reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 431.00 - Rates for Certain Respite Services › Section 431.04 - 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 EOHHS must 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 EOHHS or the
			 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 431.00 - Rates for Certain Respite Services › Section 431.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				431.00 are severable. If any provision of
				101 CMR
				431.00 or application of such provision to any
				eligible provider or fiscal intermediary is held invalid or unconstitutional,
				such determination will not affect the validity or constitutionality of any
				remaining provisions of
				101 CMR
				431.00 or application of such provisions to eligible
				providers or fiscal intermediaries in circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 432.00 - Rates for Certain Lead Agency Services › Section 432.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR
			 432.00 governs the payment rates for certain lead
			 agency services purchased by governmental units, including the Department of
			 Children and Families.
(2)
Applicable Dates of Service
. Rates contained within
			 101 CMR
			 432.00 apply for dates of service provided on or after
			 July 1, 2023.
(3)
Disclaimer of Authorization of Services
.
			 101 CMR
			 432.00 is neither authorization for nor approval of
			 the services for which rates are determined pursuant to
			 101 CMR
			 432.00. Governmental units that purchase the services
			 described in
			 101 CMR
			 432.00 are responsible for the definition,
			 authorization, and approval of services extended to clients.
(4)
Administrative
			 Bulletins
. EOHHS may issue administrative bulletins to clarify its
			 policy on substantive provisions of
			 101 CMR
			 432.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 432.00 - Rates for Certain Lead Agency Services › Section 432.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				432.00, unless the context requires otherwise, terms
				have the meanings in
				101
				CMR 432.02.
Client
. An individual that receives
				certain lead agency services purchased by a governmental unit.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) is used when required.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Flex Funding
. A method whereby,
				subject to availability, a purchasing governmental unit may provide resource
				allocations to a client(s) and/or provider(s) across the state. Flexible
				funding may be provided through a number of means including, but not limited
				to, reimbursement to client for specific support services or funds directed to
				a qualified provider for extraordinary circumstances.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Individual Consideration (I.C)
.
				Payment rates for certain services are designated as individual consideration
				(I.C.). Where I.C. rates are designated, the purchasing governmental unit will
				determine the appropriate payment as the actual cost of the item or service as
				evidenced by invoice, published tuition amount, or other price reasonably
				obtained by a competitive market for the product or service.
Lead Agency
. An agency that works in
				partnership with Massachusetts Department of Children and Families Area Offices
				and its communities to support and enhance the performance of the Area Offices
				in achieving positive permanent outcomes for children and their families. The
				lead agency does this by serving as the hub for coordinating purchased services
				and non-paid community supports.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been contracted by a purchasing governmental unit.
Reporting Year
. The provider's fiscal
				year for which costs incurred are reported to the Operational Services Division
				on the Uniform Financial Statements and Independent Auditor's Report
				(UFR).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 432.00 - Rates for Certain Lead Agency Services › Section 432.03 - 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 in the terms of the
			 purchase agreement between the eligible provider and the purchasing
			 governmental unit(s).
(2)
Reimbursement as Full Payment
. Each eligible provider
			 must, as a condition of acceptance of payment made by any purchasing
			 governmental units for services rendered, accept the approved program rate as
			 full payment and discharge of all obligations for the services rendered.
			 Payment from any other source will be used to offset the amount of the
			 purchasing governmental unit's obligation for services rendered to the publicly
			 assisted client.
(3)
Payment Limitations
. No purchasing governmental unit
			 may pay less than or more than the approved program rate.
(4)
Services Provided on the
			 Islands of Martha's Vineyard and Nantucket
. In accordance with the
			 provisions of St. 2016, c. 133, payment for services provided in programs
			 located on the islands of Martha's Vineyard and Nantucket will be made at the
			 rate for the service contained in
			 101
			 CMR 432.03(6) times a factor
			 of 1.07.
(5)
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.
(6)
Approved Rates
.
			 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 432.03.
Service
Tier
Unit of
							 Service
Rate
Lead Agency
1
Month
$29,303
2
Month
$35,571
3
Month
$41,494
4
Month
$45,631
5
Month
$62,841
6
Month
$83,214
Flex Funding
n/a
I.C.
