reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.06 - Program Innovation Provision

Current through Register 1525, July 5, 2024
(1)
Review of Program Innovation Applications
. A community
			 health center may apply for a prospective adjustment of its payment rates under
			 101 CMR
			 304.00 or establishment of a rate separate from its
			 payment rates under
			 101 CMR
			 304.00 in order to implement a program innovation that
			 advances a high priority policy initiative of the Commonwealth. EOHHS will
			 review and act on such a request within 60 days after receipt of a program
			 innovation application consisting of, but not limited to, a description of the
			 purpose and scope of the program innovation, including number of personnel
			 involved and proposed implementation process and timeline, and a detailed
			 budget of expected additional costs and project volume associated with the
			 program innovation.
(2)
Criteria
. An application pursuant to 101 CMR 304.06(1)
			 may be submitted on the basis of implementing a program innovation that
			 advances a current high priority policy initiative of a state agency.
(3)
Implementation
			 Schedule
. EOHHS will not approve an application submitted pursuant
			 to 101 CMR 304.06(1), unless the community health center demonstrates that it
			 will implement the program innovation within three months of the effective date
			 of the adjustment of its payment rates or the effective date of the separate
			 rate. EOHHS reserves the right to lower the rate retroactive to the date on
			 which the program innovation became effective if the program innovation is not
			 implemented or if actual costs are lower than projected.
(4)
Authority to Issue Additional
			 Guidance
. EOHHS reserves the right to issue an administrative
			 bulletin on this program innovation provision including, but not limited to, an
			 administrative bulletin to specify requirements related to applications,
			 evaluation, use of funds, recordkeeping, and reporting.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.07 - Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

Current through Register 1525, July 5, 2024
The following are modifiers for use in reporting provider
				preventable conditions that are National Coverage Determinations. For more
				information on the use of these modifiers,
see
Appendix V of
				the MassHealth Community Health Center Manual.
Modifier
Description
PA
Surgical or other invasive procedure on wrong body
							 part
PB
Surgical or other invasive procedure on wrong
							 patient
PC
Wrong surgery or other invasive procedure on
							 patient
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.08 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Reporting requirements are governed
			 by
			 957
			 CMR 6.00:
Cost Reporting
			 Requirements
; provided, however, that the frequency of any required
			 cost reports and the penalties, which will be no more severe than the penalties
			 permitted under 101 CMR 304.08(2), will be determined and announced
via
administrative bulletin or other written issuance
			 published by EOHHS.
(2)
Penalty for Noncompliance
. The purchasing governmental
			 unit may impose a penalty in the amount 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 304.08(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.09 - Effect of Claims Submission for MassHealth Providers

Current through Register 1525, July 5, 2024
Payment by MassHealth for community health center services
				pursuant to
				101 CMR 304.00 constitutes
				an alternative payment methodology for federally qualified health center
				services as described by
				42 U.S.C. §
									1396a(bb)(6).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 304.00 - Rates For Community Health Centers › Section 304.10 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 304.00 are
				severable, and if any provision of
				101 CMR 304.00 or
				application of such provision to any community health center or any
				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 304.00 or
				applications of such provisions to community health centers or circumstances
				other than those held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 305.00 - Rates for Behavioral Health Services Provided in Community Behavioral Health Centers › Section 305.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 305.00 governs the rates to be used by all
			 governmental units and worker's compensation insurers for outpatient behavioral
			 health services and behavioral health emergency services provided by community
			 behavioral health centers.
(2)
Applicable Dates of Service
. Rates contained in
			 101 CMR
			 305.00 apply for dates of service provided on or after
			 January 1, 2023.
(3)
Disclaimer of Authorization of Services
.
			 101 CMR
			 305.00 is not authorization for or approval of the
			 procedures for which rates are determined pursuant to
			 101 CMR
			 305.00. Purchasing agencies and insurers are
			 responsible for the definition, authorization, and approval of care and
			 services extended to publicly aided clients.
