reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 343.00 - Rates for Hospice Services › Section 343.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 343.00 governs the rates of payment used by all
			 governmental units to eligible providers for hospice services provided to
			 publicly aided individuals. The rates set forth in
			 101 CMR
			 343.00 also apply to individuals covered by M.G.L. c.
			 152 (the Workers' Compensation Act).
(2)
Applicable Dates of
			 Service
. Rates in
			 101 CMR
			 343.00 apply for dates of service provided on or after
			 October 1, 2021, unless otherwise indicated.
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 343.00 is not authorization for or approval of the
			 services for which rates are determined pursuant to
			 101 CMR
			 343.00. Governmental units that purchase care are
			 responsible for the definition, authorization, and approval of care and
			 services extended to publicly aided clients.
(4)
Coding Updates and
			 Corrections
. EOHHS may publish service code updates and
			 corrections in the form of an administrative bulletin. The publication of such
			 updates and corrections will list:
(a) codes
			 for which the code numbers only changed, with a corresponding
			 crosswalk;
(b) codes for which the
			 code remains the same, but the description has changed;
(c) deleted codes for which there is no
			 crosswalk; and
(d) new codes that
			 require new pricing. For such new codes, EOHHS applies individual consideration
			 in reimbursement until appropriate rates can be developed.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 343.00 - Rates for Hospice Services › Section 343.03 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Cost Reporting
. Providers must satisfy the applicable
			 filing and reporting requirements of
			 957
			 CMR 6.00:
Cost Reporting
			 Requirements
.
(2)
Penalty for Noncompliance
. The purchasing governmental
			 unit may reduce the payment rates by 15% for any provider that fails to submit
			 required information to the Center. The purchasing governmental unit will
			 notify the provider in advance of its intention to impose a rate
			 reduction.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 343.00 - Rates for Hospice Services › Section 343.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				343.00 are hereby declared to be severable. If any
				such provisions or the application of such provisions to any eligible provider
				or circumstances shall be held invalid or unconstitutional, such invalidity
				shall not be construed to affect the validity or constitutionality of any
				remaining provisions of
				101 CMR
				343.00 or the application of such provisions to
				eligible providers or circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 345.00 - Rates for Temporary Nursing Services › Section 345.01 - General Purpose

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR 345.00 governs the
			 rates paid by health-care providers to temporary nursing agencies registered
			 with the Department of Public Health.
(2)
Applicable Dates of
			 Service
. The rates contained in
			 101 CMR 345.00 apply for
			 dates of service provided on or after October 1, 2021.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 345.00 - Rates for Temporary Nursing Services › Section 345.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
General
. All prices are per hour. An agency's price
			 for a service provided to a nursing facility or hospital may not exceed the
			 maximum price set forth in 101 CMR 345.03(2) or (3). Rates vary by health
			 service area (HSA). The location of the nursing facility or hospital determines
			 the maximum price that may be charged.
(a)
Holidays
. Rates for holidays may not exceed 150% of
			 the maximum prices set forth in 101 CMR 345.03(2) or (3). An agency and the
			 purchasing nursing facility or hospital may define the specific times for each
			 shift and the days that constitute holidays in the written agreement for
			 services as required by
			 105 CMR
			 157.220:
Written
			 Agreements
.
(b)
Overtime
. An agency and a nursing facility or hospital
			 may agree to an overtime differential to be added to a maximum service price to
			 compensate an employee for overtime hours worked.
(c)
Exemptions
.
			 Fixed-term employees are not subject to the maximum prices set forth in 101 CMR
			 345.03.
(d)
12-hour
			 Shift
. An agency and a nursing facility or hospital may agree to a
			 single price per hour for services provided during a 12-hour shift. The price
			 per hour cannot exceed the weighted average of the combined maximum prices for
			 the applicable shifts as set forth in 101 CMR 345.03(2) or (3). For example, an
			 RN in HSA 1 providing weekday services at a nursing facility from 7:00 A.M. to
			 7:00 P.M. could be billed at a single rate of $72.45, using eight hours at
			 $71.03 and four hours at $75.29. (Example calculation: 8 x $71.03 + 4 x $75.29
			 = $869.40. $869.40/12 = $72.45.)
