reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 355.00 - Rates for Freestanding Birth Center Services › Section 355.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 355.00 governs the rates of payment to eligible
			 freestanding birth centers to be used by all governmental units for services
			 provided to publicly aided individuals.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 355.00 apply for dates of service provided on and
			 after January 19, 2024, unless otherwise indicated.
(3)
Coverage
.
			 101 CMR
			 355.00 and the rates of payment contained in
			 101 CMR
			 355.00 are full compensation for the facility
			 component of services furnished in connection with prenatal, labor, delivery,
			 newborn nursery, and postpartum care for low-risk births that can be performed
			 safely in a freestanding birth center under the scope of covered services and
			 that meet the conditions for payment for such services by the governmental
			 purchaser. Payment from any other sources is used to offset the amount of the
			 purchasing governmental unit's obligation for services rendered to the publicly
			 aided individuals.
			 101 CMR
			 355.00 does not cover professional services billed
			 separately from the birth center facility component fee by either the facility
			 or by the clinical staff.
(4)
Disclaimer of Authorization of Services
.
			 101 CMR
			 355.00 is not authorization for or approval of the
			 procedures for which rates are determined pursuant to
			 101 CMR
			 355.00. Governmental units that purchase care are
			 responsible for the definition, authorization, coverage policies, and approval
			 of care and services provided to publicly aided individuals.
(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). 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 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. 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 355.00 - Rates for Freestanding Birth Center Services › Section 355.03 - General Rate Provisions and Payment

Current through Register 1525, July 5, 2024
(1)
Rate Determination
. Rates of payment for the facility
			 component of authorized freestanding birth center facility services to which
			 101 CMR
			 355.00 applies are the lowest of
(a) the eligible provider's usual fee to the
			 general public;
(b) the eligible
			 provider's actual charge submitted; and
(c) the schedule of allowable rates set forth
			 in 101 CMR
			 355.03(5).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 355.00 - Rates for Freestanding Birth Center Services › Section 355.04 - 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 355.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 355.00 - Rates for Freestanding Birth Center Services › Section 355.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				355.00 are severable. If any provision of
				101 CMR
				355.00 or application of any provision to an
				applicable individual, entity, or circumstance is held invalid or
				unconstitutional, that holding will not be construed to affect the validity or
				constitutionality of any remaining provisions of
				101 CMR
				355.00 or application of those provisions to
				applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 356.00 - Rates For Money Follows The Person Demonstration Services › Section 356.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 356.00 governs the payment rates for Money Follows the
			 Person Demonstration (MFP Demo) services purchased by all governmental
			 units.
(2)
Applicable
			 Dates of Service
. Rates contained in
			 101 CMR
			 356.00 apply for dates of service on and after March
			 1, 2023.
(3)
Disclaimer
			 of Authorization of Services
.
			 101 CMR
			 356.00 is neither authorization for nor approval of
			 the services for which rates are determined pursuant to
			 101 CMR
			 356.00. Governmental units that purchase MFP Demo
			 services 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
			 356.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 356.00 - Rates For Money Follows The Person Demonstration Services › Section 356.03 - 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 for services included in the scope of this regulation 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
. Except as provided in
			 101
			 CMR 356.03(3), no purchasing
			 governmental unit may pay less than, or more than, the approved program
			 rate.
(4)
Rates of
			 Payment
. The approved rate is the lower of the provider's charge
			 or amount accepted as payment from another payer or the rate listed below:
Service
Rate
Assistive Technology
See
101 CMR
							 322.00:
Durable Medical Equipment, Oxygen and
							 Respiratory Therapy Equipment
Community Engagement Navigation
See
101 CMR
							 423.00:
Rates for Certain In-home Basic Living
							 Supports
Transitional Assistance
I.C.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 356.00 - Rates For Money Follows The Person Demonstration Services › Section 356.04 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Cost Reporting Requirements
. All providers must comply
			 with the requirements of
			 957 CMR
			 6.00:
Cost Reporting
			 Requirements
.
