Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 413.00 - Payments for Youth Intermediate-term Stabilization Services › Section 413.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Services Included in the Rate
. The approved rate
			 includes payment for all care and services that are part of the program of
			 services of an eligible provider, as explicitly set forth by the purchasing
			 governmental unit(s).
(2)
Reimbursement as Full Payment
. Each eligible provider
			 must, as a condition of payment by any purchasing governmental unit, accept the
			 approved rate as full payment and discharge of all obligations for the services
			 rendered. Payment by the purchasing governmental unit for services rendered to
			 the client are reduced by the amount of any payment from any other
			 source.
(3)
Payment
			 Limitations
. No purchasing governmental unit may pay less than, or
			 more than, the approved rate, except as cited in
			 101
			 CMR 413.03(2), (4), and
			 (5).
(4)
Administrative Adjustment for
			 Extraordinary Circumstances
. A method whereby, subject to
			 availability of funds, a purchasing governmental unit may provide additional
			 resource allocations to a qualified provider in response to unusual and
			 unforeseen circumstances that substantially increase the cost of service
			 delivery in ways not contemplated in the development of current rates. It must
			 be demonstrated that such cost increases gravely threaten the stability of
			 service provision such that client or consumer access to necessary services is
			 at risk. The purchasing governmental unit will evaluate the need for the
			 administrative adjustment, determine whether funding is available, and convey
			 that information to EOHHS for review to determine the amount of any
			 adjustment.
(5)
Approved Rates
. Except for the rates established for
			 substance use disorder treatment, the rates set forth in
			 101
			 CMR 413.03 govern the payment rates for
			 services purchased by the Department of Children and Families, DMH, and DYS
			 provided pursuant to contracts executed under the departments' FY 2013 or
			 subsequent procurements. The approved rate is the lower of the provider's
			 charge or amount accepted as payment from another payer or the rate listed in
			 101
			 CMR 413.03.
(a)
Youth Residential Substance
			 Use Disorder Treatment Rates Effective for Dates of Service Provided on or
			 after January 1, 2024
.
Program
							 Name
Rate
HCPCS
							 Code/Description
Youth Residential Substance
Use Disorder Treatment
$397.89
H0019-HF - Behavioral health; long-term residential
							 (nonmedical, nonacute care in a residential treatment program where stay is
							 typically longer than 30 days), without room and board, per diem (residential
							 treatment service for transitional age youth and young adults: youth
							 residential substance use disorder treatment).
Clinically Intensive Youth Residential Substance Use
							 Disorder Treatment
$523.57
H0019-HA - Behavioral health; long-term residential
							 (nonmedical, nonacute care in a residential treatment program where stay is
							 typically longer than 30 days), without room and board, per diem (residential
							 treatment services for youth: clinically intensive youth residential substance
							 use disorder treatment).
(b)
Adjudicated Youth Residential Treatment Base Rates Effective for
			 Dates of Service Provided on or after January 1, 2024.
