Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 433.00 › Section 433.03 - 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)
Approved Rates with
			 Applicable Dates of Service Provided on or after July 1, 2021
. 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 433.03(4).
(a)
Certain Substance Use
			 Disorder Programs
. Terms used in 101 CMR 433.03(4)(a) that have
			 not been defined elsewhere in 101 CMR 433.00 have the meanings in
			 101 CMR 346.02:
Definitions
.
Service/Program
Code
Unit of
							 Service
Rate
Youth Residential Substance Use Disorder
							 Treatment
H0019-HF
Per Diem
$323.55
Clinically Intensive Youth Residential Substance Use
							 Disorder Treatment
H0019-HA
Per Diem
$425.39
Residential Services
H0019
Per Diem
$149.20
Residential Rehab Pregnant
							 Enhancement
H0019-TH
Per Diem
$41.58
Residential Rehab Postpartum
							 Enhancement
H0019-HD
Per Diem
$93.35
Residential Rehab Child Enhancement
H0019-HV
Per Diem
$46.67
Medically Monitored Inpatient
							 Detoxification
H0011
Per Diem
$420.77
Clinically Managed Inpatient
							 Detoxification
H0010
Per Diem
$350.93
Transitional Support Services
H0018
Per Diem
$185.21
Second Offender Drive Alcohol Education
							 Residential
H0018-H9
Per Diem
$148.82
Jail Diversion - Phase 1
H0019-H9
Per Diem
$222.81
Jail Diversion - Phase 2
H0006-H9
Per Hour
$61.53
Family Supportive Housing
H0019-HR
Per Diem
$197.63
Family Residential Treatment
H01019-HR
Per Diem
$327.92
Supportive Case Management - Permanent
							 Adult
N/A
Enrolled Client Day
$12.43
Supportive Case Management - Permanent
							 Families
N/A
Enrolled Client Day
$25.06
Supportive Case Management - Permanent Young
							 Adult
N/A
Enrolled Client Day
$34.46
Supportive Case Management - Transitional
							 Adult
N/A
Enrolled Client Day
$14.80
Supportive Case Management - Transitional
							 Families
N/A
Enrolled Client Day
$29.79
Supportive Case Management - Transitional Young
							 Adult
N/A
Enrolled Client Day
$40.17
Supportive Case Management - House Manager
							 Add-on
N/A
Month
$2,917.00
Supportive Case Management - Outreach and
							 Staffing
Supports
N/A
Month
$3,997.00
Supportive Case Management - Low
							 Threshold
N/A
Enrolled Client Day
$51.43
Supportive Case Management - School Based Targeted
							 Prevention
N/A
Month
$16,882.00
Triage, Engagement & Assessment Services - Model
							 A -Base Rate
N/A
Monthly Per Slot
$952.00
Triage, Engagement & Assessment Services - Model
							 A -Engagement Staff Rate
N/A
Monthly Per Slot
$534.00
Triage, Engagement & Assessment Services - Model
							 A -Engagement Staff Rate Day Program Only
N/A
Monthly Per Slot
$273.00
Triage, Engagement & Assessment Services - Model
							 B -Base Rate
N/A
Monthly Per Slot
$1,141.00
Triage, Engagement & Assessment Services - Model
							 B -Engagement Staff Rate
N/A
Monthly Per Slot
$720.00
Triage, Engagement & Assessment Services - Model
							 B -Engagement Staff Rate Day Program Only
N/A
Monthly Per Slot
$447.00
Triage, Engagement & Assessment Services - Peer
							 Service Coordinator Add-on
N/A
Per Diem
$22.04
Triage, Engagement & Assessment Services - Social
							 Worker LICSW Add-on
N/A
Per Diem
$38.08
Triage, Engagement & Assessment Services - Care
							 Coordinator Add-on
N/A
Per Diem
$22.04
Triage, Engagement & Assessment Services - Direct
							 Care Staff Add-on
N/A
Per Diem
$22.04
Triage, Engagement & Assessment Services -
							 Support Staff Add-on
N/A
Per Diem
$22.04
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 1
N/A
Monthly
$2,562.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 2
N/A
Monthly
$3,611.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 3
N/A
Monthly
