Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.5 CMR 4.00 - Rates For Certain Social, Rehabilitation And Health Care Consultant Services › Section 4.02 - Definitions

Current through Register 1525, July 5, 2024
Approved Rate
. The rate per service
				unit approved by the Division, or, in the case of cost reimbursement, the
				maximum obligation approved by the Division.
Client Resources
. Revenue received in
				cash or kind from publicly aided clients to defray all or a portion of the cost
				of the service. These may include supplemental security income received by the
				operating agency to defray the room and board expense of residential clients,
				clients' food stamps, or payments made by clients according to ability to pay
				or sliding fee scale.
Consultant Services
. Services rendered
				by individuals who provide social, rehabilitation, or healthcare related
				services to clients when the services are purchased directly by governmental
				units. These do not include consultant services purchased by a provider in
				order to deliver services purchased by a governmental unit.
Cost Reimbursement
. A purchase
				arrangement, where the provider bills the purchasing governmental unit for
				costs incurred up to the stated maximum obligation.
Division
. The Division of Health Care
				Finance and Policy established under M.G.L.c. 118G
Established Charge
. The lowest fee
				that is charged by the provider to the general public or any third party payor
				other than a governmental unit, for the provision of one service unit. Fees
				which are based upon the purchaser's ability to pay, as in the case of a
				sliding fee scale, and fees which are subject to Division review and approval
				shall not be deemed to be established charges.
Fixed Costs
. Those costs, as
				determined by the Division, which are independent of inflation and the level of
				occupancy include, but are not limited to interest associated with long-term
				debt, depreciation, insurance on buildings and equipment, real estate taxes,
				lease or rental payments, and the non-income related portion of the
				Massachusetts corporate excise tax.
Governmental Unit
. The Commonwealth of
				Massachusetts and any board, commission, department, division, or agency of the
				Commonwealth of Massachusetts and any school district or other political
				subdivision of the Commonwealth of Massachusetts.
Maximum Obligation
. The maximum dollar
				amount by which a purchasing governmental unit(s) may obligate the Commonwealth
				under a contract for the purchase of health care services.
Out-of-State Governmental Unit
. A
				state other than the Commonwealth of Massachusetts and any board, commission,
				department, division, or agency of that state or the government of the United
				States.
Out-of-State Provider
. An individual,
				group or legal entity that operates or will operate a program of health care
				services which care and services have been or will be provided outside the
				Commonwealth of Massachusetts.
Program
. The organization and delivery
				of a predetermined mix or configuration of health services designed to assist
				clients in achieving a common objective, alleviate a common problem or meet a
				common need.
Provider
. Any person, partnership,
				corporation, trust or other entity providing health care services and meeting
				such conditions of participation as have been or may be adopted from time to
				time by a governmental unit purchasing such services.
Prudent Buyer Concept
. An assumption
				that any amount paid for goods and services which is above the market price or
				the amount paid by comparable providers is unreasonable.
Publicly Assisted Client
. A person who
				receives care in a program for which a governmental unit is in whole or in part
				liable for such care under a statutory program of financial assistance.
Related Party
. A person or
				organization which is associated or affiliated with or has control of or is
				controlled by the provider or is related to the provider or any director,
				stockholder, trustee, partner or administrator of the provider by common
				ownership or control or in a manner specified in sections 267(b) and (c) of the
				Internal Revenue Code of 1954 as amended provided, however, that 10% shall be
				the operative factor as set out in sections 267(b)(2)(8)(10)(11) and (12) and f
				(1)(A) and provided further that the definition of "family members" found in
				section 267(c)(4) of said code shall include, for the purposes of 114. 5 CMR
				4.00, spouses and lineal descendants of the individual's brothers and sisters,
				brothers and sisters of the individual's spouse as well as spouses and lineal
				descendants of same and lineal ancestors of the individual's spouse.
Restricted Funds
. Funds which have
				been restricted as to application by the donor or grantor, or which are
				generated from funds so restricted. Funds which have been restricted as to
				application by the board of the provider are not restricted funds.
Service Unit
. A unit of care as
				determined by the purchasing governmental unit.