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130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406)

MassachusettsregulationMassachusetts Executive Office of Health and Human Services / MassHealth (Division of Medical Assistance); certification via Massachusetts Department of Public Health

What this rule requires your agency to do

  • 1The agency must notify MassHealth of significant changes within 14 days. (130 CMR 403.405(F))(130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406))
  • 2The agency must agree to periodic inspections by the MassHealth agency or its designee to assess the quality of member care and ensure compliance with 130 CMR 403.000. (130 CMR 403.405(C))(130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406))
  • 3An out-of-state agency must be certified as a provider of home health services under the Medicare program by the Medicare-certifying agency in its state and participate in that state's Medicaid program. (130 CMR 403.406(A)(1), (B)(1))(130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406))
  • 4The agency must be certified as a provider of home health services under the Medicare program by the Massachusetts Department of Public Health and meet all requirements within the Medicare Conditions of Participation for home health agency services. (130 CMR 403.405(A))(130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406))
  • 5The agency must obtain a MassHealth provider number before delivering services to MassHealth members. (130 CMR 403.405(B))(130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406))
  • 6The agency must participate in required provider orientation. (130 CMR 403.405(D))(130 CMR 403.000: Home Health Agency (MassHealth) - Provider Eligibility and Participation (130 CMR 403.405-403.406))

Applies to: home health / home care agencies serving MassHealth members (in-state and out-of-state)

Massachusetts has no standalone home-care/personal-care agency licensure statute in force (licensure legislation, e.g. S.2555/H.4306, was still pending as of 2025-2026). The operative primary regulation governing home health agency eligibility to participate is 130 CMR 403.000, which conditions MassHealth participation on Medicare certification by the Massachusetts Department of Public Health, obtaining a MassHealth provider number, and ongoing compliance/inspection obligations.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.