(2)
Penalties 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 government unit will notify the provider in advance of its intention
			 to impose a penalty under
			 101
			 CMR 356.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 356.00 - Rates For Money Follows The Person Demonstration Services › Section 356.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				356.00 are severable. If any provision of
				101 CMR
				356.00 or application of any provision to an
				applicable individual, entity, or circumstance is held invalid or
				unconstitutional, that holding will not be construed to affect the validity or
				constitutionality of any remaining provisions of
				101 CMR
				356.00 or application of those provisions to
				applicable individuals, entities, or circumstances
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 358.00 - RATES FOR APPLIED BEHAVIOR ANALYSIS › Section 358.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR 358.00 governs the
			 rates to be used by all governmental units in making payments to eligible
			 providers of applied behavior analysis to publicly aided individuals.
(2)
Effective Date
.
			 Rates contained in
			 101 CMR 358.00 are effective
			 for dates of service on or after October 1, 2022.
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR 358.00 is not
			 authorization for or approval of the services for which rates are determined
			 pursuant to
			 101 CMR 358.00. Governmental
			 units that purchase care and services are responsible for the definition,
			 authorization, and approval of care and services provided to publicly aided
			 individuals.
(4)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy on and understanding of
			 substantive provisions of
			 101 CMR 358.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 358.00 - RATES FOR APPLIED BEHAVIOR ANALYSIS › Section 358.02 - General Definitions

Current through Register 1525, July 5, 2024
Terms used in
				101 CMR 358.00 have the
				meanings in 101 CMR 358.02.
Applied Behavior Analysis
. A
				MassHealth service that focuses on the analysis, design, implementation, and
				evaluation of social and other environmental modifications to produce
				meaningful changes in human behavior. This service provides for the performance
				of behavioral assessments; interpretation of behavior analytic data;
				development of a highly specific treatment plan; supervision and coordination
				of interventions; and training other interveners to address specific objectives
				or performance goals in order to support the acquisition of socially
				significant adaptive skills and reduction of challenging behaviors that
				interfere with a youth's successful functioning.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Eligible Provider
. Any person,
				partnership, corporation, or other entity that is authorized to provide Applied
				Behavior Analysis services in the Commonwealth of Massachusetts and who meets
				such conditions of participation as have been adopted by a governmental
				unit.
EOHHS.
The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth of
				Massachusetts or any of its departments, agencies, boards, commissions, or
				political subdivisions.
MassHealth
. The Medicaid program of
				the Commonwealth of Massachusetts, administered by EOHHS pursuant to M.G.L. c.
				118E, Titles XIX and XXI of the Social Security Act, and other applicable laws
				and waivers thereto.
Publicly Aided Individual
. A person
				for whose medical and other services a governmental unit is in whole or in part
				liable under a statutory program.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 358.00 - RATES FOR APPLIED BEHAVIOR ANALYSIS › Section 358.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rates as Full Compensation
. The rates under 101 CMR
			 358.03 constitute full compensation for applied behavior analysis services
			 provided by eligible providers to publicly aided individuals, including full
			 compensation for necessary administration and professional supervision
			 associated with patient care.
(2)
Rates of Payment
. Payment rates under 101 CMR 358.03
			 are the lowest of
(a) the eligible provider's
			 usual charge to the general public; or
(b) the schedule of allowable rates for
			 services as set forth in 101 CMR 358.03(3).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 358.00 - RATES FOR APPLIED BEHAVIOR ANALYSIS › Section 358.04 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1) An eligible
			 provider that was paid by a governmental unit for applied behavior analysis
			 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 or to the Center, as applicable:
(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 cost centers or programs
			 by filing separate UFR-Schedule Bs for each cost center or program;
			 and
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 358.00 - RATES FOR APPLIED BEHAVIOR ANALYSIS › Section 358.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 358.00 are
				severable. If any provision of
				101 CMR 358.00 or
				application of such provision to any eligible provider 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 358.00 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 359.00 - Rates for Home and Community Based Services › Section 359.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR
			 359.00 governs the payment rates, effective as
			 provided under
			 101
			 CMR 359.03 for services in four Home and
			 Community-based Services (HCBS) Waivers purchased by a governmental unit. 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. Listed in
			 101
			 CMR 359.01(1)(a) through (d)
			 are the waiver services available in each waiver.
