1. (A) The MassHealth agency provides coverage for certain individuals for a limited period of time, in accordance with 130 CMR 502.003(H): Hospital-determined Presumptive Eligibility if, on the basis of attested information, a qualified hospital determines that the individual is presumptively eligible. Coverage for members with time-limited presumptive eligibility begins on the date on which a qualified hospital makes a determination regarding presumptive eligibility and continues until

   1. (1) the end of the month following the month in which the hospital determined presumptive eligibility, if the individual has not submitted a complete application as described in 130 CMR 502.001: Application for Benefits by that date, or
   2. (2) an eligibility determination is made based upon the individual’s submission of a complete application as described in 130 CMR 502.001: Application for Benefits if the complete application was submitted prior to the end of the month following the month of the hospital presumptive eligibility determination.

2. (B) A qualified hospital, for purposes of 130 CMR 450.110, is a hospital that satisfies the following requirements, as more fully described in provider bulletins and other guidance that may be issued by the MassHealth agency:

   1. (1) participates as a MassHealth provider;
   2. (2) notifies the MassHealth agency of its election to make presumptive eligibility determinations;
   3. (3) agrees to make presumptive eligibility determinations consistent with MassHealth policies and procedures;
   4. (4) has Certified Application Counselors on site and available to assist individuals with the application process, including submitting the full application and understanding any documentation requirements; and
   5. (5) has not been disqualified from making presumptive eligibility determinations.

(130 CMR 450.111 Reserved)

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Introduction

1-21

Provider Manual Series (130 CMR 450.000)

Transmittal Letter Date

All Provider Manuals

ALL-224 12/18/17