reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR 129.00, unless the
				context requires otherwise, terms shall have the following meanings.
Base Year
. The fiscal year two years
				prior to the rate year.
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.
Final Inpatient
Per Diem
Rate
. The all-inclusive inpatient rate based upon the
				costs from the rate year filing of the ICF Cost Reports. This final rate is set
				once EOHHS's review is complete, thereby replacing the initial rate.
Governmental Unit
. The Commonwealth of
				Massachusetts and any department, agency, board, commission, division, or
				political subdivision of the Commonwealth.
ICF Cost Report
. The cost report for
				ICFs beginning with fiscal year 1996.
Initial
Per Diem
Rate
. The temporary all-inclusive inpatient rate based
				upon the cost from the base year filing of the ICF Cost Reports, inflated to
				the rate year.
Inpatient Day
. HURM standard unit of
				measure to report care of patients admitted to a hospital including the day of
				admission, but not the day of discharge. If both admission and discharge occurs
				on the same day, the day is considered a day of admission and counts as one
				inpatient day.
Intermediate Care Facility (ICF)
. An
				ICF is an institution whether operated for profit or charity, advertised,
				announced, established, or maintained for the purpose of providing diagnostic,
				medical, surgical, or restorative treatment for patients within or centrally
				based in an institution and licensed as a hospital by the Department of Public
				Health under M.G.L. c. 111, § 51 and any hospital licensed under M.G.L. c.
				19, § 19.
Publicly Aided Patient
. A person who
				receives health care and services for which a governmental unit is in whole or
				part liable under a statutory program of public assistance.
Rate Year
. The rate year is the
				12-month period, July 1st through June
				30th, to which the related rate
				applies.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.03 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
.
(a) On an annual basis, each ICF shall file
			 with the Center one copy of the ICF Cost Report in portable document format,
			 within 120 days of the close of its fiscal year. The ICF Cost Report is to be
			 completed in accordance with the instructions set forth therein and pursuant to
			 requirements of
Administrative Bulletin 97-1
and any pertinent
			 administrative bulletins issued by EOHHS pursuant to
			 101 CMR
			 129.09.
(b) Each ICF shall file, when required, trial
			 balances and supplemental financial information to support the facility's ICF
			 Cost Report filing.
(c) Each ICF
			 shall make available all books and records relating to its operation for audit
			 and/or screening, if requested by the Center.
(d) The CEO or CFO of an ICF shall certify
			 all reports, schedules, reporting forms, budget information, books, and records
			 under pains and penalties of perjury as true, correct, and accurate.
(e) The Center may, from time to time,
			 require ICFs to submit additional data and documentation needed for calculation
			 of MassHealth rates of payment or charges.
(f) The Center may, for cause documented in
			 writing, extend the filing date for the submission of reports, schedules,
			 reporting forms, budget information, books, and records.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.05 - Determination of Inpatient Rate

Current through Register 1525, July 5, 2024
(1)
General
. EOHHS shall determine an Inpatient Rate for
			 each ICF. EOHHS shall establish an Initial
Per Diem
Rate using
			 a base year ICF Cost Report inflated to the rate year pursuant to 101 CMR
			 129.05(3) and a Final
Per Diem
Rate using the rate year ICF
			 Cost Report.
(2)
Calculation of the Inpatient
Per
			 Diem
.
(a)
Allowable Total Patient Care Costs
. Allowable Total
			 Patient Care Costs are the sum of the ICF's Total Inpatient Routine and
			 Ancillary Costs plus Overhead costs associated with inpatient care as reviewed
			 and adjusted pursuant to
			 101 CMR
			 129.04.
(b) EOHHS shall divide the Allowable Total
			 Patient Care Costs pursuant to 101 CMR 129.05(2)(a) by Total Patient
			 Days.
(c) The Initial
Per
			 Diem
Rate may be adjusted pursuant to the provisions of
			 101 CMR
			 129.06(2)(e).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.06 - Administrative Adjustment to Inpatient Per Diem Rate

Current through Register 1525, July 5, 2024
(1)
Timing
. An ICF
			 may apply for a discretionary administrative adjustment to its Inpatient
Per Diem
Rate based upon the grounds set forth in 101 CMR
			 129.06(1)(a) and (b). Adjustments shall be effective on the later of:
(a) the beginning of the quarter (July
			 1st, October 1st, January
			 1st, April 1st) in which
			 a complete application is received; or
(b) the date the costs shall be
			 incurred.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.07 - Administrative Review

