Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 452.00 › Section 452.03 - 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)
State Funding Monthly
			 Calculation
. The state funding monthly average calculation is
			 calculated according to the following formula: Sum of {[(total fiscal year 2022
			 State spend on the services listed in 101 CMR 452.01(5) /12
			 (months)]}.
(5)
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 452.03(5).
(a)
Program Service Rates Effective July 1, 2022 through September 30,
			 2022
. Effective October 1, 2022, the rates revert to the rates in
			 the parent regulations listed in 101 CMR 452.01(5), unless otherwise provided
			 at 101 CMR 452.03(5).
Add-on
Unit
Rate
Workforce Investment for the Services Listed in 101
							 CMR 452.03(5)(a)
Monthly
10% of the Provider's Fiscal Year 2022 Average
							 monthly State Funding
Applicable Program
							 Service(s)
Parent
							 Regulation
Community Mental Health Center
							 Services
101 CMR 306.00:
Rates of Payment for Mental Health Services Provided in Community
							 Health Centers and Mental Health Centers
Inpatient Services, Residential Services (Excluding
							 Residential Rehab Co-occurring Enhanced), Opioid Treatment Services, Ambulatory
							 Services, Clinical Case Management Services, Day Treatment Services, Outpatient
							 Services, Supportive Case Management Services, Triage, Engagement and
							 Assessment Services, and Office-based Opioid Treatment Programs
101 CMR 346.00:
Rates for Certain Substance-related and Addictive Disorders
							 Programs
Youth Residential Substance Use Disorder Treatment,
							 Clinically Intensive Youth Residential Substance Use Disorder Treatment,
							 Clinically Intensive Residential Treatment, Congregate Care Program Services
							 and Rates and Add-on services, and the services formerly known as "Caring
							 Together" Services
101 CMR 413.00:
Payments for Youth Intermediate-term Stabilization
							 Services
Family and Micro Family Resource Centers and Staff
							 Add-on Services and DMH's Flexible Support Services
101 CMR 414.00:
Rates for Family Stabilization Services
Central Intake and Assessment Program
101 CMR 417.00:
Rates for Certain Elder Care Services
Staffing Support Services and Transitional Age Youth
							 Detoxification and Stabilization Programs
101 CMR 418.00:
Payments for Youth Short-term Stabilization and Emergency Placement
							 Services
Adult Housing and Community Support
							 Services
101 CMR 421.00:
Rates for Adult Housing and Community Support
							 Services
Clinical Team Services
101 CMR 424.00:
Rates for Certain Developmental and Support
							 Services
Alternative Lock-up Program, Conflict of Interest
							 Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and
							 Staff Add-on Services, and Young Parent Support Program and Staff Add-on
							 Services
101 CMR 427.00:
Rates for Certain Youth and Young Adult Support
							 Services
Deaf and Hard of Hearing Independent Living Services,
							 Recovery Learning Communities, and Vocational Rehabilitation Independent Living
							 Services
101 CMR 428.00:
Rates for Certain Independent Living Communities and
							 Services
Domestic Violence Community-based Services, Child
							 Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual
							 and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational
							 Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care
							 Add-on Staff Services, and Statewide Specialized Hotline
							 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
Respite Services
101 CMR 431.00:
Rates for Certain Respite Services
Lead Agency Services
101 CMR 432.00:
Rates for Certain Lead Agency Services
Psychological Services
101 CMR 329.00:
Psychological Testing,
							 Treatment, and Related Services
Psychiatric Day Treatment
101 CMR 307.00:
Rates for Psychiatric Day Treatment Center
							 Services
Applied Behavior Analysis
101 CMR 358.00:
Rates of Payment for Applied Behavior Analysis
Opioid Treatment Services (excluding codes
							 J0571-J0575 and J3490), Recovery Support Navigator, Individualized Treatment
							 and Stabilization Services
101 CMR 444.00:
Rates for Certain Substance Use Disorder Services
(b)
Program Service Rates Effective October 1, 2022 through December
			 31, 2022
. Effective January 1, 2023, the rates revert to the rates
			 in the parent regulations listed in 101 CMR 452.01(5), unless otherwise
			 provided at 101 CMR 452.03(5).