$4,659.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 4
N/A
Monthly
$5,708.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 5
N/A
Monthly
$6,757.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 6
N/A
Monthly
$8,108.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 7
N/A
Monthly
$9,459.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 8
N/A
Monthly
$10,810.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 9
N/A
Monthly
$12,162.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - Tier 10
N/A
Monthly
$13,513.00
Office Based Opioid Treatment (FQHCs) Wraparound
							 Services - 25 Client Add-on
N/A
Monthly
$1,351.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 1
N/A
Monthly
$4,714.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 2
N/A
Monthly
$5,763.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 3
N/A
Monthly
$6,811.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 4
N/A
Monthly
$7,860.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 5
N/A
Monthly
$8,908.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 6
N/A
Monthly
$10,690.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 7
N/A
Monthly
$12,472.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 8
N/A
Monthly
$14,253.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 9
N/A
Monthly
$16,035.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - Tier 10
N/A
Monthly
$17,817.00
Office Based Opioid Treatment - Outpatient Clinic
							 Wraparound Services - 25 Client Add-on
N/A
Monthly
$3,503.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 1
N/A
Monthly
$4,968.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 2
N/A
Monthly
$8,495.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 3
N/A
Monthly
$11,985.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 4
N/A
Monthly
$15,501.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 5
N/A
Monthly
$19,018.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 6
N/A
Monthly
$22,821.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 7
N/A
Monthly
$26,625.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 8
N/A
Monthly
$30,428.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 9
N/A
Monthly
$34,232.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - Tier 10
N/A
Monthly
$38,035.00
Office Based Opioid Treatment - Hospital Wraparound
							 Services - 25 Client Add-on
N/A
Monthly
$2,562.00
Office Based Opioid Treatment (FQHCs) Start-up -
							 Level 1
N/A
Monthly
$8,659.00
Office Based Opioid Treatment (FQHCs) Start-up -Level
							 2
N/A
Monthly
$12,669.00
(b)
Adult Housing and Community Support Services
. Terms
			 used in 101 CMR 433.03(4)(f) that have not been defined elsewhere in 101 CMR
			 433.00 have the meanings in
			 101 CMR 421.02:
Definitions
.
1.
Program Rates
.
Service/Program
Unit of
							 Service
Rate
Outreach and Engagement
Month
$31,757
Safe Haven: ten to 12 beds
Enrolled day
$180.45
Safe Haven: seven to nine beds
Enrolled day
$200.40
Dual Diagnosis Shelter - donated
							 space
Enrolled day
$163.66
Dual Diagnosis Shelter - with occupancy
							 costs
Enrolled day
$184.38
Housing Options Program: Level 1
Enrolled month
$40.58
Housing Options Program: Level 2
Enrolled month
$165.45
Assertive Treatment and Relapse Prevention: Model A -
							 nine to 12 clients
Enrolled day
$50.98
Assertive Treatment and Relapse Prevention: Model B -
							 six to eight clients
Enrolled day
$48.57
2.
Adult Housing and Community Support Service Add-on
			 Rates
.
Position
							 Title
Per
							 Diem
.25 FTE
							 Monthly
.50 FTE
							 Monthly
1.0 FTE
							 Monthly
Direct Care
$166
$897
$1,793
$3,587
Direct Care III
$214
$1,161
$2,321
$4,643
LICSW
$302
$1,633
$3,267
$6,534
3.
Congregate Care Hourly Add-on Rates
.
