Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 408.000 - Adult Foster Care Services › Section 408.504 - GAFC Provider Eligibility

Current through Register 1525, July 5, 2024
(A) An organization
			 seeking to participate in MassHealth as a GAFC provider must:
(1) enter into a contract with the MassHealth
			 agency;
(2) maintain a business
			 office in Massachusetts and be duly authorized to conduct a business in
			 Massachusetts that delivers health and human services to elders or people with
			 disabilities. Such business offices must:
(a)
			 be available to members during regular, posted business hours;
(b) be physically accessible to members with
			 disabilities;
(c) have clear access
			 and space for storing of business records;
(d) have a sign visible from outside the
			 facility identifying the business name and hours that the business office is
			 open;
(e) have a publicly listed
			 business name, address and local toll-free telephone number that is answered by
			 a customer service staff during business hours and that has Telecommunication
			 Device for the Deaf/Teletype (TTY/TDD) transmission and reception capability;
			 provided, that during business hours, this number cannot be a pager, answering
			 service, voice message system, or cell phone; and
(f) maintain a 24-hour voice message
			 system;
(3) accept
			 MassHealth payments as payment in full for all GAFC services;
(4) establish, maintain, and comply with
			 written policies and procedures to comply with 130 CMR 408.000;
(5) agree to periodic inspections, by the
			 MassHealth agency or its designee, that assess the quality of member care and
			 ensure compliance with 130 CMR 408.000;
(6) agree to comply with all the provisions
			 of 130 CMR 408.000, 130 CMR 450.000:
Administrative and Billing
			 Regulations
, and all other applicable MassHealth rules and
			 regulations.
(7) participate in any
			 GAFC provider orientation required by EOHHS;
(8) meet all provider participation
			 requirements described in 130 CMR 408.000 and 130 CMR 450.000:
Administrative and Billing Regulations
; and
(9) be certified as an assisted living
			 residence pursuant to 651 CMR 12.00:
Certification Procedures and
			 Standards for Assisted Living Residences
and provide GAFC only to
			 members who reside at such residence or be accredited by the National Committee
			 for Quality Assurance (NCQA), the Council on Accreditation (COA), the
			 Commission on Accreditation of Rehabilitation Facilities (CARF), or other
			 nationally recognized accreditation organizations determined acceptable by the
			 MassHealth agency. GAFC providers must provide evidence of such certification
			 or accreditation in accordance with
			 130
			 CMR 408.504(A)(9) in the
			 form and format as required by the MassHealth agency; and
(10) submit to the MassHealth agency or its
			 designee a statement of fiscal soundness attesting to the financial viability
			 of the GAFC provider supported by documentation to demonstrate that the
			 provider has adequate resources to finance the provision of services in
			 accordance with
			 130
			 CMR 408.504(A)(9) in the
			 form and format as required by the MassHealth agency.