Add-on
Unit
Rate
Workforce Investment for the Services Listed in 101
							 CMR 452.03(5)(b)
Monthly
10% of the Provider's Fiscal Year 2022 Average
							 monthly State Funding
Applicable Program
							 Service(s)
Parent Regulation
Community Mental Health Center Services
101 CMR
							 306.00:
Rates of Payment for Mental Health
							 Services Provided in Community Health Centers and Mental Health
							 Centers
Inpatient Services, Residential Services (Excluding
							 Residential Rehab Co-occurring Enhanced), Opioid Treatment Services, Ambulatory
							 Services, Clinical Case Management Services, Day Treatment Services, Outpatient
							 Services, Supportive Case Management Services, Triage, Engagement and
							 Assessment Services, and Office-based Opioid Treatment Programs
101 CMR
							 346.00:
Rates for Certain Substance-related
							 and Addictive Disorders Programs
Youth Residential Substance Use Disorder Treatment,
							 Clinically Intensive Youth Residential Substance Use Disorder Treatment,
							 Clinically Intensive Residential Treatment, Community Treatment Residential,
							 Emergency Residence, Intensive Residential Treatment, Intensive Treatment
							 Residence, Medically Complex and Behavioral Residence, Medically Complex
							 Residence, Specialty Treatment Residence, Young Adult and Youth Therapeutic
							 Group Care, Young Parent Assessment and Living Program, Staff Add-on Services,
							 and the services formerly known as "Caring Together" Services
101 CMR
							 413.00:
Payments for Youth Intermediate-term
							 Stabilization Services
Family and Micro Family Resource Centers and Staff
							 Add-on Services and DMH's Flexible Support Services
101 CMR
							 414.00:
Rates for Family Stabilization
							 Services
Central Intake and Assessment Program
101 CMR
							 417.00:
Rates for Certain Elder Care
							 Services
Adult Housing and Community Support Services
101 CMR
							 421.00:
Rates for Adult Housing and Community
							 Support Services
Clinical Team Services
101 CMR
							 424.00:
Rates for Certain Developmental and
							 Support Services
Alternative Lock-up Program, Conflict of Interest
							 Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and
							 Staff Add-on Services, and Young Parent Support Program and Staff Add-on
							 Services
101 CMR
							 427.00:
Rates for Certain Youth and Young
							 Adult Support Services
Deaf and Hard of Hearing Independent Living Services,
							 Recovery Learning Communities, and Vocational Rehabilitation Independent Living
							 Services
101 CMR
							 428.00:
Rates for Certain Independent Living
							 Communities and Services
Domestic Violence Community-based Services, Child
							 Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual
							 and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational
							 Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care
							 Add-on Staff Services, and Statewide Specialized Hotline 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
Respite Services
101 CMR
							 431.00:
Rates for Certain Respite
							 Services
Lead Agency Services
101 CMR
							 432.00:
Rates for Certain Lead Agency
							 Services
Psychological Services
101 CMR
							 329.00:
Psychological Testing, Treatment, and
							 Related Services
Psychiatric Day Treatment
101 CMR
							 307.00:
Rates for Psychiatric Day Treatment
							 Center Services
Opioid Treatment Services (excluding codes
							 J0571-J0575 and J3490), Recovery Support Navigator, Individualized Treatment
							 and Stabilization Services
101 CMR
							 444.00:
Rates for Certain Substance Use
							 Disorder Services
(c)
Program Service Rates Effective January 1, 2023 through June 30,
			 2023
. Effective July 1, 2023, the rates revert to the rates in the
			 parent regulations listed in
			 101
			 CMR 452.01(5).
Add-on
Unit
Rate
Workforce Investment for the Services Listed in
							 101
							 CMR 452.03(5)(c)
Monthly
10% of the Provider's Fiscal Year 2022 Average
							 monthly State Funding
Applicable Program Service(s)
Parent Regulation
Inpatient Services, Residential Services (Excluding
							 Residential Rehab Co-occurring Enhanced), Supportive Case Management Services,
							 Triage, Engagement and Assessment Services, and Office-based Opioid Treatment
							 Programs
101 CMR
							 346.00:
Rates for Certain Substance-related
							 and Addictive Disorders Programs
Youth Residential Substance Use Disorder Treatment,
							 Clinically Intensive Youth Residential Substance Use Disorder Treatment,
							 Clinically Intensive Residential Treatment, Community Treatment Residential,
							 Emergency Residence, Intensive Residential Treatment, Intensive Treatment
							 Residence, Medically Complex and Behavioral Residence, Medically Complex
							 Residence, Specialty Treatment Residence, Young Adult and Youth Therapeutic
							 Group Care, Young Parent Assessment and Living Program, Staff Add-on Services,
							 and the services formerly known as "Caring Together" Services
101 CMR
							 413.00:
Payments for Youth Intermediate-term
							 Stabilization Services
Family and Micro Family Resource Centers and Staff
							 Add-on Services
101 CMR
							 414.00:
Rates for Family Stabilization
							 Services
Staffing Support Services and Transitional Age Youth
							 Detoxification and Stabilization Programs
101 CMR
							 418.00:
Payments for Youth Short-term
							 Stabilization and Emergency Placement Services
Adult Housing and Community Support Services
101 CMR
							 421.00:
Rates for Adult Housing and Community
							 Support Services
Alternative Lock-up Program, Conflict of Interest
							 Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and
							 Staff Add-on Services, and Young Parent Support Program and Staff Add-on
							 Services
101 CMR
							 427.00:
Rates for Certain Youth and Young
							 Adult Support Services
Deaf and Hard of Hearing Independent Living Services,
							 Recovery Learning Communities, and Vocational Rehabilitation Independent Living
							 Services
101 CMR
							 428.00:
Rates for Certain Independent Living
							 Communities and Services
Domestic Violence Community-based Services, Child
							 Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual
							 and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational
							 Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care
							 Add-on Staff Services, and Statewide Specialized Hotline 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
Respite Services
101 CMR
							 431.00:
Rates for Certain Respite
							 Services
Lead Agency Services
101 CMR
							 432.00:
Rates for Certain Lead Agency
							 Services
Psychiatric Day Treatment
101 CMR
							 307.00:
Rates for Psychiatric Day Treatment
							 Center Services
Individualized Treatment and Stabilization
							 Services
101 CMR
							 444.00:
Rates for Certain Substance Use
							 Disorder Services