ADJUDICATED YOUTH RESIDENTIAL TREATMENT BASE
				RATES
PROVIDER LEASED
Utilization %
# of Clients
12-14
15-17
18-22
23-26
90%
$627.83
$525.21
$425.63
$386.26
85%
$664.76
$556.11
$450.67
$408.98
80%
$706.31
$590.86
$478.83
$434.54
75%
$753.40
$630.25
$510.76
$463.51
70%
$807.21
$675.27
$547.24
$496.62
65%
$869.30
$727.22
$589.33
$534.82
60%
$941.74
$787.82
$638.45
$579.39
55%
$1,027.36
$859.44
$696.49
$632.06
50%
$1,130.09
$945.38
$766.13
$695.26
PROVIDER OWNED
Utilization %
# of Clients
12-14
15-17
18-22
23-26
90%
$587.40
$484.78
$385.20
$345.83
85%
$621.95
$513.30
$407.86
$366.17
80%
$660.83
$545.38
$433.35
$389.06
75%
$704.88
$581.74
$462.24
$414.99
70%
$755.23
$623.29
$495.26
$444.64
65%
$813.32
$671.24
$533.36
$478.84
60%
$881.10
$727.18
$577.80
$518.74
55%
$961.20
$793.28
$630.33
$565.90
50%
$1,057.32
$872.61
$693.36
$622.49
STATE OWNED - SEPARATE
Utilization %
# of Clients
12-14
15-17
18-22
23-26
90%
$579.70
$477.08
$377.50
$357.80
85%
$613.80
$505.15
$399.71
$378.84
80%
$652.16
$536.72
$424.69
$402.52
75%
$695.64
$572.50
$453.00
$429.36
70%
$745.33
$613.39
$485.36
$460.02
65%
$802.66
$660.58
$522.69
$495.41
60%
$869.55
$715.62
$566.25
$536.69
55%
$948.60
$780.68
$617.73
$585.49
50%
$1,043.46
$858.75
$679.50
$644.03
STATE OWNED - CO-LOCATED
Utilization %
# of Clients
12-14
15-17
18-22
23-26
90%
$543.96
$451.26
$357.43
$338.74
85%
$575.96
$477.81
$378.45
$358.66
80%
$611.96
$507.67
$402.11
$381.08
75%
$652.76
$541.51
$428.91
$406.48
70%
$699.38
$580.19
$459.55
$435.52
65%
$753.18
$624.82
$494.90
$469.02
60%
$815.95
$676.89
$536.14
$508.11
55%
$890.12
$738.43
$584.88
$554.30
50%
$979.14
$812.27
$643.37
$609.73
Intensive Trans. Indep. Living (A)
Utilization %
# of Clients
5-11
12-14
15-17
18-22
90%
$468.70
$425.88
$420.04
$399.76
85%
$496.27
$450.93
$444.75
$423.28
80%
$527.29
$479.11
$472.55
$449.74
75%
$562.44
$511.06
$504.05
$479.72
70%
$602.61
$547.56
$540.05
$513.98
65%
$648.97
$589.68
$581.59
$553.52
60%
$703.05
$638.82
$630.06
$599.65
55%
$766.96
$696.89
$687.34
$654.16
50%
$843.66
$766.58
$756.07
$719.58
Trans. Indep. Living (B)
Utilization %
# of Clients
5-11
12-14
15-17
18-22
90%
$183.69
$131.16
$145.15
$129.30
85%
$194.50
$138.88
$153.69
$136.91
80%
$206.66
$147.56
$163.29
$145.46
75%
$220.43
$157.40
$174.18
$155.16
70%
$236.18
$168.64
$186.62
$166.25
65%
$254.35
$181.61
$200.98
$179.03
60%
$275.54
$196.74
$217.73
$193.95
55%
$300.59
$214.63
$237.52
$211.59
50%
$330.65
$236.09
$261.27
$232.74
STATE OWNED - CO-LOCATED
Utilization %
# of Clients:
12-14
15-17
18-22
23-26
90%
$427.64
$358.65
$321.72
$299.45
85%
$452.80
$379.75
$340.63
$317.07
80%
$481.09
$403.49
$361.93
$336.87
75%
$513.17
$430.39
$386.06
$359.34
70%
$549.83
$461.13
$413.63
$385.01
65%
$592.12
$496.60
$445.45
$414.61
60%
$641.46
$537.98
$482.56
$449.17
55%
$699.77
$586.89
$526.44
$490.00
50%
$769.75
$645.59
$579.08
$539.00
(c)
Residential, Community-based, and Specialty Services (Formerly
			 Known as Caring Together) Rates Effective for Dates of Service Provided on or
			 after January 1, 2024
.