Position
Hourly Rate
Direct Care
$22.04
Certified Nursing Assistant
$22.67
Direct Care III
$28.53
Occupational Therapist
$55.04
Occupational Therapist Assistant
$43.56
Case Manager, Social Worker, Clinician (MA level -
							 not Independent Licensed)
$38.10
LPN
$41.91
Registered Nurse
$63.20
Clinician with Independent License
$44.53
Social/Caseworker (BA Level)
$31.75
Nurse Practitioner/APRN
$86.75
(c)
Youth And Young Adult Support
			 Services
. Terms used in 101 CMR 433.03(4)(g) that have not been
			 defined elsewhere in 101 CMR 433.00 have the meanings in
			 101 CMR 427.02:
Definitions
.
1.
Alternative Lock-up Program Rates
.
Service/Program
Unit of
							 Service
Rate
A
Monthly
$11,547
B
Monthly
$20,111
C
Monthly
$25,703
2.
Conflict of Interest Program Rates
.
Service/Program
Unit of
							 Service
Rate
One Family
Monthly
$1,090
Five Families
Monthly
$5,448
3.
Teen Pregnancy Prevention Program Rates
.
Service/Program
Unit of
							 Service
Rate
In school
Curriculum Hour
$324.70
Outside school
Curriculum Hour
$405.88
Remote Add-on
Hour
$81.18
Peer Leadership & Youth
							 Development
Contact Hour
$243.53
Partnership Development
Hour
$46.70
4.
Therapeutic Day Services Program Rates
.
Service/Program
Unit of
							 Service
Rate
Model 1
Month
$28,418
Model 2
Month
$24,586
Model 3A
Month
$25,547
Model 3B
Month
$34,615
Model 4A
Month
$20,030
Model 4B
Month
$37,806
5.
Therapeutic Day Services Add-on Rates
.
Title
Unit of Service
.25 FTE
.5 FTE
.75 FTE
1 FTE
Clinical (LICSW)
Monthly
$1,633
$3,268
$4,900
$6,534
Peer/Direct Care
Monthly
$897
$1,794
$2,690
$3,587
Direct Care III
Monthly
$1,160
$2,321
$3,481
$4,641
6.
Young Parent Support Program Rates
.
Service/Program
Unit of
							 Service
Rate
Model A
Month
$8,435
Model B
Month
$16,869
YPS Specialty Direct Care III Add-on (.5
							 FTE)
Month
$2,321
YPS Specialty Direct Care III Add-on (1
							 FTE)
Month
$4,641
(d)
Independent Living Community
			 Programs
. Terms used in 101 CMR 433.03(4)(h) that have not been
			 defined elsewhere in 101 CMR 433.00 have the meanings in
			 101 CMR 428.02:
Definitions
.
1.
Deaf and Hard of Hearing Independent Living Service Program
			 Rates
.
Service/Program
Unit of
							 Service
Rate
DHILs - Region 1
Monthly
$46,315
DHILs - Region 2
Monthly
$40,707
DHILs - Region 3
Monthly
$36,502
DHILs - Region 4
Monthly
$33,600
DHILs - Region 5
Monthly
$21,841
DHILs - Region 6
Monthly
$18,927
DHILs - Region 7
Monthly
$11,631
DHILs - Region 8
Monthly
$7,495
2.
Recovery Learning Communities Program Rates
.
Service/Program
Unit of
							 Service
Rate
Recovery Learning Communities
Monthly
$76,935
3.
Vocational Rehabilitation Independent Living Service Program
			 Rates
.
Service/Program
Unit of
							 Service
Rate
VRIL Service Add-on
Per Hour
$129
VRIL Assessment
Per Component
$515
Independent Living Skills Training
Per Component
$1,931
Community Resource Access
Per Component
$1,931
PASS Plan
Per Component
$1,931
Single Service Purchase
Per Component
$901
VRIL Group Training Add-on
Per Client per Class
$43.49
4.
Independent Living Communities Add-on Rates
.