Case Manager/ Education Coordinator (0.5
							 FTE)
Add-on
Month
$3,340
Case Manager/ Education Coordinator (1.0
							 FTE)
Add-on
Month
$6,680
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 432.00 - Rates for Certain Lead Agency Services › Section 432.04 - 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 EOHHS must 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 EOHHS or the
			 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 432.00 - Rates for Certain Lead Agency Services › Section 432.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				432.00 are severable. If any provision of
				101 CMR
				432.00 or application of such provision to any
				eligible provider or fiscal intermediary is held invalid or unconstitutional,
				such determination will not affect the validity or constitutionality of any
				remaining provisions of
				101 CMR
				432.00 or application of such provisions to eligible
				providers or fiscal intermediaries in circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 433.00 › Section 433.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 433.00 governs the payment rates for
			 Certain Health and Human Services Programs Previously Established on July 1,
			 2021 purchased by a governmental unit, including, but not limited to,
			 Department of Developmental Services (DDS), the Massachusetts Commission for
			 the Blind (MCB), the Massachusetts Rehabilitation Commission (MRC), the
			 Department of Mental Health (DMH), the Department of Youth Services (DYS), the
			 Department of Children and Families (DCF), the Department of Public Health
			 (DPH), the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH),
			 or MassHealth.
(2)
Applicable Dates of Service
. Rates contained in 101
			 CMR 433.00 apply for dates of service provided on or after January 1,
			 2022.
(3)
Disclaimer of
			 Authorization of Services
. 101 CMR 433.00 is neither authorization
			 for nor approval of the services for which rates are determined pursuant to 101
			 CMR 433.00. Governmental units that purchase the services described in 101 CMR
			 433.00 are responsible for the definition, authorization, and approval of
			 services provided to clients.
(4)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy on substantive provisions of 101
			 CMR 433.00.
(5)
Parent
			 Regulations
. 101 CMR 433.00 describes operational add-on rates for
			 certain services whose basic rates are governed by other regulations. For
			 services not included in 101 CMR 433.00, please refer to the parent regulation
			 listed in 101 CMR 433.01(5).
Service
Parent
							 Regulation
Residential Rehabilitation programs, Clinically
							 Managed Detoxification Services, Supportive Case Management Services, Triage,
							 Engagement and Assessment Services, Youth Residential and Clinical SUD
							 Treatment Services and Office Based Opioid Treatment Services
101 CMR 346.00:
Rates for Certain Substance-Related and Addictive Disorders
							 Programs
Certain Adult Housing and Community Support
							 Services
101 CMR 421.00:
Rates for Adult Housing and Community Support
							 Services
Certain Youth and Young Adult
							 Services
101 CMR 427.00:
Rates for Certain Youth and Young Adult Support
							 Services
Certain Independent Living
							 Communities
101 CMR 428.00:
Rates for Certain Independent Living Communities and
							 Services
Sexual and Domestic Violence Services
101 CMR 429.00:
Rates for Certain Sexual and Domestic
Violence Services
Program of Assertive Community Treatment
							 Services
101 CMR 430.00:
Rates for Program of Assertive Community Treatment
							 Services
Certain Respite Services
101 CMR 431.00:
Rates for Certain Respite Services
Certain Lead Agency Services
101 CMR 432.00:
Rates for Certain Lead Agency Services
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 433.00 › Section 433.02 - Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 433.00, terms have the meanings in 101 CMR
				433.02, except as otherwise provided.
Client
. An individual receiving
				services purchased by a governmental unit.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) is used when required.
COVID -19 Payment Rate
. A rate that is
				intended to take into account the change in program model necessary due to
				COVID-19 requirements, which will be instituted at the discretion of the
				purchasing governmental unit.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been adopted by a purchasing governmental unit.
