Section 455.404 - Provider EligibilityPayment 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.
(A)In-State. To participate in MassHealth, a UCC located in Massachusetts must (1) operate under a clinic license issued by the Massachusetts Department of Public Health pursuant to 105 CMR 140.000: Licensure of Clinics; and(2) have a signed provider contract with the MassHealth agency.(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) 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) the clinic must participate in its state's Medicaid program (or the equivalent); and(3) meet the conditions set forth in 130 CMR 450.109: Out-of-state Services.Adopted by Mass Register Issue 1461, eff. 1/21/2022.