(e)
Travel Nurse
			 Factor
. For temporary nursing services provided at nursing
			 facilities or hospitals that are performed by travel nurse employees, agencies
			 may charge, and nursing facilities and hospitals may purchase, temporary
			 nursing services performed by such travel nurse employees at a factor of 19.7%
			 above the rate limits established in 101 CMR 345.03.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 345.00 - Rates for Temporary Nursing Services › Section 345.04 - General Rate Provisions

Current through Register 1525, July 5, 2024
(1) The rates
			 determined in accordance with
			 101 CMR 345.00 are full
			 compensation for temporary nursing services rendered to a nursing facility or
			 hospital, including any related administrative or supervising duties provided
			 by the agency in connection with patient care.
(2) An agency may charge a nursing facility
			 or hospital less than the rate determined by
			 101 CMR 345.00.
(3) An agency may not bill, receive payments,
			 or propose to do business with a nursing facility or hospital at a rate greater
			 than the rate established by EOHHS, and such acts constitute an unfair or
			 deceptive act or practice in violation of M.G.L. c. 93A. If an agency violates
			 this requirement, EOHHS or the nursing facility or hospital may
(a) notify the Department, which may seek to
			 suspend or revoke the agency's registration, or take other action as
			 appropriate, in accordance with the provisions of
			 105 CMR 157.000:
The Registration and Operation of Temporary Nursing Service
			 Agencies
; or
(b) request
			 that the Attorney General bring an action against the agency pursuant to its
			 enforcement of M.G.L. c. 93A or take further action to restrain or prevent the
			 agency from operating.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 345.00 - Rates for Temporary Nursing Services › Section 345.05 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Temporary Nursing Service Cost Report
. Each agency
			 must complete and file a Temporary Nursing Service Cost Report with EOHHS or
			 its designee each calendar year.
(a) EOHHS
			 will issue an administrative bulletin to inform providers of the issuance of
			 the cost report and the due date for filing the cost report. The cost report
			 will be issued at least 45 days prior to the due date.
(b) Agencies that employ only fixed-term
			 employees are not required to file a Temporary Nursing Service Cost Report.
			 Such agencies must file a certified or audited financial statement with EOHHS
			 or its designee annually, due no later than the required due date of the
			 Temporary Nursing Service Cost Report.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 345.00 - Rates for Temporary Nursing Services › Section 345.06 - Transfer of Ownership

Current through Register 1525, July 5, 2024
All issues related to the transfers of ownership including, but
				not limited to, merger, acquisition, or name change, are governed by the
				Department regulations set forth in
				105 CMR 157.000:
The Registration and Operation of Temporary Nursing Service
				Agencies
.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 345.00 - Rates for Temporary Nursing Services › Section 345.07 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 345.00 are
				severable. If any such provisions or the application of such provisions to any
				eligible provider or circumstances are held invalid or unconstitutional, such
				invalidity will not be construed to affect the validity or constitutionality of
				any remaining provisions of
				101 CMR 345.00 or the
				application of such provisions to eligible providers or circumstances other
				than those held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 346.00 - Rates for Certain Substance-related and Addictive Disorders Programs › Section 346.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 346.00 governs the payment rates for
			 certain substance-related and addictive disorders services purchased by a
			 governmental unit. The rates for health care services set forth in 101 CMR
			 346.00 also apply to individuals covered by the Workers' Compensation Act,
			 M.G.L. c. 152.
(2)
Applicable Dates of Service
. Rates contained in 101
			 CMR 346.00 apply for dates of service provided on or after January 1,
			 2024.
(3)
Disclaimer of
			 Authorization of Services
. 101 CMR 346.00 is neither authorization
			 for nor approval of the services for which rates are determined pursuant to 101
			 CMR 346.00. Governmental units that purchase the services described in 101 CMR
			 346.00 are responsible for the definition, authorization, and approval of
			 services extended to clients.