(a) ABI-N Waiver Services:
1. Adult Companion
2. Assistive Technology
3. Chore Services
4. Community-based Day Supports
5. Community Family Training
6. Community Support &
			 Navigation
7. Day
			 Services
8. Home Accessibility
			 Adaptations
9. Home Delivered
			 Meals
10. Home Health
			 Aide
11. Homemaker
12. Independent Living Supports
13. Individual Support and Community
			 Habilitation
14. Laundry
15. Occupational Therapy
16. Orientation and Mobility
			 Services
17. Peer Support
18. Personal Care
19. Physical Therapy
20. Prevocational Services
21. Respite Services
22. Shared Home Supports
23. Skilled Nursing
24. Specialized Medical Equipment
25. Speech Therapy
26. Supported Employment
27. Supportive Home Care Aide
28. Transitional Assistance
29. Vehicle Modification
30. Transportation
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 359.00 - Rates for Home and Community Based Services › Section 359.04 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General Provisions
. Providers must satisfy the
			 applicable reporting requirements of
			 957 CMR
			 6.00:
Cost Reporting Requirements
,
			 and 808 CMR
			 1.00:
Compliance, Reporting and Auditing for
			 Human and Social Services
.
(2)
Penalty for
			 Noncompliance
. The purchasing governmental unit may impose a
			 penalty of up to 15% for any provider that fails to submit required information
			 to the Center. The purchasing governmental unit will notify the provider in
			 advance of its intention to impose a penalty under
			 101
			 CMR 359.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 359.00 - Rates for Home and Community Based Services › Section 359.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				359.00 are severable. If any provision of
				101 CMR
				359.00 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
				359.00 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 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR
			 361.00 establishes rates of payment for continuous
			 skilled nursing agency services and independent nursing services rendered by
			 eligible providers to publicly aided individuals. The rates set forth in
			 101 CMR
			 361.00 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
			 361.00 apply for dates of service on or after July 1,
			 2023, unless otherwise specifically noted.
(3)
Coverage
.
(a) Separate rates are specified for the
			 following situations.
1. The eligible provider
			 bills as an individual practitioner for professional services rendered, and the
			 services are not covered by a facility rate.
2. The eligible provider bills as a provider
			 agency and employs, either through contractual agreement or salary, qualified
			 professionals who do not bill independently for professional services rendered
			 and whose services are not covered by a facility rate.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.03 - General Rate Provisions

Current through Register 1525, July 5, 2024
Rates of payment for authorized continuous skilled nursing
				services to which
				101 CMR
				361.00 applies will be the lower of
(a) the eligible provider's usual fee to
			 patients other than publicly aided patients; or
(b) the schedule of rates set forth in
			 101
			 CMR 361.04.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.04 - Rates of Payment

Current through Register 1525, July 5, 2024
(1)
Continuous Skilled Nursing Services
.
(a)
Single Patient, per
			 Straight-time Hour
. Weekend rates are the same as night rates.
Rates per 15 Minutes: Single
							 Patient, per Straight-time Hour
Code
Modifier
Agency
Individual
							 Practitioner
Description
T1002
$17.83
$14.65
RN Services, Weekday
T1002
UJ
$18.94
$15.66
RN Services, Nights
T1002
$24.66
$20.99
RN Services, Holidays
T1003
$14.71
$12.20
LPN Services, Weekday
T1003
UJ
$15.63
$13.07
LPN Services, Nights
T1003
$20.46
$17.58
LPN Services, Holidays
(b)
Multiple-patient Nursing
.
1. Two Individuals, per Straight-time Hour.
			 When only one of the individuals is publicly aided, the fee for services to the
			 publicly aided individual will be % of the appropriate rate listed in the table
			 "Two Individuals, per Straight-Time Hour." Weekend rates are the same as night
			 rates.
Rates per 15 Minutes: Two
							 Individuals, per Straight-time Hour
Code
Modifier
Agency
Individual
							 Practitioner
Description
T1002
TT
$25.08
$21.18
RN Services, Weekday
T1002
U1
$26.71
$22.72
RN Services, Nights
T1002
TT
$35.29
$30.68
RN Services, Holidays
T1003
TT
$20.79
$17.71
LPN Services, Weekday
T1003
U1
$22.17
$19.00
LPN Services, Nights
T1003
TT
$29.43
$25.75
LPN Services, Holidays
2.
Three Individuals, per Straight-time Hour
. When only
			 one of the individuals is publicly aided, the fee for services to the publicly
			 aided individual will be A of the appropriate rate listed. When two of the
			 individuals are publicly aided, the fee for services to the publicly aided
			 individuals will be 
			 2/3 of the
			 appropriate rate listed. Weekend rates are the same as night rates.