(4)
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. 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 305.00 - Rates for Behavioral Health Services Provided in Community Behavioral Health Centers › Section 305.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rates as Full Compensation
. The rates under
			 101 CMR
			 305.00 will constitute full compensation for
			 behavioral health services provided by community behavioral health centers to
			 publicly aided and industrial accident patients, including full compensation
			 for necessary administration and professional supervision associated with
			 patient care.
(2)
Rates
			 of Payment
. Except as otherwise provided in
			 101
			 CMR 305.03(4)(c), payment
			 rates under
			 101 CMR
			 305.00 will be 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 behavioral
			 health centers as set forth in
			 101
			 CMR 305.03(4)(a).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 305.00 - Rates for Behavioral Health Services Provided in Community Behavioral Health Centers › Section 305.04 - Reporting Requirements and Sanctions

Current through Register 1525, July 5, 2024
(1)
Required Reports
.
(a) Reporting requirements are governed by
			 957 CMR
			 6.00:
Cost Reporting
			 Requirements.
(b)
Additional Information
. Eligible providers must file
			 such additional information as EOHHS may from time to time reasonably
			 require.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 305.00 - Rates for Behavioral Health Services Provided in Community Behavioral Health Centers › Section 305.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				305.00 are severable, and if any provision of
				101 CMR
				305.00 or application of such provision to any
				community behavioral health center or any circumstances shall be held to be
				invalid or unconstitutional, such invalidity shall not be construed to affect
				the validity or constitutionality of any remaining provisions of
				101 CMR
				305.00 or application of such provisions to community
				behavioral health centers or circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers › Section 306.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 306.00 governs the rates to be used by all
			 governmental units and worker's compensation insurers for outpatient mental
			 health services provided by mental health centers and community health centers,
			 including mental health services provided in nursing facilities.
			 101 CMR
			 306.00 does not govern rates for psychological testing
			 services, which are governed by
			 101 CMR
			 329.00:
Psychological Testing, Treatment and
			 Related Services.
In addition,
			 101 CMR
			 306.00 does not govern rates for other services, care
			 and supplies provided by mental health center and community health centers to
			 publicly aided and industrial accident patients including, but not limited to,
			 psychiatric day treatment services, early intervention services, and medical
			 services provided in community health centers.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 306.00 apply for dates of service provided on or after
			 January 1, 2023, or as indicated in
			 101
			 CMR 306.03(5).
(3)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 306.00 is not authorization for or approval of the
			 procedures for which rates are determined pursuant to
			 101 CMR
			 306.00. Purchasing agencies and insurers are
			 responsible for the definition, authorization, and approval of care and
			 services extended to publicly aided clients.
(4)
Administrative
			 Bulletins
. EOHHS may issue administrative bulletins to clarify its
			 policy on and understanding of substantive provisions of
			 101 CMR
			 306.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers › Section 306.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rates as Full Compensation
. The rates under
			 101 CMR
			 306.00 shall constitute full compensation for mental
			 health services provided by community health centers and mental health centers
			 to publicly aided and industrial accident patients, including full compensation
			 for necessary administration and professional supervision associated with
			 patient care.
(2)
Rates
			 of Payment
. Except as otherwise provided in
			 101
			 CMR 306.03(5)(c), payment
			 rates under
			 101 CMR
			 306.00 shall be 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 mental health centers and
			 community health centers as set forth in
			 101
			 CMR 306.03(5)(a).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers › Section 306.04 - Reporting Requirements and Sanctions

Current through Register 1525, July 5, 2024
(1)
Required Reports
.
(a) Reporting requirements are governed by
			 957 CMR
			 6.00:
Cost Reporting
			 Requirements.
