Mass Senior Care is pleased to report that after months of advocacy, MassHealth today updated its nursing facility program regulations to streamline the Medicaid enrollment process and allow newly enrolling nursing facilities to begin billing and receiving payment for MassHealth services earlier than previously permitted. Under the previous Medicaid provider participation rule, facilities undergoing a change in ownership typically had to wait months to obtain Medicaid payment due to delays in CMS providing Medicare ‘tie-in’ certification notices, resulting in severe cash flow problems.
Specifically, the prior MassHealth regulation required newly enrolling facilities under a change of ownership to obtain a Medicare certification ‘tie in’ approval, prior to being able to bill for Medicaid services. Under MassHealth’s updated regulations, a newly enrolling nursing facility that has accepted assignment of the seller’s Medicare provider number may enter into a provider agreement with MassHealth under conditional enrollment. To be considered for conditional enrollment, newly enrolled facilities must complete the following additional steps:
- Completion of a fingerprint-based background check
- A site visit conducted and completed by Optum
The conditional enrollment will remain in effect for up to nine (9) months from the date of MassHealth approval and is contingent upon the facility obtaining Medicare certification within that period. Once MassHealth receives adequate documentation confirming Medicare certification – such as the Medicare Tie-In Notice, the facility’s status will be converted to full enrollment. If certification is not received within the nine-month conditional period, MassHealth payments will be suspended until the required documentation is submitted.