A renal dialysis clinic must be a participant in MassHealth on the date of service in order to be eligible for payment.

1. (A) In-State Providers. To be eligible for participation as a MassHealth provider, a renal dialysis clinic must be:

   1. (1) located and doing business in the Commonwealth of Massachusetts;
   2. (2) enrolled as a Medicare provider; and
   3. (3) licensed as an out-of-hospital dialysis unit by the Massachusetts Department of Public Health, Bureau of Hospital Facilities.
2. (B) Out-of-State Providers. A provider that does not meet the requirements of 130 CMR 412.405(A)(1) and (3) may participate in and receive payment from MassHealth only if the provider is licensed in its own state as an out-of-hospital dialysis unit and meets the requirements of 130 CMR 412.405(A)(2) and 450.109.
3. (C) Multiple Facilities. When two or more renal dialysis clinics have the same director or owner, whether or not the clinics have different names, each clinic must enroll separately with MassHealth and have its own MassHealth provider number.

(412.406 and 412.407 Reserved)

Commonwealth of Massachusetts SUBCHAPTER NUMBER AND TITLE PAGE Division of Medical Assistance 4 PROGRAM REGULATIONS

4-2

Provider Manual Series (130 CMR 412.000)

TRANSMITTAL LETTER DATE

RENAL DIALYSIS CLINIC MANUAL

REN-9 12/15/01