(b)
Additional Information
. Eligible providers must file
			 such additional information as EOHHS may from time to time reasonably
			 require.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers › Section 306.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				306.00 are severable, and if any provision of
				101 CMR
				306.00 or application of such provision to any mental
				health center or community health center or any circumstances shall be held to
				be invalid or unconstitutional, such invalidity shall not be construed to
				affect the validity or constitutionality of any remaining provisions of
				101 CMR
				306.00 or application of such provisions to mental
				health centers or community health centers or circumstances other than those
				held invalid.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 307.00 - Rates for Psychiatric Day Treatment Center Services › Section 307.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 307.00 establishes payment rates for psychiatric day
			 treatment center services rendered by eligible providers to publicly aided
			 individuals. The rates set forth in
			 101 CMR
			 307.00 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
			 307.00 apply for dates of service provided on or after
			 March 1, 2024.
(3)
Coverage
. The payment rates in
			 101 CMR
			 307.00 constitute full compensation for psychiatric
			 day treatment center services provided to publicly aided and workers'
			 compensation individuals including, but not limited to, administrative or
			 supervisory duties and costs in connection with service provision.
(4)
Disclaimer of Authorization
			 of Services
.
			 101 CMR
			 307.00 is not authorization for or approval of the
			 substantive services, or lengths of time, for which rates are paid pursuant to
			 101 CMR
			 307.00. Governmental units or workers' compensation
			 insurers that purchase services from eligible providers are responsible for the
			 definition, authorization, and approval of care and services extended to
			 covered individuals and the length of time for which the approval is
			 applicable.
(5)
Administrative Bulletins
. EOHHS may issue
			 administrative bulletins to clarify its policy upon and understanding of
			 substantive provisions of
			 101 CMR
			 307.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 307.00 - Rates for Psychiatric Day Treatment Center Services › Section 307.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				307.00, terms have the meanings in 101 CMR
				307.02.
Eligible Provider
. A psychiatric day
				treatment center that meets the conditions of participation that have been or
				may be adopted by a governmental unit purchasing psychiatric day treatment
				center services.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any department, agency, board, commission, division, or political subdivision
				of the Commonwealth.
Preadmission Evaluation Visit
. A
				comprehensive evaluation of at least one hour by a professional to determine
				the need for psychiatric day treatment program services and to design a
				treatment plan.
Psychiatric Day Treatment Center
. A
				clinic that provides a psychiatric day treatment program and is freestanding;
				that is, not financially or physically an integral part of a hospital.
Psychiatric Day Treatment Program
. A
				planned combination of diagnostic, treatment, and rehabilitative services
				provided to mentally or emotionally disturbed persons who need more active or
				inclusive treatment than is typically available through a weekly visit to a
				mental health center or hospital outpatient department, but who do not need
				full-time hospitalization or institutionalization. Such a program utilizes
				multiple, intensive, and focused activities in a supportive environment to
				enable such persons to acquire more realistic and appropriate behavior
				patterns, attitudes, and skills for eventual independent functioning in the
				community.
Publicly Aided Individual
. A person
				who receives health care and services for which a governmental unit is in whole
				or in part liable under a statutory program.
Visit
. A face-to-face encounter
				between a client and one or more staff members of a psychiatric day treatment
				center.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 307.00 - Rates for Psychiatric Day Treatment Center Services › Section 307.03 - Rates of Payment

Current through Register 1525, July 5, 2024
The rates of payment for psychiatric day treatment center
				services are listed in 101 CMR 307.03.
Code
Rate
Service
H2012
$28.77
Behavioral health day treatment, per hour
H2012-U1
$80.13
Behavioral health day treatment, per hour
							 (Preadmission evaluation visit)
90887
See
101 CMR
							 306.00:
Rates of Payment for Mental Health
							 Services Provided in Community Health and Mental Health Centers
for
							 the rate
.
