1. (A) Annual Report. Each Program of Assertive Community Treatment must submit a completed annual report, on forms furnished by the MassHealth agency, and file them with the MassHealth agency by September 30th of each year. The report must include, at minimum, the following:

   1. (1) a statement that the provider has reviewed and updated, as necessary, its written policies and procedures during the reporting period. Each provider must provide a copy of the provider’s written policies and procedures as requested by the MassHealth agency;
   2. (2) a list of all staff who meet the staff composition requirements as listed in 130 CMR 464.412, which includes the following information: staff name, license number, type of license, and board certification, if applicable, and a list of the clinical supervisor for any clinical staff who are unlicensed or not independently licensed;
   3. (3) a statement describing the role of the psychiatrist;
   4. (4) a statement describing the current language capacities, capacity to provide services to specialized populations, and utilization of evidence-based modalities in the delivery of PACT services;
   5. (5) written attestation that the provider complies with 130 CMR 464.000; and
   6. (6) any other information that the MassHealth agency may request.

2. (B) Staffing and Personnel Reports.

   1. (1) Each PACT provider must report to the MassHealth agency, within 30 days, any leadership or prescribing staffing changes to the roles identified in 130 CMR 464.412.
   2. (2) If any licensed staff member is sanctioned or disciplined by the Department of Public Health
   3. (DPH) or an out-of-state clinician’s relevant state licensing agency, or is sanctioned by the staff member's board of licensure, the provider must report the following to MassHealth within ten days of notification of the sanction or disciplinary action: the name of the individual, the individual's license number, a copy of the official notification of sanction or disciplinary action, and a statement about intended next steps by both the PACT provider and the staff member to address the sanction or disciplinary action.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-5

Provider Manual Series (130 CMR 464.000)

Transmittal Letter Date

Program of Assertive Community

Treatment Manual

PACT-1 11/1/2025

1. (C) Each PACT provider must report adverse incidents to the MassHealth agency within 24 hours of discovery of the incident or, if the incident occurs on a holiday or weekend, on the next business day, in a format specified by the MassHealth agency.
2. (D) Each PACT provider must inform the MassHealth agency within 15 days of any citation or loss of licensure or accreditation issued to the provider by another agency including, but not limited to, the Department of Mental Health or an out-of-state provider’s relevant state licensing agency, or any changes to or loss of Medicare participation and enrollment.
3. (E) Each PACT provider must comply with all reporting requirements that may pertain to the practice, facility, or staffing as directed by the MassHealth agency.