Reporting Year
. The provider's fiscal
				year for which costs incurred are reported to the Operational Services Division
				on the Uniform Financial Statements and Independent Auditor's Report
				(UFR).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 433.00 › Section 433.04 - 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 EOHHS must 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 EOHHS or the
			 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 433.00 › Section 433.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 433.00 are severable. If any
				provision of 101 CMR 433.00 or application of such provision to any eligible
				provider or fiscal intermediary is held invalid or unconstitutional, such
				determination will not affect the validity or constitutionality of any
				remaining provisions of 101 CMR 433.00 or application of such provisions to
				eligible providers or fiscal intermediaries in circumstances other than those
				held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 444.00 - Rates for Certain Substance Use Disorder Services › Section 444.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 444.00 governs rates of payment for opioid treatment
			 services to be used by all governmental units making payment to eligible
			 providers of certain substance use disorder services to publicly assisted
			 clients. The rates for health care services set forth in
			 101 CMR
			 444.00 also apply to individuals covered by M.G.L. c.
			 152 (the Workers' Compensation Act).
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 444.00 apply for dates of service provided on or after
			 January 1, 2023.
(3)
Disclaimer of Authorization of Services
.
			 101 CMR
			 444.00 is neither authorization for nor approval of
			 the substantive services for which rates are determined pursuant to
			 101 CMR
			 444.00. Governmental units that purchase services from
			 eligible providers are responsible for the definition, authorization, and
			 approval of services extended to publicly assisted 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 444.00 - Rates for Certain Substance Use Disorder Services › Section 444.03 - 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 444.03(2).
(3) An eligible provider that was paid by a
			 governmental unit for opioid treatment services provided in a prior fiscal
			 year, and whose program operated for the entire prior fiscal year must submit
			 the following information to the Operational Services Division and/or to the
			 Center for Health Information and Analysis as required:
a. An annual Uniform Financial Statements and
			 Independent Auditor's Report (UFR) completed in accordance with:
1. the filing requirements and schedule of
			 808 CMR
			 1.00:
Compliance, Reporting and Auditing for
			 Human and Social Services;
and
2. any special instructions appearing in the
			 UFR Audit & Preparation Manual, which may require that certain providers
			 distinguish certain programs by filing separate UFR Schedule Bs for each
			 program; and
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 444.00 - Rates for Certain Substance Use Disorder Services › Section 444.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				444.00 are severable. If any provision of
				101 CMR
				444.00 or application of such provision to any
				eligible provider or fiscal intermediary is held invalid or unconstitutional,
				such determination will not affect the validity or constitutionality of any
				remaining provisions of
				101 CMR
				444.00 or application of such provisions to eligible
				providers or fiscal intermediaries in circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 445.00 › Section 445.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 445.00 governs the payment rates for
			 Adult Day Health Services, Day Habilitation Services, Day Services,
			 Prevocational Services, and Supported Employment Services as defined in 101 CMR
			 445.02, purchased by a governmental unit.
(2)
Applicable Dates of
			 Service
. Rates contained in 101 CMR 445.00 apply for dates of
			 service as stated in 101 CMR 445.03(2).
(3)
Disclaimer of Authorization
			 of Services
. 101 CMR 445.00 is neither authorization for nor
			 approval of the services for which rates are determined pursuant to 101 CMR
			 445.00. Governmental units that purchase the services described in 101 CMR
			 445.00 are responsible for the definition, authorization, and approval of
			 services provided to clients.
(4)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy on substantive provisions of 101
			 CMR 445.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 445.00 › Section 445.04 - 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 EOHHS must 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 EOHHS or the
			 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 445.00 › Section 445.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 445.00 are severable. If any
				provision of 101 CMR 445.00 or application of such provision to any eligible
				provider or fiscal intermediary is held invalid or unconstitutional, such
				determination will not affect the validity or constitutionality of any
				remaining provisions of 101 CMR 445.00 or application of such provisions to
				eligible providers or fiscal intermediaries in circumstances other than those
				held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 446.00 - COVID-19 Payment Rates for Certain Community Health Care Providers › Section 446.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
. 101 CMR 446.00 governs the rates of
			 payment to certain community health care providers to be used by all
			 governmental units for services provided to publicly aided individuals. The
			 rates set forth in 101 CMR 446.03(1), (4) and (5) also apply to such services
			 paid for by governmental units for individuals covered by M.G.L. c. 152 (the
			 Workers' Compensation Act). These rates are for services related to Coronavirus
			 Disease 2019 (COVID-19).
(2)
Applicable Dates of Service
. Rates contained in 101
			 CMR 446.00 apply for dates of service on or after November 25, 2022, except as
			 otherwise noted.