(4)
Coding Updates and Corrections
. EOHHS may publish
			 procedure code updates and corrections in the form of an administrative
			 bulletin. The publication of such updates and corrections will list
(a) codes for which only the code numbers
			 change, with the corresponding cross references between existing and new
			 codes;
(b) deleted codes for which
			 there are no corresponding new codes; and
(c) codes for entirely new services that
			 require pricing. EOHHS will list these codes and apply individual consideration
			 (I.C.) reimbursement for these codes until appropriate rates can be
			 developed.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 346.00 - Rates for Certain Substance-related and Addictive Disorders Programs › Section 346.03 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Reporting for Annual Review
. Unless exempted in
			 101
			 CMR 346.03, each operating agency must, on or
			 before the 15th day of the fifth month after the end
			 of its fiscal year, submit to EOHHS
(a) a
			 copy of its Uniform Financial Statements and Independent Auditor's Report
			 completed in accordance with the filing requirements of the Operational
			 Services Division, Executive Office for Administration and Finance;
			 and
(b) a supplemental program
			 questionnaire, if requested by EOHHS.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 346.00 - Rates for Certain Substance-related and Addictive Disorders Programs › Section 346.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 346.00 are severable. If any
				provision of 101 CMR 346.00 or application of any provision to an applicable
				individual, entity, or circumstance is held invalid or unconstitutional, that
				holding will not be construed to affect the validity or constitutionality of
				any remaining provisions of 101 CMR 346.00 or application of those provisions
				to applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 347.00 - Rates for Freestanding Ambulatory Surgery Center Services › Section 347.03 - General Rate Provisions and Payment

Current through Register 1525, July 5, 2024
(1)
Rate Determination
. Rates of payment for authorized
			 FASC services to which
			 101 CMR
			 347.00 applies are the lowest of
(a) the eligible provider's usual fee to the
			 general public;
(b) the eligible
			 provider's actual charge submitted; and
(c) the schedule of allowable rates set forth
			 in 101 CMR
			 347.03(6).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 347.00 - Rates for Freestanding Ambulatory Surgery Center Services › Section 347.04 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Reporting requirements are governed
			 by 957 CMR
			 6.00:
Cost Reporting
			 Requirements
.
(2)
Penalty for Noncompliance
. A purchasing governmental
			 unit may impose a penalty in the amount of up to 15% of its payments to any
			 provider that fails to submit required information. The purchasing governmental
			 unit will notify the provider in advance of its intention to impose a penalty
			 under
			 101
			 CMR 347.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 347.00 - Rates for Freestanding Ambulatory Surgery Center Services › Section 347.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				347.00 are severable, and if any provision of
				101 CMR
				347.00 or application of such provision to any FASC or
				any circumstances are held to be invalid or unconstitutional, such invalidity
				will not be construed to affect the validity or constitutionality of any
				remaining provisions to eligible FASCs or circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 348.00 - Rates for Day Habilitation Services › Section 348.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope, Purpose, and Effective Date
. 101 CMR 348.00
			 governs the payment rates for day habilitation services rendered to publicly
			 aided individuals. The rates set forth in 101 CMR 348.00 also apply to day
			 habilitation services governed by 130 CMR 419.000:
Day Habilitation
			 Center Services
and other comparable programs.
(2)
Applicable Dates of
			 Service
. Rates contained in 101 CMR 348.00 are effective for dates
			 of service on and after January 19, 2024, unless otherwise indicated.
(3)
Coverage
. The
			 payment rates in 101 CMR 348.00 are full compensation for day habilitation
			 services provided to publicly aided individuals as well as for any related
			 administrative or supervisory duties rendered in connection with the provision
			 of day habilitation services.
(4)
Coding Updates and Corrections
. EOHHS may publish
			 procedure code updates and corrections in the form of an Administrative
			 Bulletin. The publication of such updates and corrections will list:
(a) codes for which only the code numbers
			 change, with the corresponding cross references between existing and new
			 codes;
(b) codes for which the code
			 number remains the same but the description has changed; and
(c) deleted codes for which there are no
			 corresponding new codes.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 348.00 - Rates for Day Habilitation Services › Section 348.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rate
			 as Full Payment
. Each eligible provider must, as a condition of
			 receipt of payment from one or more purchasing governmental units for services
			 rendered, accept the approved rates as full payment and discharge of all
			 obligations for the services rendered, subject only to appellate rights as set
			 forth in M.G.L. 118E. There will be no duplication or supplementation of
			 payment from sources other than those expressly recognized or anticipated in
			 the computation of the rate. Any client resources or third-party payments
			 received on behalf of a publicly assisted client will reduce, by that amount,
			 the amount of the purchasing governmental unit's obligation for services
			 rendered to the publicly assisted client.
