Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 405.000 - Community Health Center Services › Section 405.405 - Certification

Current through Register 1525, July 5, 2024
(A)
Application
. An
			 application for certification as a CHC must be made on the form provided by the
			 MassHealth agency and must be submitted to the MassHealth agency's program
			 specialist for CHCs. Upon receipt of the completed application, the program
			 specialist or his or her designee may arrange for a site visit with the
			 applicant to determine compliance with
			 130 CMR
			 405.406 through
			 405.416,
			 and if the applicant offers one or more of the services described in
			 130 CMR
			 405.431 through
			 405.471,
			 compliance with the applicable portions of those sections. Based on the
			 information revealed by the application and the site visit, the MassHealth
			 agency will determine whether the applicant is certifiable, provisionally
			 certifiable, or not certifiable. The program specialist will promptly notify
			 the applicant of the determination in writing. If the applicant is not
			 certifiable, the notice will contain a statement of the reasons for that
			 determination.
(B)
Certification
. A determination of certifiability
			 indicates that the applicant has been found by the MassHealth agency to be in
			 compliance with
			 130 CMR
			 405.406 through
			 405.416
			 and, to the extent applicable, with
			 130 CMR
			 405.431 through
			 405.471.
			 Upon such determination of certifiability, the CHC may enter into a provider
			 contract with the MassHealth agency in accordance with 130 CMR 450.000:
Administrative and Billing Regulations
.
(C)
Provisional
			 Certification
. Provisional certification means that the MassHealth
			 agency has determined the applicant to be in compliance with
			 130 CMR
			 405.405(B), except for one
			 or more of the following:
			 130 CMR
			 405.408(F):
Nutrition Services
, 405.408(C):
Obstetrics/Gynecology
, 405.414:
Translation
			 Services
, or 405.415:
Emergency Backup Services
. If
			 an applicant has been provisionally certified, the letter of notification will
			 specify the certification requirements with which the applicant has failed to
			 comply and the schedule for achieving compliance. When requirements for full
			 certification have been met, the MassHealth agency will certify the CHC. Upon
			 notice of provisional certification, the CHC may enter into a provider contract
			 with the MassHealth agency in accordance with 130 CMR 450.000:
Administrative and Billing Regulations
, on the condition that
			 such provider contract, by its own terms, will expire upon the date fixed in
			 the letter of notification for full compliance.
(D)
Review of
			 Certification
.
(1) The MassHealth
			 agency's program specialist for CHCs has the right to review a certified or
			 provisionally certified provider's continued compliance with the conditions for
			 certification referred to in
			 130 CMR 405.405(A) through
			 (C) upon reasonable notice and at any
			 reasonable time during the hours of operation of the provider. The program
			 specialist has the right to revoke the certification or provisional
			 certification of a provider, subject to any applicable provisions of 130 CMR
			 450.000:
Administrative and Billing Regulations
, if such
			 review reveals that the provider has failed or ceased to meet such
			 conditions.
(2) Any changes in the
			 manager or professional services director or in the scope of services provided
			 by a CHC must be reported in writing to the MassHealth agency's program
			 specialist for CHCs. Any additions to the scope of services must be approved in
			 writing by the program specialist before they are payable by the MassHealth
			 agency. Elimination of services may result in review of the CHC by the
			 MassHealth agency to determine whether the CHC still meets the requirements for
			 certification set forth in
			 130 CMR
			 405.405.