(3)
Disclaimer of Authorization of Services
. 101 CMR
			 446.00 is not authorization for or approval of the services for which rates are
			 determined pursuant to 101 CMR 446.00. Governmental units that purchase
			 services are responsible for the definition, authorization, and approval of
			 care and services provided to publicly aided individuals.
(4)
Coverage
. The
			 rates of payment in 101 CMR 446.00 constitute payment in full for all services
			 provided by an eligible provider, including administration and professional
			 supervision services. The payment rates will apply to COVID-19 services
			 provided by eligible providers to publicly aided individuals under the
			 conditions described by the purchasing governmental unit.
(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 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 existing and new codes
			 and the codes 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, or codes that had been
			 previously added at individual consideration (I.C.). EOHHS may list and price
			 these codes according to the rate methodology used in setting rates when
			 Medicare fees are available. When Medicare fees are not available, EOHHS may
			 apply 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 446.00 - COVID-19 Payment Rates for Certain Community Health Care Providers › Section 446.03 - General Rate Provisions and Payment

Current through Register 1525, July 5, 2024
(1)
Community Health Centers
.
(a)
General Rate
			 Determination
. Rates of payment for services for which 101 CMR
			 446.03(1) applies are the lowest of
1. the
			 eligible provider's usual fee to patients other than publicly aided
			 individuals;
2. the eligible
			 provider's actual charge submitted; or
3. the schedule of allowable fees set forth
			 in 101 CMR 446.03(1)(c), taking into account appropriate modifiers and any
			 other applicable rate provisions in accordance with 101 CMR
			 446.03(1).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 446.00 - COVID-19 Payment Rates for Certain Community Health Care Providers › Section 446.04 - Special Contracts

Current through Register 1525, July 5, 2024
Notwithstanding 101 CMR 446.03, a governmental unit may enter
				into a special contract with an eligible provider under which the governmental
				unit will pay for services authorized, but not listed herein, or authorized
				services performed in exceptional circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 446.00 - COVID-19 Payment Rates for Certain Community Health Care Providers › Section 446.05 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Except as otherwise provided,
			 reporting requirements are governed by
			 957
			 CMR 6.00:
Cost Reporting
			 Requirements
.
(2)
Penalty for Noncompliance
. Except as otherwise
			 provided, 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 446.05(2)
			 .
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 446.00 - COVID-19 Payment Rates for Certain Community Health Care Providers › Section 446.06 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 446.00 are severable and if any
				provisions of 101 CMR 446.00 or the application of such provisions to any
				person or circumstances is held to be invalid or unconstitutional, such
				invalidity will not be construed to affect the validity or constitutionality of
				any remaining provisions of 101 CMR 446.00 or 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 448.00 › Section 448.02 - Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 448.00, terms have the meanings as defined
				in 101 CMR 448.02, except as otherwise provided.
Client
. An individual receiving
				services purchased by a governmental unit.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) pursuant to
				808 CMR 1.00:
Compliance, Reporting and Auditing for Human and Social
				Services
is used when required.
COVID-19 Payment Rate
. A rate that is
				intended to take into account the change in program model necessary due to
				COVID-19 requirements, which will be instituted at the discretion of the
				purchasing governmental unit.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been adopted by a purchasing governmental unit.
Reporting Year
. The provider's fiscal
				year for which costs incurred are reported to the Operational Services Division
				on the Uniform Financial Statements and Independent Auditor's Report (UFR)
				pursuant to
				808 CMR 1.00:
Compliance, Reporting and Auditing for Human and Social
				Services
.
State Funding
. The aggregate amount of
				payments to a provider by a governmental unit for services purchased at rates
				established in 101 CMR 448.01(5). State funding does not include any amounts
				attributable to federal funding or grant funds.
Workforce Investment
. Funds directed
				to a provider for workforce investment. As a condition of receipt of these
				additional funds, eligible provider agencies must complete an attestation
				assuring EOHHS that they will use at least 90% of the funds for health and
				human service workforce development, which could include hiring and retention
				bonuses and other categories of front-line worker compensation.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 448.00 › Section 448.03 - 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 in the terms of the
			 purchase agreement between the eligible provider and the purchasing
			 governmental unit(s).