Current through Register 1525, July 5, 2024
(1)
Purpose of Administrative Review
. To ensure that an
			 ICF facility's rates are in continuing compliance with
			 101 CMR 129.00, EOHHS may,
			 at any time and upon its own motion, review an approved rate upon notice to the
			 facility.
(2)
Administrative Review of Transfers of Cost
. Where an
			 ICF has reduced costs or increased costs by transfer of those costs to other
			 persons or entities that provide health care and services, EOHHS may modify the
			 Inpatient Rate to reflect the change in costs. In order to give effect to a
			 transfer of cost, each ICF must file information concerning cost, volume, and
			 revenue 30 days prior to implementation of a proposed transfer of cost, and
			 must submit any additional information regarding the transfer of cost that
			 EOHHS may require.
(3)
Administrative Review and Decision
. Upon notice of
			 administrative review, the ICF shall submit such books, records, documentation,
			 and information as EOHHS may require. After review, EOHHS shall render a
			 written decision and statement of reasons for its decision.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.08 - Appeal

Current through Register 1525, July 5, 2024
An ICF that is aggrieved by any action or failure to act under
				101 CMR 129.00 may file an
				appeal within 30 days to the Division of Administrative Law Appeals pursuant to
				the requirements of M.G.L. c. 118E and M.G.L. c. 7, § 4H. The pendency of
				an appeal does not limit EOHHS's right to undertake administrative review under
				101 CMR
				129.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.09 - Administrative Bulletins

Current through Register 1525, July 5, 2024
EOHHS may, from time to time, issue administrative bulletins to
				clarify substantive provisions of
				101 CMR 129.00. In addition,
				EOHHS may issue administrative bulletins that specify the information and
				documentation necessary to implement
				101 CMR
				129.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.10 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 129.00 are hereby
				declared to be severable, and if such provisions or the application of such
				provisions to any person 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 129.00 or the
				application of such provisions to ICFs or circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 204.00 governs the payment rates for
			 services provided by resident care facilities to publicly aided and industrial
			 accident residents, and pertaining to certain COVID-19 related costs as
			 described in 101 CMR 204.00. Residential care units of nursing facilities are
			 governed by 101 CMR 206.00:
Standard Payments to Nursing
			 Facilities
.
(2)
Applicable Dates of Service
. Rates contained in 101
			 CMR 204.00 apply for services provided on or after January 1, 2024.
(3)
Disclaimer of Authorization
			 of Services
. 101 CMR 204.00 is not authorization for or approval
			 of the substantive services or the time period for which rates are determined
			 pursuant to 101 CMR 204.00. Governmental units and insurers that purchase
			 services from eligible providers are responsible for the definition,
			 authorization, and approval of services provided to publicly aided or
			 industrial accident residents.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.03 - General Rate Provisions

Current through Register 1525, July 5, 2024
(1)
General
. EOHHS will determine a payment rate for dates
			 of service on or after January 1, 2024, for each facility as follows.
(a)
Preliminary
			 Rate
. The facility's preliminary rate is equal to the sum of
1. allowable variable costs determined under
			 101
			 CMR 204.04; and
2. allowable capital and other fixed costs as
			 determined under
			 101
			 CMR 204.05.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.05 - Capital and Other Fixed Costs

Current through Register 1525, July 5, 2024
(1)
Allowable Fixed Costs
.
(a) Allowable fixed costs include the
			 allowable portion of depreciation, long-term interest, real estate taxes,
			 personal property taxes on resident care facility equipment, the non-income
			 portion of the Massachusetts corporate excise tax, building insurance, and
			 rental of equipment located at the facility, less any recoverable fixed cost
			 income.
(b) EOHHS will calculate
			 the provider's capital and other fixed costs
per diem
by
			 dividing allowable fixed costs by the constructed bed capacity times the days
			 in the rate year times the greater of 90% or the actual utilization rate in the
			 base year.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.06 - Equity and Use and Occupancy Allowance