(2)
Approved Day Habilitation
			 Program Rates
. For services provided in day habilitation programs
			 in the community, the approved rates include payment for all care and services
			 that are customarily part of the program of services of an eligible provider,
			 subject only to the terms of the purchase agreement between the eligible
			 provider and the purchasing governmental unit(s). The rate of payment for
			 authorized services is the lower of the established charge or the rate listed
			 in 101 CMR
			 348.03(5).
(3)
Day Habilitation Services in
			 Nursing Facilities
. Certain residents of nursing facilities who
			 qualify for day habilitation services may be unable to participate in these
			 services in community settings. These individuals may qualify for day
			 habilitation services to be provided at the nursing facility in which they
			 reside. In order to be eligible for these nursing facility services, the
			 individual must meet criteria established by the MassHealth agency. The
			 approved rates cover all care and services associated with the provision of day
			 habilitation services in a nursing facility.
(a)
Serving One, Two, or Three
			 Individuals in a Nursing Facility
. In situations where no more
			 than three residents receive day habilitation services in the nursing facility,
			 the rates do not vary by client need. The rates of payment for authorized
			 services, including transportation, must be the lower of the established charge
			 or the rate listed in
			 101
			 CMR 348.03(5).
(b)
Serving Four or More
			 Individuals in a Nursing Facility
. For a staffing level of one to
			 four or more, refer to approved community day habilitation program rates, along
			 with the transportation rate listed in
			 101
			 CMR 348.03(5). A maximum of
			 two transportation units can be billed for at most one person for any given
			 nursing facility visit, in accordance with purchasers'
			 specifications.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 348.00 - Rates for Day Habilitation Services › Section 348.04 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Reporting requirements are governed
			 by 957 CMR 6.00:
Cost Reporting Requirements
.
(2)
Penalty for
			 Noncompliance
. The purchasing governmental unit may impose a
			 penalty in the amount of up to 15% of its payments to any provider that fails
			 to submit required information. The purchasing governmental unit will notify
			 the provider in advance of its intention to impose a penalty under
			 101
			 CMR 348.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 348.00 - Rates for Day Habilitation Services › Section 348.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 348.00 are severable. If any
				provision of 101 CMR 348.00 or application of any provision to any applicable
				individual, entity, or circumstance is held invalid or unconstitutional, that
				holding will not be construed to affect the validity or constitutionality of
				any remaining provisions of 101 CMR 348.00 or application of those provisions
				to applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 349.00 - Rates For Early Intervention Program Services › Section 349.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 349.00 governs rates of payment to be
			 used by all governmental units making payment to eligible providers for Early
			 Intervention program services to publicly assisted clients. 101 CMR 349.00 does
			 not govern the rates for specialty services, which are governed by 101 CMR
			 358.00:
Rates of Payment for Applied Behavior
			 Analysis
.
(2)
Applicable Dates of Service
. Rates contained in 101
			 CMR 349.00 apply for dates of service provided on or after the dates as listed
			 in 101 CMR
			 349.04(3).
(3)
Disclaimer of Authorization
			 of Services
. 101 CMR 349.00 is not authorization for or approval
			 of the substantive services for which rates are determined pursuant to 101 CMR
			 349.00. The Department of Public Health, which is designated as the lead
			 agency, is responsible for the definition, authorization, and approval of
			 services extended to publicly assisted clients by eligible providers.
(4)
Administrative
			 Bulletins
. EOHHS may issue administrative bulletins to clarify its
			 policy on substantive provisions of 101 CMR 349.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 349.00 - Rates For Early Intervention Program Services › Section 349.03 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Reporting for Annual Review
. Unless exempted, each
			 operating agency must, on or before the 15th day of
			 the fifth month after the end of its fiscal year, file a
(a) Uniform Financial Statements and
			 Independent Auditor's Report completed in accordance with the filing
			 requirements of the Operational Services Division, Executive Office for
			 Administration and Finance; and
(b)
			 supplemental program questionnaire or any other data collection form if
			 requested by EOHHS.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 349.00 - Rates For Early Intervention Program Services › Section 349.04 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Services Included in the Rate
. The approved rates
			 include payment for all care and services that are or have been customarily
			 part of the Early Intervention program of the eligible provider, including
			 necessary administration, supervision, travel, transportation, and support
			 services, subject only to the terms of the purchase agreement between the
			 eligible provider and the purchasing governmental units.
(2)
Payment Terms
.