(2)
Reimbursement as Full Payment
. Each eligible provider
			 must, as a condition of acceptance of payment made by any purchasing
			 governmental units for services rendered, accept the approved program rate as
			 full payment and discharge of all obligations for the services rendered.
			 Payment from any other source will be used to offset the amount of the
			 purchasing governmental unit's obligation for services rendered to the publicly
			 assisted client.
(3)
Payment Limitations
. No purchasing governmental unit
			 may pay less than or more than the approved program rate.
(4)
Lump Sum
			 Payment
. Purchasing governmental units may pay a lump sum payment
			 limited to the equivalent of six monthly units. The lump sum payment will be
			 calculated according to the following formula: Sum of {[(total May 2021 (one
			 month) State spend on the services listed in 101 CMR 448.01(5) *(Add-on rate of
			 10%)*(6 units)]}.
(5)
Approved Rates with Applicable Dates of Service Provided from July
			 1, 2021 through June 30, 2022
. 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 448.03(5). Effective July 1, 2022, the rates revert to
			 the rates in the parent regulations listed in 101 CMR 448.01(5).
Add-on
Unit
Rate
Workforce Investment for the Services Listed in 101
							 CMR 448.01(5)
Monthly
10% of the Provider's May 2021 (FY21) State
							 Funding
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 448.00 › Section 448.04 - 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 EOHHS must 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 EOHHS or the
			 purchasing governmental unit upon request all records relating to its reported
			 costs, including costs of any entity related by common ownership or
			 control.
(c)
Field
			 Audits
. EOHHS may conduct a field audit. EOHHS will make
			 reasonable attempts to schedule an audit at the mutual convenience of both
			 parties.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 448.00 › Section 448.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 448.00 are severable. If any
				provision of 101 CMR 448.00 or application of such provision to any eligible
				provider or fiscal intermediary is held invalid or unconstitutional, such
				determination will not affect the validity or constitutionality of any
				remaining provisions of 101 CMR 448.00 or application of such provisions to
				eligible providers or fiscal intermediaries in circumstances other than those
				held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 449.00 - Rates for Certain Home- and Community-based Services Related to Workforce Development › Section 449.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR
			 449.00 governs the payment rates for
			 MassHealth-covered state plan home health aide services purchased by a
			 governmental unit.
			 101 CMR
			 449.00 also governs the payment rates for
			 MassHealth-covered homemaker and personal care homemaker waiver services when
			 purchased by a governmental unit in one of four MassHealth Home and
			 Community-based Services (HCBS) Waivers. The four HCBS Waivers are: Acquired
			 Brain Injury Non-residential Habilitation (ABI-N) Waiver, Acquired Brain Injury
			 Residential Habilitation (ABI-RH) Waiver, Moving Forward Plan Community Living
			 (MFP-CL) Waiver, and Moving Forward Plan Residential Supports (MFP-RS)
			 Waiver.
(2)
Applicable
			 Dates of Service
. Rates contained in
			 101 CMR
			 449.00 apply for dates of service as stated in
			 101
			 CMR 449.03.
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 449.00 is neither authorization for nor approval of
			 the services for which rates are determined pursuant to
			 101 CMR
			 449.00. Governmental units that purchase the services
			 described in
			 101 CMR
			 350.00:
Rates for Home Health
			 Services
,
			 101 CMR
			 359.00:
Rates for Home and Community-based
			 Services Waivers
, and
			 101 CMR
			 453.00:
Enhanced Rates for Certain Home- and
			 Community-based Services Related to Section 9817 of the American Rescue Plan
			 Act
are responsible for the definition, authorization, and approval of
			 services provided to clients.
(4)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy on substantive provisions of
			 101 CMR
			 449.00.
(5)
Parent
			 Regulations
.
			 101 CMR
			 449.00 describes operational add-on rates for certain
			 services whose basic rates are governed by other regulations. For services not
			 included in
			 101 CMR
			 449.00, please refer to the parent regulation at
			 101 CMR
			 350.00:
Rates for Home Health
			 Services
,
			 101 CMR
			 359.00:
Rates for Home and Community-based
			 Services Waivers
, or
			 101 CMR
			 453.00:
Enhanced Rates for Certain Home- and
			 Community-based Services Related to Section 9817 of the American Rescue Plan
			 Act
.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 449.00 - Rates for Certain Home- and Community-based Services Related to Workforce Development › Section 449.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				449.00, terms have the meanings in
				101
				CMR 449.02, except as otherwise
				provided.
