CDR RFA Attachment B Additional Required Documents and Information.docx
DOCX document 25 KB Posted
- Attached to
- 23LCEHSCDRHOSPITALRFA: RY 2023 Chronic Disease and Rehabilitation Hospital Request for Applications
- Solicitation number
- BD-23-1039-EHS01-EHS01-79579
- Issued by
- Suffolk County, Massachusetts
About this file
This document is Attachment B from the Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) MassHealth Program's Request for Applications (RFA) for Chronic Disease and Rehabilitation Hospitals wishing to participate as MassHealth providers in Rate Year 2023. The attachment outlines additional required documents and information that applicant hospitals must provide, including proof of legal existence, ownership or operating status, and copies of current licenses issued by the Department of Public Health.
The RFA itself seeks applications from eligible, in-state Chronic Disease and Rehabilitation Hospitals to participate as MassHealth providers. The RFA does not specify any quantities, response dates, award dates, or contract term. Pricing terms, set-asides, funding details, and other salient information are not provided in the attached document.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 1 to RY23 Chronic Disease Rehab Hospitals RFA.docx | DOCX document | |
| APPENDIX 1 Payment Rates.docx | DOCX document | |
| CDR RFA Attachment D CDR Hospital Contract RY23.docx | DOCX document | |
| APPENDIX 3 Quality Performance Incentive and Supplemental Payments.doc | DOC document | |
| CDR RFA Attachment C Contractor Certification Form.docx | DOCX document | |
| CDR RFA Attachment A Application for Participation.docx | DOCX document | |
| Amendment 1 to CDR RFA ATTACHMENT D - CDR Hospital Contract RY23.docx | DOCX document | |
| APPENDIX 3 Quality Performance Incentive and Supplemental Payments RY24.docx | DOCX document | |
| APPENDIX 1 Payment Rates RY24.docx | DOCX document | |
| APPENDIX 2 Quality Improvement.doc | DOC document | |
| RY23 Chronic Disease Rehab Hospitals RFA - Rev 1.docx | DOCX document |
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Text version
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
MASSHEALTH PROGRAM CDR HOSPITAL RFA
ATTACHMENT B: Additional Required Documents and Information
1. Is the licensee of the applicant Hospital the operator of the Hospital facility?
yes ☐ no ☐ If not, the following information must be provided:
Name of Operator:
Address of Operator:
Telephone Number:
2. Is the licensee of the applicant Hospital the owner of the real estate that comprises the Hospital facility?
yes ☐ no ☐ If not, the following information must be provided:
Name of Landlord:
Address of Landlord:
Telephone Number:
3. If the licensee of the applicant Hospital is a not-for-profit corporation, it must provide:
a current original “Short Form Certificate of Legal Existence”, which Massachusetts corporations may obtain from:
Secretary of State’s Office Corporate Division One Ashburton Place - Room 1715 Boston, MA 02108
Note: Foreign (non-Massachusetts) not-for-profit corporations must submit equivalent documentation from the Secretary of State where incorporated, and a copy of the corporation’s Massachusetts Foreign Corporation Certificate.
4. If the licensee of the applicant Hospital is a for-profit corporation, it must provide:
a current original “Short Form Certificate of Legal Existence with Officers”, which Massachusetts corporations may obtain from the Secretary of State’s Office at the address listed above.
Note: Foreign (non-Massachusetts) for-profit corporations must submit equivalent documentation from the Secretary of State where incorporated, and a copy of the corporation’s Massachusetts Foreign Corporation Certificate.
5. If the licensee of the applicant Hospital is a corporation, it must submit a current original Clerk’s Certificate (1) certifying that the individual executing the contract on behalf of the licensee of the applicant Hospital has the authority and is authorized to do so; and (2) listing the names and titles of all current officers.
6. If the licensee of the applicant Hospital is not a corporation (e.g., limited partnership or trust), appropriate evidence of legal existence must be provided.
7. A copy of the applicant Hospital’s current license that was issued by the Department of Public Health must be attached.
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