RESIDENTIAL SERVICES (Formerly known as Caring
				Together)
Program Type
Model
Rate per Month
CIRT
Clinically Intensive Residential Treatment
$222,265
IRTP
Intensive Residential Treatment Program,
							 co-located
$283,502
Intensive Residential Treatment Program, not
							 co-located
$288,141
STARR
Six Beds
$66,404
Nine Beds
$87,476
12 Beds
$116,238
15 Beds
$139,510
Teen Parenting
TLP 1:5 (per slot)
$6,358
House Parent (per slot)
$6,420
STEP (per slot)
$3,024
RESIDENTIAL SERVICES (Formerly known as Caring
				Together)
Program Type
Model
Rate
per
							 Diem
Group Home
Intensive 1:3
$354.02
Group Home 1:4
$297.74
Pre-independent Living
$255.54
Independent Living
$110.35
STARR
Six Bed
$418.50
Nine Beds
$367.73
12 Beds
$345.74
15 Beds
$332.25
Teen Parenting
Enhanced 1:4
$295.59
COMMUNITY-BASED SERVICES (Formerly known as Caring
				Together)
Program Type
Model
Rate
per
							 Diem
Continuum
Community Wrap
$119.02
Adjusted GH 1:3
$357.77
Adjusted GH 1:4
$297.07
Follow Along
$69.63
Stepping Out
$48.45
Specialty Services (Formerly known as Caring
							 Together)
Service
Rate
per
							 Diem
Transitional Age Youth: Adult
							 Continuum
$164.03
Transitional Age Youth: Young Adult Group Living
							 Environment
$355.74
Intensive 1:1 Supported Living
$697.09
Intensive 1:2 Group Home
$434.50
Intensive 1:3 Group Home with expanded
							 nursing
$417.31
Medically Complex Needs GH, nine beds
$494.08
Medically Complex Needs GH, nine beds with expanded
							 nursing
$585.04
Medically Complex Needs GH, six beds
$516.57
Medically Complex Needs GH, six beds with expanded
							 nursing
$658.53
Medically Complex Needs GH, 12 beds
$462.24
Medically Complex Needs GH, 12 beds with expanded
							 nursing
$523.59
Transition to IFC Add-on
$41.66
Teen Parenting Emergency Beds Add-on (per
							 day)
$15.24
Teen Parenting Emergency Beds Add-on (per
							 month)
$463.50
(d)
Congregate Care Program Rates Effective for Dates of Service
			 Provided on or after July 1, 2023
.
Congregate Care Program
Rate
Unit
Clinically Intensive Residential
							 Treatment
$388,523
monthly program rate
Community Treatment Residence
							 (Non-ERTP)
$522.47
per bed day
Community Treatment Residence (ERTP)
$545.04
per bed day
Intensive Home Based Therapeutic Care
$189.18
per day per person
Emergency Residence
$636.00
per bed day
Intensive Emergency Residence
$755.87
per bed day
Intensive Residential Treatment
							 Program
$497,888
monthly program rate
Intensive Treatment Residence
							 (Non-ERTP)
$777.62
per bed day
Intensive Treatment Residence (ERTP)
$794.19
per bed day
Intensive Treatment Residence Emergency
							 Intake-Add-on
$119.42
per bed day
Medically Complex & Behavioral Residence
							 (Non-ERTP)
$737.48
per bed day
Medically Complex & Behavioral Residence
							 (ERTP)
$754.05
per bed day
Medically Complex Residence
							 (Non-ERTP)
$759.25
per bed day
Medically Complex Residence (ERTP)
$771.68
per bed day
Specialty Treatment Residence (Commercially Sexually
							 Exploited Children)
$668.66
per bed day
Specialty Treatment Residence
							 (Non-ERTP)
$660.85
per bed day
Specialty Treatment Residence (ERTP)
$674.03
per bed day
Therapeutic Group Care - 6 beds
$99,178
monthly program rate
Therapeutic Group Care - 9 beds
$135,891
monthly program rate
Therapeutic Group Care - 12 beds
$170,267
monthly program rate
Young Adult Supported Living
$195.39
per bed day
Young Adult Therapeutic Care
							 -Outreach
$63.21
daily slot rate
Young Adult Therapeutic Care -Staffed
							 Apartments
$87,633
monthly program rate
Young Adult Therapeutic Care -Staffed
							 Apartments
$14,605
monthly single apt.
