Provider applicants applying or reapplying to become a MassHealth provider may be required to pay the state an application fee.
Federal law generally requires provider applicants for enrollment or reenrollment into a Medicaid program to pay a federal application fee. See 42 CFR 455.460 implementing Section 6401 of the Affordable Care Act (ACA).
About the Application Fee
- The application fee is $554 for calendar year 2016 (effective January 1, 2016). The fee may change from year to year based on adjustments to the Consumer Price Index for Urban Areas (CPI-U).
- The application fee applies to certain provider applicants who are enrolling or reenrolling, and to providers adding a new service location.
Providers who are required to pay the fee but enrolled in Medicare or another state’s Medicaid or CHIP program, and have paid the application to the Medicare contractor or the other state’s program, are exempt (see below: Payment and Documentation of the Application Fee).
- The fee is nonrefundable. If a provider applicant does not meet participatory requirements or does not submit the appropriate documentation required within time frames requested, the fee will not be refunded. Any subsequent submissions of an application for enrollment or reenrollment to MassHealth would require payment of a new application fee.
Payment and Documentation of the Application Fee
Provider types subject to the fee are:
- ICF-MR State Schools
- Acute In-Patient Hospitals
- Chronic In-Patient Hospitals
- Psychiatric In-Patient Hospitals
- Semi-Acute In-Patient Hospitals
- Skilled Nursing Facilities that do not participate in Medicare
All other providers are exempt from the fee.
Unless you are exempt or have an approved hardship request, MassHealth will not process your application until the application fee has been paid. To pay the application fee, provider applicants must use the secure payment site (linked below).
MassHealth does not accept paper checks. Please print a copy of your confirmation of payment and submit it with your application.
Payments Made to Medicare or Another State’s Medicaid Program
If you have previously paid the application fee to a Medicare contractor or another state’s Medicaid program, you must complete the Attestation of Application Fee Payment form and submit it with your application. To do so, click on the link below.
Request for Hardship Exception
If the provider applicant believes the application fee would be a significant financial hardship, a Hardship Exception Request form may be submitted. To do so, click on the link below.
MassHealth will review your hardship request. MassHealth has the authority to approve or deny your hardship request. If MassHealth approves your request, MassHealth will forward it to the Centers for Medicare & Medicaid Services (CMS) for review. CMS will notify MassHealth about the status of your request. MassHealth will notify you of CMS’s decision. Please note that MassHealth cannot process your enrollment application until the hardship request has been adjudicated.
If your hardship exception request is approved, MassHealth will process your provider application, and a final determination of your application will be sent to the doing business address listed on your application.
If MassHealth or CMS denies your request, you may not appeal this decision, and MassHealth cannot process your provider enrollment application until the application fee is paid.
If your hardship exception request has been denied, MassHealth will notify you and give you 10 business days to pay the application fee. If the application fee is not paid within 10 business days, your application will be denied. You may resubmit your application along with the application fee at any time.