Payment for the services described in 130 CMR 434.000 will be made only to the outpatient department of a psychiatric hospital participating in MassHealth on the date of service.

1. (A) In State. To participate in MassHealth, psychiatric inpatient hospitals located in Massachusetts must

   1. (1) operate under a psychiatric inpatient hospital license issued by the Massachusetts Department of Mental Health;
   2. (2) have a signed provider contract with the MassHealth agency that specifies the conditions of participation in MassHealth; and
   3. (3) participate in the Medicare program.

2. (B) Out of State. To participate in MassHealth, an out-of-state psychiatric inpatient hospital must obtain a MassHealth provider number and meet the following criteria:

   1. (1) operate under a hospital license from or be approved as a hospital by the governing or licensing agency in its state;
   2. (2) participate in the Medicare program; and
   3. (3) participate in that state's medical assistance program (or the equivalent).

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-4

Provider Manual Series (130 CMR 434.000)

Transmittal Letter Date

Psychiatric Outpatient Hospital Manual

POH-4 12/26/08