Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 420.00 - Rates for Adult Long-term Residential Services › Section 420.03 - 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, except as cited in
			 101 CMR 420.03.
(4)
Administrative Adjustment for Extraordinary
			 Circumstances
. A method whereby, subject to availability of funds,
			 a purchasing governmental unit may provide additional resource allocations to a
			 qualified provider in response to unusual and unforeseen circumstances that
			 substantially increase the cost of service delivery in ways not contemplated in
			 the development of current rates. Providers 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.
(5)
Blended Contract Rate
			 Calculation
. Purchasing governmental units may pay a blended
			 contract rate for the purchase of two or more ALTR programs. The blended rate
			 will be calculated according to the following formula: Sum of {[(
Per
			 Diem
rate for Program Model 1)*(Units purchased of Program Model
			 1)*(Number of clients purchased in Program 1) / (Total number of clients in
			 Program 1)], [(
Per Diem
rate for Program Model 2)*(Units
			 purchased of Program Model 2) * (Number of clients purchased in Program 2) /
			 (Total number of clients in Program 2)], [(
Per Diem
rate for
			 Program Model 3)*(Units purchased of Program Model 3) * (Number of clients
			 purchased in Program 3) / (Total number of clients in Program 3)],_,[Total
			 funding for Add-ons]} Divided by the [(Sum of the Units purchased)*(Count of
			 clients)] for all programs in the contract.
(6)
Service Model Naming
			 Convention
. 101 CMR 420.03(6)(a) and (b) describe the naming
			 convention for the service models as listed in the rate tables.
(a)
Basic and
			 Intermediate
. The name of each service model rate consists of six
			 characters. The first character represents the category of the service tier,
			 "B" for basic, and "I" for intermediate. The second through fifth characters
			 describe the number of direct care FTEs associated with the model. The sixth
			 character represents the capacity range for the model. Capacity 1 models are
			 represented with "A", capacity 2-3 models are represented with "B", and
			 capacity 4+ models are represented with "C". Example: I06.5B describes an
			 intermediate, 6.5 FTE program with capacity of 2 or 3.
(b)
Medical/Clinical
. The name of each medical/clinical
			 service model rate consists of seven characters. The first character, "M",
			 represents the medical/clinical service tier. The second through fifth
			 characters describe the number of direct care FTEs associated with the model.
			 The sixth character represents the capacity range for the model. Capacity 1
			 models are represented with "A", capacity 2-3 models are represented with "B",
			 and capacity 4+ models are represented with "C". The seventh character
			 represents the level of incremental resources contained in the medical/clinical
			 service model. Example: M10.5C2 represents a medical level 2 program with 10.5
			 FTEs and a capacity of four or more.