(a)
Reimbursement as Full
			 Payment
. Each eligible provider must, as a condition of acceptance
			 of payment made by one or more purchasing governmental units for services
			 rendered, accept the approved program rates as full payment and discharge of
			 all obligations for the services rendered, subject only to appellate rights as
			 set forth in M.G.L. c. 118E. There must be no duplication of or supplemental
			 payment in excess of the approved program rates from sources other than those
			 expressly recognized or anticipated in the computation of the rates. Any client
			 resources not expressly recognized or anticipated in the computation of the
			 rate will reduce, by that amount, the purchasing governmental unit's obligation
			 for services rendered to the publicly assisted client.
(b)
Payment
			 Limitations
. Except as provided in
			 101
			 CMR 349.03(3),
			 349.04(2)(a),
			 and 349.04(3),
			 no purchasing governmental unit may pay less than, or more than, the approved
			 program rate.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 349.00 - Rates For Early Intervention Program Services › Section 349.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 349.00 are severable. If any
				provision of 101 CMR 349.00 or application of such provision to any applicable
				individual, entity, or circumstance is held invalid or unconstitutional, that
				holding will not be construed to affect the validity or constitutionality of
				any remaining provisions of 101 CMR 349.00, or application of those provisions
				to applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 350.00 - Rates for Home Health Services › Section 350.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR
			 350.00 establishes rates of payment for home health
			 services described in
			 130 CMR
			 403.000:
Home Health Agency
that are
			 provided by eligible providers to publicly aided individuals. The rates set
			 forth in
			 101 CMR
			 350.00 also apply to individuals covered by M.G.L. c.
			 152 (the Workers' Compensation Act). For rates applicable to continuous skilled
			 nursing services provided by a home health agency or an independent nurse to
			 publicly aided individuals,
see
101 CMR
			 361.00:
Rates for Continuous Skilled Nursing
			 Services
.
(2)
Applicable Dates of Service
. Rates contained in
			 101 CMR
			 350.00 apply for dates of service provided on or after
			 July 1, 2023.
(3)
Coverage
. The allowable fees established pursuant to
			 101 CMR
			 350.00 for services provided to publicly aided
			 individuals apply to all home health services, as defined in
			 101
			 CMR 350.02, regardless of the type of program
			 under which MassHealth is purchasing the services. The allowable fees are full
			 compensation for the home health services rendered, including but not limited
			 to administrative or supervisory duties and costs in connection with service
			 provision.
(4)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy on substantive provisions of
			 101 CMR
			 350.00 and to specify the information and
			 documentation necessary to implement
			 101 CMR
			 350.00.
(5)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 350.00 is not authorization for or approval of the
			 substantive services, or lengths of time, for which rates are paid pursuant to
			 101 CMR
			 350.00. Governmental units or workers compensation
			 insurers that purchase services from eligible providers are responsible to
			 define, authorize, and approve the services extended to covered individuals and
			 the length of time for which the approval is applicable.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 350.00 - Rates for Home Health Services › Section 350.03 - General Rate Provisions

Current through Register 1525, July 5, 2024
Rates of payment for authorized home health services to which
				101 CMR
				350.00 applies will be the lower of
(a) the eligible provider's usual fee to
			 patients other than publicly aided patients; or
(b) the schedule of rates set forth in
			 101
			 CMR 350.04.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 350.00 - Rates for Home Health Services › Section 350.04 - Rates of Payment for Home Health Services in the Home

Current through Register 1525, July 5, 2024
For dates of service on or after July 1, 2023, the base rate
				for home health services is the lower of the established charge or the rate
				listed in
				101
				CMR 350.04(1).
Code
Rate
Unit
Service
G0299
$107.88
Per Visit
Services of an RN in home health setting (one through
							 30 calendar days)
G0300
$107.88
Per Visit
Services of an LPN in home health setting (one
							 through 30 calendar days)
G0299 UD
$87.43
Per Visit
Services of an RN in home health setting (31+
							 calendar days)
G0300 UD
$87.43
Per Visit
Services of an LPN in home health setting (31+
							 calendar days)
T1502
$71.52
Per Visit
Administration of oral, intramuscular, and/or
							 subcutaneous medication by health care agency/professional per visit (RN or
							 LPN) (Use only for medication administration visit.)