See
101 CMR
							 306.00:
Rates of Payment for Mental Health
							 Services Provided in Community Health and Mental Health Centers
for
							 the rate.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 307.00 - Rates for Psychiatric Day Treatment Center Services › Section 307.04 - Filing and 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
. A 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
			 for noncompliance under 101 CMR 307.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 307.00 - Rates for Psychiatric Day Treatment Center Services › Section 307.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				307.00 are severable. If any provision of
				101 CMR
				307.00 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
				307.00 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 309.00 - Rates for Certain Services for the Personal Care Attendant Program › Section 309.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 309.00 governs the rates of payment to be used by all
			 governmental units for the personal care attendant (PCA) program.
			 101 CMR
			 309.00 also governs payments for PCA services provided
			 to individuals covered by M.G.L. c. 152 (the Worker's Compensation Act). Rates
			 for transitional living program services are approved under 114.5 CMR 4.00:
Rates for
			 Certain Social, Rehabilitation and Health Care Services.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 309.00 apply for dates of service described in
			 101
			 CMR 309.03.
(3)
Coverage
. The
			 payment rates established by
			 101 CMR
			 309.00 apply to certain services for the PCA program
			 provided by eligible PCA providers and personal care management (PCM) agencies
			 to enable publicly aided persons with permanent or chronic disabilities to live
			 independently in the community. The payment rates established by
			 101 CMR
			 309.00 are full compensation for services rendered and
			 for certain related administrative or supervisory duties rendered in the
			 provision of services.
(4)
Disclaimer of Authorization of Services
.
			 101 CMR
			 309.00 is not authorization for or approval of the
			 services for which rates are established by
			 101 CMR
			 309.00. Governmental units that purchase PCA services
			 are responsible for the definition, authorization, and approval of care and
			 services extended to publicly aided individuals.
(5)
Coding Updates and
			 Corrections
. EOHHS may publish service code updates and
			 corrections by administrative bulletin. Updates may reference coding systems
			 including, but not limited to, the American Medical Association's Current
			 Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System
			 (HCPCS) maintained by the Centers for Medicare & Medicaid Services (CMS).
			 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. These codes will be paid on an individual consideration basis
			 until rates are established.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 309.00 - Rates for Certain Services for the Personal Care Attendant Program › Section 309.04 - 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)
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 309.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 309.00 - Rates for Certain Services for the Personal Care Attendant Program › Section 309.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				309.00 are severable. If any provision of
				101 CMR
				309.00 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
				309.00 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 310.00 - Rates for Adult Day Health Services › Section 310.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 310.00 governs the payment rates for adult day health
			 services provided to publicly aided individuals. The payment rates in
			 101 CMR
			 310.00 also apply to individuals covered by the
			 Workers' Compensation Act, M.G.L. c. 152.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 310.00 are effective for dates of service as listed in
			 101
			 CMR 310.03(4).
(3)
Coverage
. The
			 payment rates in
			 101 CMR
			 310.00 are full compensation for adult day health
			 services as well as for any related administrative or supervisory duties
			 rendered in connection with the provision of adult day health
			 services.
(4)
Disclaimer of Authorization of Services
.
			 101 CMR
			 310.00 is neither authorization for nor approval of
			 the substantive services for which rates are determined pursuant to
			 101 CMR
			 310.00. Governmental units or workers' compensation
			 insurers that purchase care are responsible for the definition, authorization,
			 and approval of care and services to covered individuals.
(5)
Administrative
			 Bulletins
. EOHHS may issue administrative bulletins to clarify its
			 policy on and understanding of substantive provisions of
			 101 CMR
			 310.00.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 310.00 - Rates for Adult Day Health Services › Section 310.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rate as Full Payment
. Each eligible provider must, as
			 a condition of receipt of payment from one or more purchasing governmental
			 units for services rendered, accept the approved rates as full payment and
			 discharge of all obligations for the services rendered, subject only to
			 appellate rights as set forth in M.G.L. 118E. There will be no duplication or
			 supplementation of payment from sources other than those expressly recognized
			 or anticipated in the computation of the rate. Any client resources or
			 third-party payments received on behalf of a publicly assisted client must
			 reduce, by that amount, the amount of the purchasing governmental unit's
			 obligation for services rendered to the publicly assisted client.
