1. (A) In State. Each program is eligible to participate only if the program is:

   1. (1) for provider types eligible for such enrollment, enrolled as a Medicare provider;
   2. (2) licensed or approved by the Massachusetts Department of Public Health to provide the appropriate substance use disorder treatment service pursuant to 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs and as defined in 130 CMR 418.404 (A);
   3. (3) enrolled and actively participating with the MassHealth agency as a billing provider, as evidenced by the issuance of a Provider Identification and Service Location (PIDSL) number for the provision of substance use disorder treatment services at that location.

2. (B) Out of State. Each out-of-state program is eligible to participate only if the program:

   1. (1) meets the following criteria:

      1. (a) is licensed by the appropriate state agency under whose jurisdiction it operates to provide equivalent substance use disorder services;

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-9

Provider Manual Series (130 CMR 418.000)

Transmittal Letter Date

Substance Use Disorder Treatment

Manual SUD-24 03/28/2025

1. (b) participates in its own state's medical assistance program or its equivalent; and
2. (c) has a rate of reimbursement established by the appropriate rate setting regulatory body of its state.
3. (2) for provider types eligible for such enrollment, is a Medicare-participating provider; and
4. (3) is enrolled and actively participating with the MassHealth agency as a provider of substance use disorder services, and obtains a MassHealth PIDSL number.