Rates per 15 Minutes: Three
							 Individuals, per Straight-Time Hour
Code
Modifier
Agency
Individual
							 Practitioner
Description
T1002
U2
$29.96
$24.56
RN Services, Weekday
T1002
U3
$31.88
$26.35
RN Services, Nights
T1002
U2
$41.90
$35.65
RN Services, Holidays
T1003
U2
$25.23
$20.54
LPN Services, Weekday
T1003
U3
$26.85
$22.06
LPN Services, Nights
T1003
U2
$35.32
$29.92
LPN Services, Holidays
(c)
Overtime
.
			 Weekend rates are the same as night rates.
Rates per 15 Minutes:
							 Overtime
Code
Modifier
Agency
Individual
							 Practitioner
Description
T1002
TU
$24.66
$20.99
RN Services, Weekday
T1002
U4
$26.31
$22.52
RN Services, Nights
T1002
TU
$34.89
$30.49
RN Services, Holidays
T1003
TU
$20.46
$17.58
LPN Services, Weekday
T1003
U4
$21.86
$18.87
LPN Services, Nights
T1003
TU
$29.11
$25.60
LPN Services, Holidays
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.05 - Administrative Adjustment

Current through Register 1525, July 5, 2024
(1) A certified
			 home health agency or CSN agency may apply for a change in rate(s) of payment
			 due to costs associated with providing interpreter and security/escort services
			 as defined in
			 101
			 CMR 361.02.
(2) Administrative adjustment may be provided
			 on a prospective basis only.
(3)
			 Administrative relief will consist of an adjustment to the rate calculated by
			 dividing the costs from the most recently filed and reviewed Cost Report filed
			 pursuant to
			 101
			 CMR 361.06, by the number of service units
			 reported for that corresponding period. The costs allowed will be limited to
			 reasonable costs as defined in
			 101
			 CMR 361.02.
(4) An administrative adjustment that an
			 agency was awarded in a prior period may be updated by EOHHS using data from
			 the most recent Cost Report.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.06 - Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Cost Reports
. Cost 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 361.06(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 361.00 - Rates for Continuous Skilled Nursing Agency and Independent Nursing Services › Section 361.07 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				361.00 are severable. If any provision of
				101 CMR
				361.00 or application of any provision to an
				applicable individual, entity, or circumstance is held invalid or
				unconstitutional, that holding will not be construed to affect the validity or
				constitutionality of any remaining provisions of
				101 CMR
				361.00 or application of those provisions to
				applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 362.00 - Rates for Community Support Program Services › Section 362.01 - General Provision

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 362.00 governs the rates to be used by all
			 governmental units and worker's compensation insurers for community support
			 program services provided by community support programs.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 362.00 apply for dates of service provided on or after
			 April 1, 2023.
(3)
Disclaimer of Authorization of Services
.
			 101 CMR
			 362.00 is neither authorization for nor approval of
			 the services for which rates are determined pursuant to
			 101 CMR
			 362.00. Governmental units that purchase the services
			 described in
			 101 CMR
			 362.00 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 and understanding of substantive provisions of
			 101 CMR
			 362.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 362.00 - Rates for Community Support Program Services › Section 362.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rates as Full Compensation
. The rates under
			 101 CMR
			 362.00 constitute full compensation for community
			 support program services provided by community support programs to publicly
			 aided and industrial accident patients, including full compensation for
			 necessary administration and professional supervision associated with patient
			 care.
(2)
Rates of
			 Payment
. Payment rates under
			 101 CMR
			 362.00 are the lower of
(a) the eligible provider's usual charge to
			 the general public; or
(b) the
			 schedule of allowable rates for services provided by community support programs
			 as set forth in
			 101
			 CMR 362.03(4).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 362.00 - Rates for Community Support Program Services › Section 362.04 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				362.00 are severable. If any provision of
				101 CMR
				362.00 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
				362.00 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 410.00 - Rates for Competitive Integrated Employment Services › Section 410.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 410.00 governs the payment rates for
			 competitive integrated employment services (CIES) purchased by a governmental
			 unit. CIES are provided to assist clients to obtain and retain competitive
			 employment in an integrated, community-based work setting with wages and
			 benefits that are comparable to those received by other workers in similar
			 positions. CIES consist of five separate service components, each associated
			 with a specific client outcome: intake, evaluation, and assessment;
			 job-targeted educational and skills development activities; job development and
			 placement; initial employment supports; and ongoing and interim supports. CIES
			 are furnished under an Executive Office of Health and Human Services (EOHHS)
			 Master Agreement (MA). Providers qualified to deliver CIES under the MA will be
			 engaged separately by EOHHS departments to deliver specified
			 services.