(2)
Covered
			 Services
. The payment rates in
			 101 CMR
			 310.00 apply to adult day health services provided by
			 eligible providers in a day setting, where:
(a) a patient's medical condition indicates a
			 need for nursing care, supervision or a need for therapeutic services that
			 alone or in combination would require institutional placement; or
(b) a patient's psycho-social condition is
			 such that without program intervention the patient's medical condition would
			 continue to deteriorate or is such that institutional placement is
			 imminent.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 310.00 - Rates for Adult Day Health Services › Section 310.04 - 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 310.04.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 310.00 - Rates for Adult Day Health Services › Section 310.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				310.00 are severable. If any provision of
				101 CMR
				310.00 or application of any provisions to an
				applicable person, 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
				310.00 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 312.00 - Rates for Family Planning Services › Section 312.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope, Purpose and Effective Date
.
			 101 CMR
			 312.00 governs the rates of payment used by all
			 governmental units to pay eligible providers which provide family planning
			 services to publicly aided individuals.
(2)
Applicable Dates of
			 Service
. Rates in
			 101 CMR
			 312.00 apply for dates of service provided on or after
			 January 1, 2023, unless otherwise indicated.
(3)
Coverage
.
			 101 CMR
			 312.00 and the rates of payment in
			 101 CMR
			 312.00 apply to family planning services rendered by
			 eligible providers at a family planning agency setting. The rates of payment
			 under
			 101 CMR
			 312.00 are full compensation for all services
			 rendered.
(4)
Disclaimer of Authorization of Services
.
			 101 CMR
			 312.00 is not authorization for or approval of the
			 procedures for which rates are determined pursuant to
			 101 CMR
			 312.00. Governmental units that purchase care are
			 responsible for the definition, authorization, coverage policies, and approval
			 of the care and services extended to publicly-aided individuals.
(5)
Coding Updates and
			 Corrections
. EOHHS may publish procedure 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) and/or 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 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 312.00 - Rates for Family Planning Services › Section 312.02 - General Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				312.00, unless the context clearly otherwise requires,
				the following terms have the following meanings:
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Comprehensive Family Planning Agency
.
				A public or private agency that demonstrates the capability of providing family
				planning medical services, family planning counseling services, follow-up
				health care, outreach and community education.
Eligible Provider
. A comprehensive
				family planning agency which meets such conditions of participation as may be
				required by a governmental unit purchasing such services.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Established Patient
. A patient who has
				received professional services from the provider within the past three
				years.
Governmental Unit
. The Commonwealth,
				any department, agency, board or commission of the Commonwealth and any
				political subdivision of the Commonwealth.
Individual Consideration (I.C.)
. For
				specified drugs, injectables/vaccines, and medical and related supplies that
				are listed in
				101
				CMR 312.03(4)  with I.C.,
				payment will be at cost, subject to any documentation requirements of the
				governmental unit.
New Patient
. A patient who has not
				received any professional services from the provider within the past three
				years.
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.
Separate Procedure
. Some of the listed
				procedures are commonly performed as an integral part of a total service and,
				as such, do not warrant a separate identification or payment. When, however,
				such a procedure is performed independently of, and is not immediately related
				to other services, it may be listed separately in the procedure description.
				Thus, when a procedure that is ordinarily a component of a larger procedure is
				performed alone for a specific purpose, it may be considered to be a separate
				procedure.
There are certain procedures designated as "(SP)" which are in
				addition to those procedures designated "separate procedure" by the AMA-CPT
				coding structure. These "(SP)" procedures were designated "Independent
				Procedures" (IP) in the former six-digit coding structure.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 312.00 - Rates for Family Planning Services › Section 312.03 - General Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Reimbursement as Full Payment
. Each eligible provider
			 must, as a condition of payment made by the purchasing governmental unit for
			 services rendered, accept the approved program rate as full payment and
			 discharge of all obligations for the services rendered. Any third-party
			 payments or sliding fees received on behalf of a publicly aided individual
			 reduces, by that amount, the purchasing governmental unit's payment for
			 services rendered to the publicly aided individual.
