Payment for the services described in 130 CMR 455.000 will be made only to providers of UCC services who are participating in MassHealth on the date of service.

1. (A) In State. To participate in MassHealth, a UCC located in Massachusetts must

   1. (1) operate under a clinic license issued by the Massachusetts Department of Public Health pursuant to 105 CMR 140.100 et seq.; and
   2. (2) have a signed provider contract with the MassHealth agency.

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

   1. (1) if the clinic is required by its own state's law to be licensed, the clinic must be licensed by the appropriate state agency under whose jurisdiction it operates;
   2. (2) the clinic must participate in its state’s Medicaid program (or the equivalent); and
   3. (3) meet the conditions set forth in 130 CMR 450.109: Out-of-state Services.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-3

Provider Manual Series (130 CMR 455.000)

Transmittal Letter Date

Urgent Care Clinic Manual

UCC-1 01/21/22