Current through Register 1525, July 5, 2024
(1)
General
. EOHHS will include a return on average equity
			 capital for proprietary providers. EOHHS will include a use and occupancy
			 allowance for nonprofit providers.
(2)
Average Equity Capital
			 Allowance
. Average equity capital is the difference between the
			 provider's allowable book value of fixed assets, including land, at the
			 beginning and end of the year, and the provider's allowable long-term
			 liabilities at the beginning and end of the year. The average equity capital is
			 then multiplied by a rate of 3.00%.
(a) EOHHS
			 will reduce average equity capital by building, improvements, equipment, and
			 software depreciation allowed in prior years.
(b) EOHHS will not include mortgage
			 acquisition costs, such as capitalized legal fees and prepaid interest on
			 long-term obligations, or equity in buildings or equipment not located at the
			 resident care facility, in average equity capital.
(c) EOHHS will not reduce average equity
			 capital by long-term loans for which interest has been excluded as a result of
			 debt not supported by allowable fixed assets.
(d) If a facility replaces beds, reimbursable
			 equity will be recalculated using the newly established allowable fixed assets
			 and allowable debt.
(e) EOHHS will
			 calculate the
per diem
average equity capital by multiplying
			 the average equity capital by a rate of 3.00% then dividing by the constructed
			 bed capacity times the days in the rate year times the greater of 90% or the
			 actual utilization rate in the base year.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.07 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
.
(a)
Resident Care Facility Cost Report
. Each provider must
			 complete and file a residential care cost report each calendar year with the
			 Center, containing the facility's claim for reimbursement and the complete
			 financial condition of the facility, including all applicable management
			 company, central office, and real estate expenses.
(b)
Realty Company Cost
			 Report
. A provider that does not own the real property of the
			 facility, and pays rent to an affiliated or non-affiliated realty trust or
			 other business entity, must file or cause to be filed a realty company cost
			 report with the Center. If no report is filed, EOHHS will not reimburse the
			 costs associated with the provider's rental expense.
(c)
Management Company Cost
			 Report
. A provider that claims management or central office
			 expenses must file a separate management company cost report with the Center
			 for each entity for which it claims management or central office expense. If
			 these costs are claimed for reimbursement, the provider must certify that costs
			 are reasonable and necessary for the care of publicly aided residents in
			 Massachusetts.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.08 - Other Provisions

Current through Register 1525, July 5, 2024
(1)
Special Rate Provisions
.
(a)
New Facilities and Major
			 Additions
. EOHHS will calculate projected rates for new facilities
			 and facilities with major additions in the rate year. The provider must file a
			 projected cost report that projects the reasonably anticipated costs and
			 anticipated resident days for a 12-month period commencing with the first date
			 of licensure.
1.
New Facilities
			 and Facilities with Major Additions Becoming Operational Prior to July
			 1st of the Rate Year
.
a.
First Rate Year
.
			 EOHHS will calculate a projected rate based on the projected cost report. The
			 effective date of the rate will be the first date of licensure through December
			 31st of the first rate year that the facility
			 becomes operational.
b.
Second Rate Year
. EOHHS will calculate the rate for
			 the second rate year based on the projected cost report described in
			 101
			 CMR 204.07.
c.
Third Rate Year
.
			 The rate for the third rate year is based on the first calendar year cost
			 report of actual expenditures.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.09 - Certain COVID-19-related Costs Add-on Payment Provisions

Current through Register 1525, July 5, 2024
(1)
General
			 Provision
. Resident care facilities eligible under
			 101
			 CMR 204.09 will receive an add-on payment
			 that must be used to reimburse for costs related to COVID-19 in accordance with
			 St. 2022, c. 268. This add-on payment, which is to be made in accordance with
			 St. 2022, c. 268, is intended to be made in calendar year 2024 and represents
			 approximately half of the payments intended to be made to resident care
			 facilities with rates established in 101 CMR 204.00.
(2)
Calculation of Certain
			 COVID-19 Related Costs Add-on Payment
. EOHHS will calculate the
			 add-on payment for each facility as follows.
(a) Determine the total number of resident
			 care beds as of June 7, 2023, that are
1. in
			 resident care facilities licensed by DPH;
2. in resident care facilities that are not
			 subject to licensure pursuant to M.G.L. c. 111, §73B, and had SSI/SSP or
			 EAEDC days in calendar year 2021; or
3. in facilities that are licensed by DPH as
			 nursing facilities, but where such facility has a majority of resident care
			 beds over nursing beds, and where such facility has not otherwise received
			 payments for either resident care or nursing beds pursuant to 101 CMR
			 206.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.10 - Resident Care Cost Quotient

