The MassHealth agency does not pay an ADH provider

1. (A) for any portion of a day during which the member is receiving services provided by a Home Health Agency while the member is in attendance at the ADH program under 130 CMR 403.000: Home Health Agency that are duplicative of services covered under ADH;
2. (B) when the member is a resident or inpatient of a hospital, nursing facility, or intermediate care facility for the intellectually disabled; except on dates of admission and discharge;
3. (C) if the provider has not received prior authorization from the MassHealth agency or its designee;
4. (D) for any canceled program days or any time periods missed by a member for any reason; and
5. (E) for any portion of a day during which the member is absent from the site, unless the program documents that the member was receiving services from the program staff outside of the ADH program in a community setting.
6. (F) The MassHealth agency does not pay for ADH transportation for members on days where the member does not have an ADH service claim for ADH attendance that day.