(2)
Rates
. Subject
			 to the conditions listed herein, rates of payment for authorized family
			 planning services for which
			 101 CMR
			 312.00 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 fees listed
			 below in
			 101
			 CMR 312.03(4).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 312.00 - Rates for Family Planning Services › Section 312.04 - 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 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 312.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 312.00 - Rates for Family Planning Services › Section 312.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR
				312.00 are severable and if any provision of
				101 CMR
				312.00 or the application of such provision 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 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 313.00 - Rates For Freestanding Clinics Providing Abortion And Sterilization Services › Section 313.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope, Purpose and Effective Date
.
			 101 CMR
			 313.00 governs the rates of payment used by
			 governmental units to pay eligible providers for abortion and sterilization
			 services provided to publicly aided individuals.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 313.00 apply for dates of service provided on or after
			 January 1, 2023, unless otherwise indicated.
(3)
Coverage
.
			 101 CMR
			 313.00 and the rates of payment contained in
			 101 CMR
			 313.00 apply to abortion and sterilization services
			 rendered by eligible providers in an ambulatory clinic setting. The rates of
			 payment under
			 101 CMR
			 313.00 are full compensation for all services
			 rendered.
(4)
Disclaimer of Authorization of Services
.
			 101 CMR
			 313.00 is neither authorization for nor approval of
			 the substantive services for which rates are determined pursuant to
			 101 CMR
			 313.00. Governmental units that purchase services from
			 eligible providers are responsible for the definition, authorization, coverage
			 policies, and approval of the care and services extended to publicly aided
			 individuals.
(5)
Coding
			 Updates and Corrections
. EOHHS may publish procedure 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) and/or 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 reference 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 is no
			 corresponding new code; and
(d)
			 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 313.00 - Rates For Freestanding Clinics Providing Abortion And Sterilization Services › Section 313.02 - General Definitions

Current through Register 1525, July 5, 2024
Ambulatory Abortion
or
Sterilization Clinic
. A state-licensed freestanding
				ambulatory clinic that provides abortion or sterilization services and which is
				in compliance with applicable clinic licensure rules and regulations.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Eligible Provider
. State-licensed
				freestanding ambulatory abortion or sterilization clinics providing abortion
				and/or sterilization services which meet such conditions of participation as
				may be required by a governmental unit purchasing such services.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Established Patient
. A patient who has
				received professional services from the provider within the past three
				years.
Governmental Unit
. The Commonwealth,
				any department, agency, board or commission of the Commonwealth and any
				political subdivision of the Commonwealth.
Individual Consideration (I.C.)
. For
				specified drugs and injectables listed in
				101
				CMR 313.03(5)  with I.C.,
				payment will be at cost, subject to any documentation requirements of the
				governmental unit.
Modifier
. Listed services and
				procedures may be modified under certain circumstances. When applicable, the
				modifying circumstances must be identified by the addition of the appropriate
				two-letter or numeric designation.
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 313.00 - Rates For Freestanding Clinics Providing Abortion And Sterilization Services › Section 313.03 - General Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rate Determination
. Rates of payment for eligible
			 providers of abortion and sterilization services 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 allowable fees set forth in
			 101
			 CMR 313.03(5).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 313.00 - Rates For Freestanding Clinics Providing Abortion And Sterilization Services › Section 313.04 - 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
. A purchasing governmental
			 unit may impose a penalty in the amount 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 313.04(2).
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 313.00 - Rates For Freestanding Clinics Providing Abortion And Sterilization Services › Section 313.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				101 CMR 313.00 are
				severable, and if any provision of
				101 CMR 313.00 or the
				application of such provision 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 313.00 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 314.00 - Rates for Dental Services › Section 314.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope
. 101 CMR 314.00 governs the rates of payments
			 used by all governmental units in making payments to eligible dental providers
			 for dental services rendered to publicly aided individuals.