Current through Register 1525, July 5, 2024
(1) Beginning July
			 1, 2022, residential care facilities must have a Resident Care Cost Quotient
			 (RCC-Q) that meets or exceeds a threshold of 80%. For the rate year beginning
			 in SFY 2024, a residential care facility's rate may be subject to a downward
			 adjustment if the facility fails to be at or above the specified RCC-Q
			 threshold in the previous state fiscal year.
(2) The RCC-Q will be calculated by dividing
			 certain resident care expenses by the facility's total revenue, excluding the
			 revenue for non-residential care facility lines of business, and excluding
			 endowment income. EOHHS may further identify or clarify these certain resident
			 care expenses by administrative bulletin or other written issuance. A
			 multiplier may be applied to certain resident care expenses related to one or
			 more resident care workforce position types. EOHHS may establish the workforce
			 position types eligible for any multiplier, details related to application of
			 such multiplier, and the magnitude of such multiplier in calculating the RCC-Q,
			 by administrative bulletin or other written issuance.
(3) All resident care facilities, including
			 facilities described in
			 101
			 CMR 204.10(5), will be
			 required to submit an interim compliance report by March
			 1st of each year and a final compliance report by
			 September 1st of each year. The interim report will
			 be used to inform facilities if they are on track to meet the RCC-Q threshold
			 in the reporting period. The final compliance report will be used for
			 determining whether the facility met that threshold and whether a downward
			 adjustment will be applied to the facility's rate in the following rate
			 year.
(4) The downward adjustment
			 to the rate will be applied in the following rate year to facilities that
			 failed to meet the RCC-Q threshold or failed to submit the final report by the
			 final compliance report due date. Such downward adjustment will be applied as
			 follows.
(a) For every 1% below the 80% RCC-Q
			 threshold, a 0.5% downward adjustment will be applied to the facility's
			 rate.
(b) The maximum downward
			 adjustment calculated in accordance with
			 101
			 CMR 204.10(4)(a)  may be no
			 more than 5% of the facility's rate. EOHHS may apply the maximum downward
			 adjustment of 5% in the following rate year for facilities that fail to submit
			 the final report by the due date established in
			 101
			 CMR 204.10(3).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.01 - Scope and Purpose

Current through Register 1525, July 5, 2024
101 CMR
				206.00 governs the payments effective October 1, 2023,
				for services rendered to publicly aided and industrial accident residents by
				nursing facilities including residents in a residential care unit of a nursing
				facility.
				101 CMR
				206.00 does not govern nursing facility payments
				pursuant to a contract with the Office of Medicaid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.03 - General Payment Provisions

Current through Register 1525, July 5, 2024
(1) General. Nursing
			 facility payments are prospective rates based on reported costs for a prior
			 base year.
(a) The nursing standard payments
			 and the operating cost standard payments are established in
			 101
			 CMR 206.04. The base year for the nursing
			 standard payments and the operating cost standard payments effective October 1,
			 2023, is 2019. The nursing and operating payments are increased from the base
			 year by a cost adjustment factor of 21.94%.
(b) The capital payments are established in
			 101
			 CMR 206.05. The base year for the capital
			 payments effective October 1, 2023, is 2019. The capital payments are increased
			 from the base year by a cost adjustment factor of 7.55%.
(c) Payments may be adjusted to include
			 additional payments in accordance with
			 101
			 CMR 206.06.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.05 - Capital Payments

Current through Register 1525, July 5, 2024
(1)
Nursing Facility Capital Payments
. Effective October
			 1, 2023, nursing facilities will receive capital payments calculated as
			 follows, with exceptions as described in
			 101
			 CMR 206.05(2)  through
			 101
			 CMR 206.05(5).
(a) Calculate the sum of the allowable
			 portion of capital costs during the base year, less any recoverable fixed cost
			 income. Apply a cost adjustment factor as described in
			 101
			 CMR 206.03(1)(b).
(b) Multiply the number of beds by the number
			 of days in the rate year and then multiply the product by the greater of 90% or
			 the actual utilization rate in the base year.
(c) EOHHS will calculate the provider's
			 capital payment by dividing the result of
			 101
			 CMR 206.05(1)(a)  by the
			 result of
			 101
			 CMR 206.05(1)(b), subject to
			 the limitations described in
			 101
			 CMR 206.05(4).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.06 - Adjustments to Standard Nursing Facility Rates