(2)
Applicable Dates of Service
. Rates contained in 101
			 CMR 410.00 apply for dates of service provided on or after July 1,
			 2024.
(3)
Disclaimer of
			 Authorization of Services
. 101 CMR 410.00 is neither authorization
			 for nor approval of the services for which rates are determined pursuant to 101
			 CMR 410.00. Governmental units that purchase CIES 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 410.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 410.00 - Rates for Competitive Integrated Employment Services › Section 410.02 - Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 410.00, unless the context requires
				otherwise, terms have the meanings in
				101
				CMR 410.02.
Client
. An individual that receives
				CIES purchased by a governmental unit including, but not limited to, clients
				currently or formerly receiving services from the Department of Developmental
				Services: Employment Supports; the Massachusetts Rehabilitation Commission:
				Vocational Rehabilitation, Community-based Employment Services; the Department
				of Transitional Assistance: Supported Work Program, ESP-Workforce Investment
				Area (WIA), Community-based Employment Service, Supplemental Nutrition
				Assistance Program (SNAP), Employment and Training; Massachusetts Commission
				for the Blind: Personal Vocational Adjustment. A governmental unit may also
				purchase additional CIES at the rates set forth in
				101
				CMR 410.03(3).
Competitive Integrated Employment
. A
				job in an integrated, community-based work setting where the client receives
				wages and benefits paid by an employer that are comparable to wages and
				benefits paid to workers in similar positions.
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.
Extraordinary Circumstances/Flex
				Funding
. A method whereby, subject to availability, a purchasing
				governmental unit may provide resource allocations to a client and/or a
				provider across the state. Flexible funding may be provided through a number of
				means including, but not limited to, reimbursement to the 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.
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 or may be 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 410.00 - Rates for Competitive Integrated Employment Services › Section 410.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Payment Methods
.
(a)
General
. Purchasing governmental units will pay
			 providers a total payment per completed service component as defined in
			 101
			 CMR 410.03(2).
1.
Standard Progress
			 Documentation
. Providers must use a standard form to document
			 initiation and completion of a service component for each client. Providers
			 must submit all progress documentation, billing, and performance reporting
			 through the Enterprise Invoice Management Service.
2.
Initial Payment
.
			 The purchasing governmental unit pays the provider an initial payment based on
			 a specified percentage of the total payment at the initiation of a service
			 component for a client. For intake, evaluation, and assessment, the purchasing
			 governmental unit makes an initial payment equal to 20% of the service
			 component payment in
			 101
			 CMR 410.03(3). For all other
			 service components, except ongoing and interim supports, the purchasing agency
			 makes an initial payment equal to 40% of the service component payment in
			 101
			 CMR 410.03(3). EOHHS may
			 revise these percentages by administrative bulletin.
3.
Final Payment
.
			 The purchasing governmental unit pays the difference between the initial
			 payment and the total service component payment upon completion of the service
			 component and submission of required documentation.
4.
Administrative Adjustment for
			 Extraordinary Circumstances
. A provider may petition the
			 purchasing governmental unit for an administrative adjustment to reflect
			 increases in operating costs due to unusual and unforeseen circumstances or
			 extraordinary client service requirements not considered in the development of
			 the current rates. Unusual and unforeseen circumstances are events of
			 catastrophic nature (
e.g
., fire, flood, or earthquake) that
			 are not covered by insurance that the prudent provider would carry. The
			 provider must demonstrate 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.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 410.00 - Rates for Competitive Integrated Employment Services › Section 410.04 - 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 410.00 - Rates for Competitive Integrated Employment Services › Section 410.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 410.00 are severable. If any
				provision of 101 CMR 410.00 or application of any provision to an applicable
				individual, entity, or circumstance is held invalid or unconstitutional, that
				holding will not be construed to affect the validity or constitutionality of
				any remaining provisions of 101 CMR 410.00 or application of those provisions
				to applicable individuals, entities, or circumstances.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 411.00 - Rates for Certain Placement, Support, and Shared Living Services › Section 411.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR 411.00 governs the
			 payment rates for certain placement, support, and shared living services
			 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
			 Children and Families (DCF), and the Department of Youth Services
			 (DYS).