(2)
Applicable Dates of
			 Service
. Rates contained in 101 CMR 314.00 apply for dates of
			 service provided on or after June 1, 2024.
(3)
Coverage
. The
			 rates of payment contained in 101 CMR 314.00 or determined in accordance with
			 the provisions of 101 CMR 314.00, are full compensation for dental services
			 rendered to publicly aided individuals as well as for any related
			 administrative or supervisory duties in connection with the provision of
			 services, without regard to where these services are rendered.
(4)
Disclaimer of Authorization
			 of Services
. 101 CMR 314.00 is neither authorization for nor
			 approval of the substantive services for which rates are determined pursuant to
			 101 CMR 314.00. Governmental units that purchase services from eligible
			 providers are responsible for the definition, authorization, and approval of
			 services extended to publicly aided patients.
(5)
Coding Updates and
			 Corrections
. EOHHS may publish procedure code updates and
			 corrections in the form of an administrative bulletin. Updates may reference
			 coding systems including, but not limited to, the American Dental Association's
			 Current Dental Terminology (CDT). The publication of such updates and
			 corrections will list
(a) codes for which the
			 code numbers change, with the corresponding cross-reference between new codes
			 and 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 may 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 314.00 - Rates for Dental Services › Section 314.02 - Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 314.00, unless the context requires
				otherwise, terms have the meanings ascribed in
				101
				CMR 314.02.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Early Periodic Screening, Diagnostic and Treatment
				(EPSDT)-eligible MassHealth Members
. Publicly aided individuals
				who are eligible to receive EPSDT services under 130 CMR 420.000:
Dental Services
and 130 CMR 450.000:
Administrative
				and Billing Regulations
.
Eligible Dental Provider
.
(a) A provider of dental services who meets
			 the conditions of participation of a governmental unit purchasing such
			 services. Eligible dental providers may include the following:
1. dentists registered by the Massachusetts
			 Board of Registration in Dentistry in accordance with the provisions of M.G.L.
			 c. 112;
2. authorized governmental,
			 nonprofit, or charitably incorporated dental clinics not involved with teaching
			 dental students;
3. authorized
			 dental clinics that wholly or partially derive support from Title V funds under
			 the Social Security Act;
4.
			 teaching dental clinics operated by dental education institutions;
			 and
5. public health dental
			 hygienists who are certified by the Massachusetts Board of Registration in
			 Dentistry and who provide services in public health settings that include
			 schools, long-term nursing facilities, medical facilities, and
			 shelters.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 314.00 - Rates for Dental Services › Section 314.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Rate Determination
. Subject to
			 101
			 CMR 314.03(2) and (3), rates
			 of payment for authorized dental services to which 101 CMR 314.00 applies will
			 be the lower of
(a) the eligible dentist
			 provider's usual and customary fee to patients other than publicly aided
			 individuals; or
(b) the allowable
			 fee listed in
			 101
			 CMR 314.04,
			 314.05, or
			 314.06, as
			 applicable.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 314.00 - Rates for Dental Services › Section 314.04 - Allowable Fees: Anesthesia Services (Hospital)

Current through Register 1525, July 5, 2024
Reimbursement for anesthesia services is set forth in 101 CMR
				316.00:
Rates for Surgery and Anesthesia
				Services
.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 314.00 - Rates for Dental Services › Section 314.06 - Allowable Fees: Hospital Services

Current through Register 1525, July 5, 2024
Maximum allowable fees for professional services rendered in a
				hospital setting are governed under 101 CMR 316.00:
Rates for Surgery
				and Anesthesia Services
, 101 CMR 318.00:
Rates for Radiology
				Services
, and 101 CMR 317.00:
Rates for Medicine
				Services
.
Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 314.00 - Rates for Dental Services › Section 314.07 - Filing and 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 314.07(2).