Young Adult Therapeutic Care -Supported
							 Apartments
$6,236
monthly single apt.
Young Adult Therapeutic Care -Supported Apartments
							 Hold
$65.52
daily rate
Young Parent Assessment
$406.33
per assessment
Young Parent Living Program
$9,481.57
monthly bed rate
Youth & Young Adult Group
							 Residence
$408.96
per bed day
Youth & Young Adult Supported Living
							 Community
$378.49
per bed day
(e)
Add-on Rates Effective for Dates of Service Provided on or after
			 January 1, 2024
.
Add-on Rates (Monthly)
Position
1.0 FTE
0.75 FTE
0.50 FTE
0.25 FTE
Direct Care
$4,244
$3,183
$2,122
$1,061
Certified Nursing Assistant
$4,023
$3,017
$2,011
$1,006
Direct Care III
$5,415
$4,061
$2,708
$1,354
Occupational Therapist
$8,634
$6,475
$4,317
$2,158
Occupational Therapist Assistant
$7,137
$5,353
$3,568
$1,784
Case Manager, Social Worker, Clinician (MA level-not
							 Independent Licensed)
$6,829
$5,122
$3,414
$1,707
LPN
$6,497
$4,873
$3,248
$1,624
Registered Nurse
$10,523
$7,893
$5,262
$2,631
Clinician w/Independent License
$7,858
$5,894
$3,929
$1,965
Social/Caseworker (BA Level)
$5,448
$4,086
$2,724
$1,362
Add-on Rates (Hourly)
Position
Rate
Direct Care
$26.10
Certified Nursing Assistant
$24.73
Direct Care III
$33.29
Occupational Therapist
$58.86
Occupational Therapist Assistant
$48.68
Case Manager, Social Worker, Clinician (MA level -
							 not Independent Licensed)
$46.57
LPN
$44.30
Registered Nurse
$71.77
Clinician w/Independent License
$53.60
Social/Caseworker (BA Level)
$37.17
Nurse Practitioner/APRN
$94.45
Psychologist/Psychiatrist (PhD)
$152.17
Forensic Psychiatrist
$181.00
Other Add-on Rates
Service
Rate
Canine Therapy
$10,000 per dog
Extraordinary Circumstances/Flex
							 Funding
Individual Consideration (I.C.)
Adjudicated Youth Residential
							 Treatment Add-on Rates
Position -
							 Add-on
Unit
Rate
Clinical Director
Per Youth, Per Day
$37.69
Clinician (LICSW)
Per Youth, Per Day
$29.96
Direct Care
Per Youth, Per Day
$15.46
(f)
Community Service Network (CSN)/READY Rates Effective for Dates of
			 Service Provided on or after January 1, 2024
.
Community Service Network
							 (CSN)/READY
Rates are based on region, and reflect per client per
							 enrollment day.
Model
Rate per Client per Enrollment
							 Day
Central Region
$44.05
Metro Boston Region
$62.81
Northeast Region
$32.22
Southeast Region
$38.65
West Region
$41.16
Community Service Network (CSN) Add-on
							 Rates
Add-on
Unit
Rate
Occupancy Add-on:
Monthly
$10,000.00
Youth Service Coordinator Add-on: 0.50
							 FTE
Monthly
$2,900
Youth Service Coordinator Add-on: 1.0
							 FTE
Monthly
$5,801
Administrative Assistant/Transporter Add-on: 0.50
							 FTE
Monthly
$2,268
Administrative Assistant/Transporter Add-on: 1.0
							 FTE
Monthly
$4,536
READY Program: 1.0 FTE
Enrolled Day
$19.61