T1503
$71.52
Per Visit
Administration of medication other than oral,
							 intramuscular, and/or subcutaneous medication by health care
							 agency/professional per visit (RN or LPN) (Use only for medication
							 administration visit.)
99058
$28.99
Per Visit
Office services provided on an emergency
							 basis
G0151
$94.05
Per Visit
Services of physical therapist in the home health
							 setting
G0152
$97.06
Per Visit
Services of occupational therapist in the home health
							 setting
G0153
$99.55
Per Visit
Services of speech/language therapist in the home
							 health setting
G0156
$10.18
Per 15 Minutes
Services of home health aide in the home health
							 setting
G0156 UD
$10.18
Per 15 Minutes
Services of home health aide in the home health
							 setting for ADL support
G0493
$107.88
Per Visit
Services of an RN for the observation and assessment
							 of the patient's condition provided every 60 days to members utilizing home
							 health aide services for ADL support
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 350.00 - Rates for Home Health Services › Section 350.05 - Administrative Adjustment

Current through Register 1525, July 5, 2024
(1) A certified
			 home health agency may apply for a change in rate(s) of payment due to costs
			 associated with providing interpreter and security/escort services as defined
			 in 101 CMR 350.02.
(2) Administrative adjustment may be provided
			 on a prospective basis only.
(3)
			 Administrative relief will consist of an adjustment to the rate calculated by
			 dividing the costs from the most recently filed and reviewed cost report by the
			 number of service units reported for that corresponding period. The costs
			 allowed will be limited to reasonable costs as defined in
			 101
			 CMR 350.02.
(4) An administrative adjustment that an
			 agency was awarded in a prior period may be updated by EOHHS using data from
			 the most recent Cost Report filed pursuant to
			 101
			 CMR 350.06.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 350.00 - Rates for Home Health Services › Section 350.06 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Reporting requirements are governed
			 by 957 CMR
			 6.00:
Cost Reporting
			 Requirements
.
(2)
Penalty for Noncompliance
. The purchasing governmental
			 unit may impose a penalty in the amount of up to 15% of its payments to any
			 provider that fails to submit required information. The purchasing governmental
			 unit will notify the provider in advance of its intention to impose a penalty
			 under
			 101
			 CMR 350.06(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 350.00 - Rates for Home Health Services › Section 350.07 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				350.00 are severable. If any provision of
				101 CMR
				350.00 or application of any provision to an
				applicable individual, entity, or circumstance is held invalid or
				unconstitutional, that holding will not be construed to affect the validity or
				constitutionality of any remaining provisions of
				101 CMR
				350.00 or application of those provisions to
				applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 351.00 - Rates for Certain Adult Foster Care Services › Section 351.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 351.00 governs the MassHealth payment rates for adult
			 foster care services and group adult foster care services described in
			 130 CMR
			 408.000:
Adult Foster Care
that are
			 provided by participating providers to eligible publicly aided
			 individuals.
(2)
Applicable Dates of Service
. The rates contained in
			 101 CMR
			 351.00 apply for dates of service provided on or after
			 July 1, 2023.
(3)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify provisions of
			 101 CMR
			 351.00.
(4)
Coding Updates and
			 Corrections
. EOHHS may publish procedure code updates and
			 corrections in the form of an administrative bulletin if the coding system
			 adds, deletes, or changes relevant codes.
(5)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 351.00 is neither authorization for nor approval of
			 the services for which rates are determined pursuant to
			 101 CMR
			 351.00. Governmental units that purchase services
			 described in
			 101 CMR
			 351.00 are responsible for the definition,
			 authorization, and approval of services provided to publicly aided
			 individuals.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 351.00 - Rates for Certain Adult Foster Care Services › Section 351.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Reimbursement as Full Payment
. The payment rates in
			 101 CMR
			 351.00 are full compensation for all adult foster care
			 services or group adult foster care services rendered to members, including any
			 related administrative or supervisory duties in connection with the provision
			 of AFC services or GAFC services outlined in
			 130 CMR
			 408.000:
Adult Foster Care
.
(2)
Payment Rates
.
			 The rates for AFC services, including GAFC services, are set forth in
			 101
			 CMR 351.03(2).