Current through Register 1525, July 5, 2024
(1)
Certification of Public
			 Expenditures of a Nursing Facility Owned and Operated by a
			 Municipality
.
(a) Within 60 days
			 after the filing of its Medicare CMS-2540 cost report, a nursing facility,
			 which is owned and operated by a municipality, may submit a request for
			 Certified Public Expenditures (CPE) to EOHHS. This CPE will account for its
			 public expenditures of providing Medicaid services to eligible Medicaid
			 recipients. The submission will be based on the inpatient routine service cost
			 reported on the CMS-2540 Medicare cost report.
(b) Following review of the nursing
			 facility's submission, EOHHS will, within 60 days of the submission, approve,
			 deny, or revise the amount of the CPE request based upon its evaluation of the
			 reported costs and payments. The final approved amount will be equal to the
			 difference between the Medicaid interim payments and the total allowable
			 Medicaid costs as determined by EOHHS. This final determined amount will be
			 certified by the municipality as eligible for federal match.
(c) Interim payments are based on the
			 standard payment methodology pursuant to
			 101 CMR
			 206.00.
(d) EOHHS will determine total allowable
			 Medicaid costs based on the Medicare CMS-2540 Cost Report and will determine a
per diem
rate calculated as follows.
1.
Medicaid Allowable Skilled
			 Nursing Facility Costs
. Total allowable costs (Worksheet B, Part
			 I, Line 30, Col 18), divided by total days (Worksheet S-3, Line 1, Col 7),
			 times Medicaid days (worksheet S-3, Line 1, Col 5).
2.
Medicaid Allowable Nursing
			 Facility Costs
. Total allowable costs (Worksheet B, Part I, Line
			 31, Col 18), divided by total days (Worksheet S-3, Line 3, Col 7), times
			 Medicaid days (Worksheet S-3, Line 3, Col 5).
3.
Total Allowable Medicaid
			 Costs
. The sum of the amount determined in
			 101
			 CMR 206.06(1)(d)1. and
			 2.
(e) EOHHS will
			 calculate an interim reconciliation based on the difference between the interim
			 payments and total allowable Medicaid costs from the as-filed CMS-2540 Cost
			 Report. The nursing facility must notify EOHHS immediately if the CMS-2540 is
			 reopened or an audit is completed. Within 60 days after receiving notification
			 of the final Medicare settlement EOHHS will retroactively adjust the final
			 settlement amount.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.07 - Payments for Individuals in a Disaster Struck Nursing Facility

Current through Register 1525, July 5, 2024
(1) Payment to a Disaster Struck Nursing
			 Facility for individuals that must be temporarily evacuated to another facility
			 (Resident Accepting Nursing Facility) may continue for up to 30 days after the
			 disaster event.
(2) Payment will be
			 the same as if the individual was residing in the Disaster Struck Nursing
			 Facility. No other payment will be made to either the Disaster Struck Nursing
			 Facility or the Resident Accepting Nursing Facility for evacuated individuals.
			 The Disaster Struck Nursing Facility must meet the following conditions in
			 order to receive payment for evacuated individuals:
(a) The Disaster Struck Nursing Facility must
			 have a contract with the Resident Accepting Nursing Facility. The contract must
			 include:
1. terms of payment and mechanisms
			 to resolve any contract disputes;
2. protocols for sharing care and treatment
			 information between the two facilities; and
3. requirements that both facilities meet all
			 conditions of Medicaid participation, as determined by the MassHealth
			 agency.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.08 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Cost Reports
.
(a)
Nursing Facility Cost
			 Report
. Each provider must complete and file a Nursing Facility
			 Cost Report (SNF-CR) each calendar year with the Center. The Nursing Facility
			 Cost Report must contain the complete financial condition of the provider,
			 including all applicable management company, central office, and real estate
			 expenses. If a provider has closed on or before November
			 30th, the provider is not required to file an SNF-CR
			 report.
(b)
Realty
			 Company Cost Report
. A provider that does not own the real
			 property of the nursing facility and pays rent to an affiliated or
			 nonaffiliated realty company, trust, or other business entity must file or
			 cause to be filed a separate Realty Company Cost Report with the
			 Center.
(c)
Management
			 Company Cost Report
. A provider must file a separate Management
			 Company Cost Report with the Center for each entity for which it reports
			 management or central office expenses related to the care of Massachusetts
			 publicly aided residents. If the provider identifies such costs, the provider
			 must certify that costs are reasonable and necessary for the care of publicly
			 aided residents in Massachusetts.
(d)
Financial
			 Statements
. If a provider or its parent organization is required
			 or elects to obtain compiled, reviewed, or independent audited financial
			 statements for purposes other than filing an annual Nursing Facility Cost
			 Report in accordance with
			 101 CMR
			 206.00, the provider must file a complete copy of
			 these financial statements with the Center, that most closely correspond to the
			 provider's Nursing Facility Cost Report fiscal period. Nothing in
			 101
			 CMR 206.08(1)(d)  will be
			 construed as an additional requirement that nursing homes complete audited,
			 reviewed, or compiled financial statements solely to comply with the Center's
			 annual cost reporting requirements.
(e)
Clinical Data
.
			 EOHHS may require providers to submit patient level data for the purpose of
			 measuring clinical performance in a format specified by EOHHS. EOHHS may
			 designate required data, data specifications, and other data collection
			 requirements by administrative bulletin.
(f)
CMS-2540
			 Reports
. State operated nursing facilities that meet the
			 definition in 42 CFR
			 433.50(a)(i) must file a
			 CMS-2540 report with the Center annually. The state-operated nursing facility
			 must report the final disposition made by the Medicare intermediary.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.09 - Special Provisions