Client
. An individual receiving
				services purchased by a governmental unit.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) is used when required.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been adopted by a purchasing governmental unit.
Reporting Year
. The provider's fiscal
				year for which costs incurred are reported to the Operational Services Division
				on the Uniform Financial Statements and Independent Auditor's Report
				(UFR).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 449.00 - Rates for Certain Home- and Community-based Services Related to Workforce Development › Section 449.03 - 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 a provider, as explicitly set forth in the terms of the purchase
			 agreement between the provider and the purchasing governmental
			 unit(s).
(2)
Reimbursement as Full Payment
. Each eligible provider
			 must, as a condition of acceptance of payment made by any purchasing
			 governmental units for services rendered, accept the approved program rate as
			 full payment and discharge of all obligations for the services rendered.
			 Payment from any other source will be used to offset the amount of the
			 purchasing governmental unit's obligation for services rendered to the publicly
			 assisted client.
(3)
Payment Limitations
. No purchasing governmental unit
			 may pay less than or more than the approved program rate.
(4)
Approved Rates with
			 Applicable Dates of Service Provided on or after July 1, 2022
. 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 449.03(4).
(a)
Home Health Aide
			 Services
. Terms used in
			 101
			 CMR 449.03(4)(a)  that have
			 not been defined elsewhere in
			 101 CMR
			 449.00 have the meanings in
			 101
			 CMR 350.02:
General
			 Definitions
.
Code
Unit
Rate
Per Unit Rate
							 Add-on
Total
G0156
Per 15 minutes
$7.40
$0.89
$8.29
G0156 UD
Per 15 minutes
$7.40
$0.89
$8.29
99509
Per 15 minutes
$7.40
$0.89
$8.29
(b)
Home- and Community-based Services Waivers
. Terms used
			 in 101 CMR 449.03(4)(b)
			  that have not been defined elsewhere in
			 101 CMR
			 449.00 have the meanings in
			 101
			 CMR 359.02:
Definitions
.
1.
Approved Rates
.
Code
Service
Unit
Rate
Per Unit Rate
							 Add-on
Total
S5130 U4,
S5130 U8 U1
Homemaker (Agency Rate)
Per 15 minutes
$6.93
$0.99
$7.92
S5130 U8 U2,
S5130 U8 UB
Homemaker (Non-agency Rate for Individual Providers
							 and Self-directed Services)
Per 15 minutes
$6.22
$0.99
$7.21
G0156 U8
Home Health Aide (Agency Rate)
Per 15 minutes
See
101
							 CMR
							 449.03(4)(a).
T1019 U4,
T1019 U8 U1
Personal Care (Agency Rate)
Per 15 minutes
$6.99
$0.99
$7.98
2.
Non-agency Rates for Self-directed Services
. The
			 non-agency rates for self-directed services consist of two components: the
			 self-directed worker rate and the employer expense component (EEC).
Service
Unit
Self-directed Worker
							 Rate
Employer Expense
							 Component
Self-directed Service
							 Rate
Homemaker
Per 15 minutes
$6.40
$0.81
$7.21
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 449.00 - Rates for Certain Home- and Community-based Services Related to Workforce Development › Section 449.04 - 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 EOHHS must 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 EOHHS or the
			 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 449.00 - Rates for Certain Home- and Community-based Services Related to Workforce Development › Section 449.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				449.00 are severable. If any provision of
				101 CMR
				449.00 or application of such provision to any
				eligible provider or fiscal intermediary is held invalid or unconstitutional,
				such determination will not affect the validity or constitutionality of any
				remaining provisions of
				101 CMR
				449.00 or application of such provisions to eligible
				providers or fiscal intermediaries in circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 452.00 › Section 452.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
. 101 CMR 452.00 governs the payment
			 rates for workforce investment for certain Health and Human Services programs
			 purchased by a governmental unit including, but not limited to, the Department
			 of Developmental Services (DDS), the Massachusetts Commission for the Blind
			 (MCB), the Massachusetts Rehabilitation Commission (MRC), the Department of
			 Mental Health (DMH), the Department of Public Health (DPH), the Massachusetts
			 Commission for the Deaf and Hard of Hearing (MCDHH), the Department of Children
			 and Families (DCF), the Department of Youth Services (DYS), the Executive
			 Office of Elder Affairs (EOEA), and MassHealth.