(2)
Applicable
			 Dates of Service
. Rates contained in
			 101 CMR 411.00 apply for
			 dates of service provided on or after July 1, 2022.
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR 411.00 is neither
			 authorization for nor approval of the services for which rates are determined
			 pursuant to
			 101 CMR 411.00. Governmental
			 units that purchase such services 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 411.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 411.00 - Rates for Certain Placement, Support, and Shared Living Services › Section 411.04 - 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
			 perjuryas 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 411.00 - Rates for Certain Placement, Support, and Shared Living Services › Section 411.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 411.00 are
				severable. If any provision of
				101 CMR 411.00 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 411.00 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 412.00 - Rates for Family Transitional Support Services › Section 412.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 101 CMR 412.00 governs the
			 payment rates for family transitional support (FTS) services purchased by a
			 governmental unit.
(2)
Applicable Dates of Service
. Rates contained in
			 101 CMR 412.00 apply for
			 dates of service provided on or after July 1, 2022.
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR 412.00 is neither
			 authorization for nor approval of the services for which rates are determined
			 pursuant to
			 101 CMR 412.00. Governmental
			 units that purchase the services described in
			 101 CMR 412.00 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 412.00.
(5)
Services and Rates Covered by
			 Other Regulations
. Payment rates for the services listed in 101
			 CMR 412.01(5) are not included within the scope of
			 101 CMR 412.00 and are
			 governed by other regulations promulgated by EOHHS as follows.
Service
Regulation
Client Financial Assistance/Flex Funding
							 Administration
101 CMR 414.00:
Rates for Family Stabilization Services
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 412.00 - Rates for Family Transitional Support Services › Section 412.03 - 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 by any other
			 source.
(3)
Payment
			 Limitations
. No purchasing governmental unit may pay less than or
			 more than the approved rate.
(4)
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 412.03(4).
Program/Service
							 Type
Rate
Unit
Emergency Shelter: Full program rate
$217.49
Per room per day
Emergency Shelter: Lower facility cost
							 program
$201.78
Per room per day
Residential Housing Stabilization: Full program
							 rate
$112.15
Per room per day
Residential Housing Stabilization: Lower facility
							 cost program
$95.21
Per room per day
Housing Stabilization Advocacy and Supportive
							 Services
$64.40
Per room per day
Domestic Violence, Substance Misuse, and Trauma: Full
							 program rate
$243.07
Per room per day
Client Financial Assistance/Flex
							 Funding
I.C.
N/A
Add-on Staff
Title
Unit of Service
.25 FTE
Direct Care Staff
Monthly
$1,033
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 412.00 - Rates for Family Transitional Support Services › Section 412.04 - 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 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 412.00 - Rates for Family Transitional Support Services › Section 412.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 412.00 are
				severable. If any provision of
				101 CMR 412.00 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 412.00 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 413.00 - Payments for Youth Intermediate-term Stabilization Services › Section 413.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 413.00 governs the payment rates for
			 youth intermediate-term stabilization services, as further described in 101 CMR
			 413.00, purchased by a governmental unit.
(2)
Applicable Dates of
			 Service
. Rates contained in 101 CMR 413.00 apply for dates of
			 service as described in
			 101
			 CMR 413.03(5).
(3)
Disclaimer of Authorization
			 of Services
. 101 CMR 413.00 is neither authorization for nor
			 approval of the services for which rates are determined pursuant to 101 CMR
			 413.00. Governmental units that purchase the services described in 101 CMR
			 413.00 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 413.00.
(5)
Services and Rates Covered by Other Regulations
.
			 Payment rates for the following services are not included within the scope of
			 101 CMR 413.00 and are governed by other regulations promulgated by EOHHS as
			 follows.
Service
Regulation
Enhanced Intensive Foster Care
101 CMR 411.00:
Rates for Certain Placement,
							 Support, and Shared Living Services
Medical Consultation
101 CMR 317.00:
Rates for Medicine
							 Services
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 413.04 - 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 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 413.00 - Payments for Youth Intermediate-term Stabilization Services › Section 413.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of 101 CMR 413.00 are severable. If any
				provision of 101 CMR 413.00 or application of any provision to an applicable
				individual, entity, or circumstance is held invalid or unconstitutional, that
				holding will not be construed to affect the validity or constitutionality of
				any remaining provisions of 101 CMR 413.00 or application of those provisions
				to applicable individuals, entities, or circumstances.