Current through Register 1525, July 5, 2024
(1)
Rate
			 Filings
. EOHHS will file certified rates of payment for nursing
			 facilities with the Secretary of the Commonwealth.
(2)
Appeals
. A
			 provider may file an appeal at the Division of Administrative Law Appeals of
			 any rate established pursuant to
			 101 CMR
			 206.00 within 30 calendar days after EOHHS files the
			 rate with the Secretary of the Commonwealth. EOHHS may amend a rate or request
			 additional information from the provider even if the provider has filed a
			 pending appeal.
(3)
Administrative Bulletins
. EOHHS and the Center may
			 issue administrative bulletins to clarify provisions of
			 101 CMR
			 206.00 or to specify data collection requirements.
			 Such bulletins will be deemed to be incorporated in the provisions of
			 101 CMR
			 206.00. EOHHS and the Center will file the bulletins
			 with the Secretary of the Commonwealth, distribute copies to providers, and
			 make the bulletins accessible to the public at EOHHS's and the Center's offices
			 during regular business hours.
(4)
Severability
. The provisions of
			 101 CMR
			 206.00 are severable. If any provision of
			 101 CMR
			 206.00 or the application of any provision of
			 101 CMR
			 206.00 is held invalid or unconstitutional, such
			 provision will not be construed to affect the validity or constitutionality of
			 any other provision of
			 101 CMR
			 206.00 or the application of any other
			 provision.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.10 - Other Payment Provisions

Current through Register 1525, July 5, 2024
(1)
Temporary Resident Add-on
.
(a) For dates of service beginning October 1,
			 2022, a nursing facility will be eligible for a member-specific temporary
			 resident add-on if the resident meets all of the following criteria:
1. MassHealth is the resident's primary payer
			 for nursing facility services at the time of admission;
2. the resident is medically eligible for
			 nursing facility services under
			 130
			 CMR 456.409:
Services Requirement for
			 Medical Eligibility
;
3.
			 the resident was transferred to the nursing facility for temporary residence
			 purposes directly from their home; and
4. the resident was discharged from the
			 nursing facility to their home within 30 calendar days of the admission
			 date.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.11 - Rates for Severe Mental and Neurological Disorder Services

Current through Register 1525, July 5, 2024
(1)
Qualifying Nursing
			 Facility
. Effective for dates of service beginning January 15,
			 2022, qualifying nursing facilities will be able to receive a member-based
per diem
rate for residents with severe mental or neurological
			 disorders who are receiving specialized rehabilitation services for such
			 disorders. In order to qualify for this member-based
per diem
rate, a nursing facility must
(a) as of August
			 1, 2020, operate to provide nursing facility services, including the
			 specialized rehabilitative services described in
			 101
			 CMR 206.11(1)(c), to
			 residents with mental or neurological disorders, including residents with
			 acquired brain injuries;
(b)
			 demonstrate, in the form and manner requested by EOHHS, that the percentage of
			 the facility's annual resident days for residents with mental or neurological
			 disorders, including residents with acquired or traumatic brain injuries, is at
			 least 50% of its total annual resident days;
(c) provide the following specialized
			 rehabilitation services for its residents:
1.
			 an individualized therapeutic skill development plan for each member;
2. individual counseling;
3. group counseling (therapeutic and life
			 skills groups), with group sessions offered multiple times each week to ensure
			 access based on member needs and preferences;
4. sensory modulation and cognitive
			 rehabilitation;
5.
			 neuropsychological testing, evaluation, and intervention;
6. alcohol and substance abuse counseling and
			 prevention;
7. all mental health
			 services as indicated by each resident's PASRR Level II evaluation, or
			 coordinate with additional providers and practitioners, who may separately bill
			 or be paid under the appropriate provider regulations, for services designated
			 as specialized services under the PASRR program and therefore are services that
			 are not included in standard nursing facility services;
8. vocational programming; and
9. community reintegration.
(d) Maintain a program staff of
			 specially trained professionals including, but not limited to, a
			 neuropsychiatrist, a neuropsychologist, licensed mental health counselors,
			 vocational specialists, life skills counselors, certified brain injury
			 specialists, substance abuse counselors, and therapeutic technicians. All such
			 staff must be trained in behavior modification and de-escalation
			 techniques.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.12 - Direct Care Cost Quotient

