4-13 404.416: Prohibited Marketing Activities .............................................................................. 4-13

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series (130 CMR 404.000)

Transmittal Letter Date

Adult Day Health Manual

ADH-26 07/27/18