(2)
Applicable Dates of
			 Service
. Rates contained in 101 CMR 452.00 apply for dates of
			 service as stated in 101 CMR 452.03(5).
(3)
Disclaimer of Authorization
			 of Services
. 101 CMR 452.00 is neither authorization for nor
			 approval of the services for which rates are determined pursuant to 101 CMR
			 452.00. Governmental units that purchase the services described in 101 CMR
			 452.00 are responsible for the definition, authorization, and approval of
			 services provided to clients.
(4)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy on substantive provisions of 101
			 CMR 452.00.
(5)
Parent
			 Regulations
. 101 CMR 452.00 describes operational add-on rates for
			 certain services whose basic rates are governed by other regulations. For
			 services not included in 101 CMR 452.01(5), please refer to the parent
			 regulation listed below.
Parent Regulation
101 CMR 306.00:
Rates of Payment for Mental Health Services Provided in Community
							 Health Centers and Mental Health Centers
101 CMR 346.00:
Rates for Certain Substance-related and Addictive Disorders
							 Programs
101 CMR 413.00:
Payments for Youth Intermediate-term Stabilization
							 Services
101 CMR 414.00:
Rates for Family Stabilization Services
101 CMR 417.00:
Rates for Certain Elder Care Services
101 CMR 418.00:
Payments for Youth Short-term Stabilization and Emergency
							 Services
101 CMR 421.00:
Rates for Adult Housing and Community Support
							 Services
101 CMR 424.00:
Rates for Certain Developmental and Support
							 Services
101 CMR 427.00:
Rates for Certain Youth and Young Adult Support
							 Services
101 CMR 428.00:
Rates for Certain Independent Living Communities and
							 Services
101 CMR 429.00:
Rates for Certain Sexual and Domestic Violence
							 Services
101 CMR 430.00:
Rates for Program of Assertive Community Treatment
							 Services
101 CMR 431.00:
Rates for Certain Respite Services
101 CMR 432.00:
Rates for Certain Lead Agency Services
101 CMR 329.00:
Psychological Testing,
							 Treatment, and Related Services
101 CMR 307.00:
Rates for Psychiatric Day Treatment Center
							 Services
101 CMR 358.00:
Rates of Payment for Applied Behavior Analysis
101 CMR 444.00:
Rates for Certain Substance Use Disorder Services
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 452.00 › Section 452.02 - Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 452.00, terms have the meanings as defined
				in 101 CMR 452.02, except as otherwise provided.
Client
. An individual receiving
				services purchased by a governmental unit.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) pursuant to
				808 CMR 1.00:
Compliance, Reporting and Auditing for Human and Social
				Services
is used when required.
COVID-19 Payment Rate
. A rate that is
				intended to take into account the change in program model necessary due to
				COVID-19 requirements, which will be instituted at the discretion of the
				purchasing governmental unit.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been adopted by a purchasing governmental unit.
Reporting Year
. The provider's fiscal
				year for which costs incurred are reported to the Operational Services Division
				on the Uniform Financial Statements and Independent Auditor's Report (UFR)
				pursuant to
				808 CMR 1.00:
Compliance, Reporting and Auditing for Human and Social
				Services
.
State Funding
. The aggregate amount of
				payments to a provider by a governmental unit for services purchased at rates
				established in 101 CMR 452.01(5). State funding does not include any amounts
				attributable to federal funding or grant funds.
Workforce Investment
. Funds directed
				to a provider for workforce investment. As a condition of receipt of these
				additional funds, eligible provider agencies must complete an attestation
				assuring EOHHS that they will use at least 90% of the funds for health and
				human service workforce development, which could include hiring and retention
				bonuses and other categories of front-line worker compensation.