Current through Register 1525, July 5, 2024
(1) Beginning
			 October 1, 2020, nursing facilities must have a Direct Care Cost Quotient
			 (DCC-Q), as described in
			 101
			 CMR 206.12(2), of at least
			 75%. For the rate year beginning October 1, 2022, a nursing facility rate will
			 be subject to a downward adjustment if the facility failed to be at or above
			 the 75% DCC-Q threshold for the period of July 1, 2021, through June 30, 2022.
			 For rate years beginning on or after October 1, 2023, a nursing facility rate
			 will be subject to a downward adjustment if the facility fails to be at or
			 above the 75% DCC-Q threshold in the previous full fiscal year.
(2) The DCC-Q will be calculated by dividing
			 certain direct care workforce expenses, such as nursing, dietary, restorative
			 therapy, or social worker staff expenses, by the facility's total revenue,
			 excluding the revenue for non-nursing facility lines of business and
			 subtracting the User Fee Assessments, certain federal and state payments,
			 certain prescription drug expenses, and certain other ancillary costs related
			 to services provided to Medicare residents, to be identified
via
administrative bulletin or other written issuance.
(a) A multiplier may be applied to one or
			 more direct care workforce position types as an incentive. A multiplier must be
			 calculated by multiplying the cost associated with a given direct care
			 workforce position type in the numerator by 1.5 or more, but not to exceed
			 3.
(b) The workforce position types
			 eligible for any multiplier described in
			 101
			 CMR 206.12(2)  and the
			 magnitude of such multiplier in calculating the DCC-Q may be established by
			 EOHHS
via
administrative bulletin or other written
			 issuance.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.13 - Average Staffing Hours Incentive

Current through Register 1525, July 5, 2024
(1) As of October 5,
			 2020, each nursing facility is required to submit information on its staffing
			 levels, including information demonstrating the facility's average hours per
			 patient day to EOHHS, in the manner and format requested by EOHHS
via
administrative bulletin or other written
			 issuance.
(2) As of January 1,
			 2021, a nursing facility that fails to meet an average of at least 3.58 hours
			 per patient day in accordance with
			 101
			 CMR 206.13(1), is subject to
			 a downward adjustment equal to 2% of the facility's standard rate for that
			 calendar quarter. The dollar amount resulting from this adjustment will be
			 considered an overpayment pursuant to
			 130
			 CMR 450.235:
Overpayments
.
(3)
			 To determine a facility's average hours per patient day in each calendar
			 quarter, EOHHS will divide the facility's total number of productive hours
			 worked by nursing staff, including registered nurses, licensed practical nurses
			 and nurses' aides, in the calendar quarter by the facility's total number of
			 patient days in that calendar quarter.
(4) EOHHS may issue administrative bulletins
			 or other written issuance to further clarify these provisions and to provide
			 additional guidance regarding what qualifies as productive hours, what staff
			 types are included in nursing staff, the reporting requirements, and the
			 requirements for disputing the calculation described in
			 101
			 CMR 206.13(3).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.14 - Special Requirements Related to St. 2022, c. 268

Current through Register 1525, July 5, 2024
Recognizing the constraints on nursing facility capacity and
				the intent of St. 2022, c. 268 to support economic growth and relief in the
				Commonwealth, nursing facilities are expected to use the incremental increases
				in funding resulting from the increased nursing and operating standard rates
				cost adjustment factor funded by St. 2022, c. 268 and implemented in
				101
				CMR 206.03(1)(a)  and
				101
				CMR 206.06(7)(b), to support
				nursing facility workforce, direct care staffing, and capacity in order to
				increase capacity and the timeliness of admissions.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.15 - Add-on for Members with Complicated High-cost Care Needs