Service
							 Code-Modifier
Rate
Unit
Service
							 Description
S5140
$54.37
Per Diem
AFC Level I
S5140-TG
$91.31
Per Diem
AFC Level II
S5140-TF
$54.37
Per Diem
AFC Level I Alternative Caregiver Day
S5140-U5
$91.31
Per Diem
AFC Level II Alternative Caregiver Day
S5140-U6
$54.37
Per Diem
AFC Level I MLOA Day
S5140-TG-U6
$91.31
Per Diem
AFC Level II MLOA Day
S5140-U7
$54.37
Per Diem
AFC Level I NMLOA Day
S5140-TG-U7
$91.31
Per Diem
AFC Level II NMLOA Day
T1028
$266.62
Per Admission
AFC Intake and Assessment Services
H0043
$43.53
Per Diem
GAFC
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 351.00 - Rates for Certain Adult Foster Care Services › Section 351.04 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Reporting requirements are governed
			 by 957 CMR
			 6.00
: Cost Reporting
			 Requirements
.
(2)
Penalty for Noncompliance
. A purchasing governmental
			 unit may impose a penalty in the amount of up to 15% of its payments to any
			 provider that fails to submit required information. The purchasing governmental
			 unit will notify the provider in advance of its intention to impose a penalty
			 under
			 101
			 CMR 351.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 351.00 - Rates for Certain Adult Foster Care Services › Section 351.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				351.00 are severable, and if any provisions of
				101 CMR
				351.00 or application of such provision to any
				eligible provider or any such circumstances are held to be invalid or
				unconstitutional, such invalidity will not be construed to affect the validity
				or constitutionality of any remaining provisions to any eligible providers or
				circumstances other than those held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 352.00 - Rates of Payment for Certain Children's Behavioral Health Services › Section 352.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 352.00 governs the rates to be used by all
			 governmental units for certain outpatient children's behavioral health services
			 provided by community service agencies and other eligible providers.
			 101 CMR
			 352.00 does not govern rates for psychological testing
			 services, which are governed by
			 101 CMR
			 329.00:
Rates for Psychological and
			 Independent Clinical Social Work Services
, or rates for mental health
			 services, which are governed by
			 101 CMR
			 306.00:
Rates of Payment for Mental Health
			 Services Provided in Community Health Centers and Mental Health
			 Centers
. In addition,
			 101 CMR
			 352.00 does not govern rates for other services, care,
			 and supplies provided to publicly aided patients including, but not limited to,
			 psychiatric day treatment services, early intervention services, and medical
			 services provided in community health centers.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 352.00 apply for dates of service provided on or after
			 August 1, 2023, or as indicated in
			 101
			 CMR 352.03(3).
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 352.00 is not authorization for or approval of the
			 procedures for which rates are determined pursuant to
			 101 CMR
			 352.00. Purchasing agencies and insurers are
			 responsible for the definition, authorization, and approval of care and
			 services extended to publicly aided clients.
(4)
Administrative
			 Bulletins
. EOHHS may issue administrative bulletins to clarify its
			 policy on and understanding of substantive provisions of
			 101 CMR
			 352.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 352.00 - Rates of Payment for Certain Children's Behavioral Health Services › Section 352.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rates as Full Compensation
. The rates under
			 101
			 CMR 352.03 constitute full compensation for
			 children's behavioral health services provided by community service agencies to
			 publicly aided patients, including full compensation for necessary
			 administration and professional supervision associated with patient
			 care.
(2)
Rates of
			 Payment
. Payment rates under
			 101
			 CMR 352.03 are the lowest of
(a) the eligible provider's usual charge to
			 the general public;
(b) the amount
			 accepted as payment from another payer; or
(c) the schedule of allowable rates for
			 services as set forth in
			 101
			 CMR 352.03(3).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 352.00 - Rates of Payment for Certain Children's Behavioral Health Services › Section 352.04 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General Provisions
.
(a)
Accurate Data
.
			 All reports, schedules, additional information, books, and records that are
			 filed or made available to the Center pursuant to M.G.L. c. 12C, § 22,
			 shall be certified under pains and penalties of perjury as true, correct, and
			 accurate by the executive director or chief financial officer of the
			 provider.
