Section 404.411 - Withdrawal by an ADH Provider from MassHealthAn ADH provider that intends to withdraw from MassHealth must satisfy all of the following obligations:
(A)MassHealth Notification.(1) An ADH provider electing to withdraw from participation in MassHealth must send written notice to the MassHealth agency or its designee, of the provider's intention to withdraw from the ADH program. The ADH provider must send the withdrawal notice by certified or registered mail (return receipt requested), to the MassHealth Adult Day Health Unit. The notice must be received by the MassHealth agency or its designee, no fewer than 90 days before the effective date of withdrawal.(2)Emergency Withdrawal. In the instance of alleged emergency withdrawal, the ADH provider must contact the MassHealth agency, or its designee, within one business day of the emergency withdrawal and follow-up, in writing, within the next three business days informing MassHealth, or its designee, of the reasoning for such emergency withdrawal, and must provide proof in documentation or other form as the MassHealth agency may require.(B)Notification to Member and Authorized Representatives. (1) The ADH provider must notify all members, authorized representatives of members, and other funding sources in writing of the intended closing date no fewer than 90 days from the intended closing date and specify the assistance to be provided to each member in identifying alternative services (see105 CMR 158.024(A): Voluntary Closure).(2) On the same date on which the ADH provider sends a withdrawal notice to the MassHealth agency, the provider must give notice, in hand, to all members to whom it is providing ADH services and the member's authorized representatives. The notice must advise that any member who is eligible for MassHealth on the effective date of the withdrawal must relocate to another ADH provider participating in MassHealth to ensure continuation of MassHealth payment of services and must be determined eligible to continue to receive the services. A copy of this notice must be forwarded to the MassHealth agency or its designee.(3) The notice must also state that the ADH provider will work promptly and diligently to arrange for the relocation of members to MassHealth-participating ADH providers or, if appropriate, alternative community-service providers.(C)Admission Requirements and Relocation Requirements.(1) An ADH provider must not admit any new MassHealth members after the date on which a withdrawal notice was sent to the MassHealth agency or its designee, and Provider Enrollment Center. Members of the ADH program, for whom prior authorization was sought prior to the withdrawal notice being sent, who are then authorized for ADH after the notice of withdrawal are not considered newly admitted members.(2) An ADH provider that withdraws from participation in MassHealth must assist members to whom it has been providing ADH services to identify and locate another ADH provider, and must continue to provide its current level of ADH until all members receiving ADH from the ADH provider have been admitted with a new ADH provider or another qualified MassHealth provider.(3) The ADH provider seeking to withdraw from MassHealth must work promptly and diligently to arrange for the relocation of members to MassHealth-participating ADH programs or other qualified MassHealth providers.(4) The ADH provider must forward a list of all members currently receiving services at the ADH program. The ADH provider must notify the MassHealth agency or its designee in writing as members are placed in other programs or begin to receive alternative services, including the name of the new program or service and the members' start date in the new program or service.Amended by Mass Register Issue 1370, eff. 7/27/2018.