Current through Register 1525, July 5, 2024
(1)
Members with Complicated
			 High-cost Care Needs
. Nursing facilities may receive a
			 member-based rate add-on, in addition to the facility's standard
per
			 diem
rate established under
			 101 CMR
			 206.00, for any member (for example, a resident
			 requiring 1:1 staffing), for whom reasonable and allowable direct care costs
			 associated with providing for such member's clinical care needs are
			 significantly greater than the standard nursing facility rate (for example,
			 because the member's care needs necessitates the purchase or rental of
			 specialized equipment or hiring of additional staff). The facility may receive
			 an add-on for such member, as calculated according to
			 101
			 CMR 206.15(2), provided that
			 all of the following conditions are met:
(a)
			 Prior to admission, the facility certifies that the direct care costs
			 associated or expected to be associated with providing services to such member
			 are necessary to provide the services recommended by the member's physician and
			 care team, and documented in the member's care plan;
(b) The facility submitted a summary of
			 expected direct care costs associated with providing services to such member
			 demonstrating that the requirements of
			 101
			 CMR 206.15 have been met;
(c) The facility provides the MassHealth
			 agency with any additional or clarifying documentation in support of the actual
			 or expected direct care costs associated with the resident's care needs;
			 and
(d) The facility receives
			 approval from the MassHealth agency for the add-on.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 304.00 governs the payment rates to be used by
			 governmental units and purchasers under M.G.L. c. 152 (the Workers'
			 Compensation Act) for community health center services.
(2)
Applicable Dates of
			 Service
. Rates in
			 101 CMR
			 304.00 apply for dates of service provided on or after
			 January 1, 2023, unless otherwise indicated.
(3)
Coverage
. The
			 rates of payment under
			 101 CMR
			 304.00 constitute full compensation for community
			 health center services provided to publicly aided individuals as well as full
			 compensation for necessary administration, professional supervision, and
			 supporting services associated with patient care. Any client resources or
			 third-party payments received on behalf of a publicly aided individual will
			 reduce, by that amount, the amount of the purchasing governmental unit's
			 obligation for services rendered to the publicly aided individual.
(4)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 304.00 is not authorization for or approval of the
			 services for which rates are determined. The purchasing governmental unit or
			 purchaser under M.G.L. c. 152 is responsible for the definition, authorization,
			 and approval of services.
(5)
Coding Updates and Corrections
. EOHHS may publish
			 service code updates and corrections in the form of an administrative bulletin.
			 Updates may reference coding systems including, but not limited to, the
			 American Medical Association's
Current Procedural Terminology
			 (CPT)
and/or the
Healthcare Common Procedure Coding System
			 (HCPCS)
. The publication of such updates and corrections will list:
(a) codes for which the code numbers change,
			 with the corresponding cross references between new codes and the code being
			 replaced. Rates for such new codes are set at the rate of the code that is
			 being replaced;
(b) codes for which
			 the code number remains the same, but the description has changed;
(c) deleted codes for which there are no
			 corresponding new codes; and
(d)
			 codes for entirely new services that require pricing. EOHHS will list these
			 codes and apply individual consideration (I.C.) payment 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 304.00 - Rates For Community Health Centers › Section 304.03 - General Rate Provisions and Maximum Allowable Fees

Current through Register 1525, July 5, 2024
(1)
Rate
			 Determination
. Rates of payment for authorized community health
			 center services to which
			 101 CMR
			 304.00 applies are the lower of
(a) the community health center's usual
			 charge to the general public (other than publicly aided individuals or
			 industrial accident patients) for the same or similar services; or
(b) the schedule of allowable fees set forth
			 in 101 CMR 304.04.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.05 - Adjustment to Ensure Title XIX Access or Quality

Current through Register 1525, July 5, 2024
A community health center may request an adjustment of rates if
				it can demonstrate that access to service delivery is threatened. In order to
				qualify, the community health center must obtain certification from EOHHS that,
				without an increase in rates, access to services to MassHealth members will be
				jeopardized or that the quality of service will fall below levels acceptable to
				EOHHS and required by Title XIX. If EOHHS makes such a certification, the
				community health center may submit an application for a rate adjustment. The
				community health center's application must include a copy of EOHHS
				certification, the number of clients in need of the particular service, the
				number of visits required, evidence of the direct relationship between
				services, and the cost of providing care and the minimal additional costs to
				adequately provide the services. EOHHS will review and act on a request for a
				change in rates within 60 days of the receipt of a completed
				application.