(b)
Examination of Records
. Each provider must make
			 available to the Center or purchasing governmental unit upon request all
			 records relating to its reported costs, including costs of any entity related
			 by common ownership or control.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 352.00 - Rates of Payment for Certain Children's Behavioral Health Services › Section 352.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				352.00 are severable. If any provision of
				101 CMR
				352.00 or application of any provision to an
				applicable individual, entity, or circumstance is held invalid or
				unconstitutional, that holding will not be construed to affect the validity or
				constitutionality of any remaining provisions of
				101 CMR
				352.00 or application of those provisions to
				applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 353.00 - Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services › Section 353.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR 353.00 governs
			 certain payments to Primary Care Clinicians (PCCs) for Primary Care Clinician
			 (PCC) services provided to MassHealth members as part of the MassHealth PCC
			 Plan, and to Primary Care ACO-participating Primary Care Providers
			 (participating PCPs) for participating PCP services provided to members
			 enrolled in MassHealth Primary Care ACOs. The enhancement rate payments
			 described in
			 101 CMR 353.00 are in
			 addition to payments issued under the Acute Hospital Request for Applications,
			 and
			 101 CMR 304.00:
Rates for Community Health Centers
;
			 101 CMR
			 316.00:
Surgery and Anesthesia
			 Services
;
			 101 CMR
			 317.00:
Medicine
; and
			 101 CMR
			 318.00:
Radiology
.
(2)
Disclaimer of Authorization
			 of Services
.
			 101 CMR 353.00 is not
			 authorization for or approval of the procedures for which payments are
			 determined pursuant to
			 101 CMR 353.00. Purchasing
			 agencies and insurers are responsible for the definition, authorization, and
			 approval of care and services extended to publicly aided individuals.
(3)
Administrative
			 Bulletins
. EOHHS may issue administrative bulletins to clarify its
			 policy on and understanding of substantive provisions of
			 101 CMR 353.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 353.00 - Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services › Section 353.02 - General Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
. Terms used in
				101 CMR 353.00 will have the
				meaning ascribed in 101 CMR 353.02.
Accountable Care Organization (ACO)
.
				An entity that enters into a population-based payment model contract with EOHHS
				as an accountable care organization, wherein the entity is held financially
				accountable for the cost and quality of care for an attributed or enrolled
				member population. ACOs include Accountable Care Partnership Plans, Primary
				Care ACOs, and MCO-administered ACOs.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Primary Care ACO
. A type of ACO with
				which the MassHealth agency contracts under its ACO program.
Primary Care Clinician (PCC)
. Any
				MassHealth provider that participates as a primary care provider for MassHealth
				members enrolled in the PCC Plan, as described in
				130 CMR
				450.118:
Primary Care Clinician (PCC)
				Plan
.
Publicly Aided Individual
. A person
				whose medical and other services is paid for in whole or in part by the
				Commonwealth of Massachusetts or any of its departments, agencies, boards,
				commissions, or political subdivisions.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 353.00 - Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services › Section 353.03 - General Payment Provisions

Current through Register 1525, July 5, 2024
(A) Primary Care
			 Clinicians (PCCs) receive an enhanced rate for certain types of primary and
			 preventive care visits provided to PCC Plan members enrolled with the PCC on
			 the date of service. Ten dollars is added to the fee for the procedure code
			 billed. The MassHealth agency pays PCCs an enhanced fee for delivering primary
			 care services in accordance with the terms of the PCC provider
			 contract.
(B) Primary Care
			 ACO-participating Primary Care Providers (participating PCPs) receive an
			 enhanced rate for certain types of primary and preventive care visits provided
			 to Primary Care ACO members enrolled with the participating PCP on the date of
			 service. Ten dollars is added to the fee for the procedure code for the
			 procedure code billed. The MassHealth agency pays participating PCPs an
			 enhanced fee for delivering primary care services in accordance with the terms
			 of the participating PCP contract.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 353.00 - Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services › Section 353.04 - Penalty for Noncompliance with Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
The purchasing governmental unit may impose a penalty in the
				amount of up to 15% of its payments to any provider that fails to submit
				required information. The purchasing governmental unit will notify the provider
				in advance of its intention to impose a penalty under 101 CMR
				353.04.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 353.00 - Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services › Section 353.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 353.00 are
				severable, and if any provision of
				101 CMR 353.00 or
				application of such provision to any community service agency or any
				circumstances shall be held to be invalid or unconstitutional, such invalidity
				shall not be construed to affect the validity or constitutionality of any
				remaining provisions of
				101 CMR 353.00 or
				application of such provisions to community service agencies or circumstances
				other than those held invalid.