Position
Unit of
							 Service
Rate
Direct Care 0.25 FTE Add-on
Monthly
$1,161
Direct Care 0.5 FTE Add-on
Monthly
$2,321
Direct Care 0.75 FTE Add-on
Monthly
$3,482
Direct Care 1.0 FTE Add-on
Monthly
$4,643
(e)
Sexual and Domestic Violence
			 Services
. Terms used in 101 CMR 433.03(4)(i) that have not been
			 defined elsewhere in 101 CMR 433.00 have the meanings in
			 101 CMR 429.02:
Definitions
.
Service/Program
Unit of
							 Service
Rate
Domestic Violence Community-based
							 Services
.25 Direct Care FTE
$1,952
Child Exposed to Domestic Violence
							 Services
.25 Direct Care FTE
$2,097
Supervised Visitation Services
.25 Direct Care FTE
$1,990
Sexual and Domestic Violence Equity
							 Services
.25 Direct Care FTE
$1,952
Sexual and Domestic Violence Equity Legal
							 Services
.25 Direct Care FTE
$3,028
Intimate Partner Abuse Education
							 Services
Per Cohort
$2,658
Intimate Partner Abuse Education Services - Outreach
							 and Development
Monthly
$443
Rape Crisis Centers - Dual Agency Tier
							 1
Monthly
$67,141
Rape Crisis Centers - Dual Agency Tier
							 2
Monthly
$58,974
Rape Crisis Centers - Dual Agency Tier
							 3
Monthly
$50,807
Rape Crisis Centers - Dual Agency Tier
							 4
Monthly
$42,640
Rape Crisis Centers - Dual Agency Tier
							 5
Monthly
$34,473
Rape Crisis Centers - Dual Agency Tier
							 6
Monthly
$26,306
Rape Crisis Centers - Dual Agency Tier
							 7
Monthly
$18,139
Rape Crisis Centers - Dual Agency Tier
							 8
Monthly
$9,972
Rape Crisis Centers - Stand-alone Agency Tier
							 1
Monthly
$70,328
Rape Crisis Centers - Stand-alone Agency Tier
							 2
Monthly
$61,771
Rape Crisis Centers - Stand-alone Agency Tier
							 3
Monthly
$53,214
Rape Crisis Centers - Stand-alone Agency Tier
							 4
Monthly
$44,658
Rape Crisis Centers - Stand-alone Agency Tier
							 5
Monthly
$36,101
Rape Crisis Centers - Stand-alone Agency Tier
							 6
Monthly
$27,544
Rape Crisis Centers - Stand-alone Agency Tier
							 7
Monthly
$18,987
Rape Crisis Centers - Stand-alone Agency Tier
							 8
Monthly
$10,430
Rape Crisis Satellite Center Add-on
Hourly
$40.40
Rape Crisis Direct Care 0.25 FTE
							 Add-on
Monthly
$1,952
(f)
Program of Assertive Community Treatment
. Terms used
			 in 101 CMR 433.03(4)(j) that have not been defined elsewhere in 101 CMR 433.00
			 have the meanings in
			 101 CMR 430.02:
Definitions
.
Service/Program
Unit of
							 Service
Rate
Program of Assertive Community Treatment -
							 PACT50
Enrollment Day
$54.02
Program of Assertive Community Treatment -
							 PACT80
Enrollment Day
$49.83
Program of Assertive Community Treatment - Forensic
							 PACT
Enrollment Day
$78.54
Program of Assertive Community Treatment - Forensic
							 GLE
Bed Day
$323.39
(g)
Certain Respite Services
. Terms used in 101 CMR
			 433.03(4)(k) that have not been defined elsewhere in 101 CMR 433.00 have the
			 meanings in
			 101 CMR 431.02:
Definitions
.
Service/Program
Unit of
							 Service
Rate
Respite - A
Month
$60,629
Respite - B
Month
$83,628
Respite - C
Month
$172,054
Respite - Peer Model
Month
$43,271
Respite - Site Only
Per Diem
$262.40
Respite - Mobile Only
Per Diem
$130.52
(h)
Lead Agency Services
. Terms used in 101 CMR
			 433.03(4)(l) that have not been defined elsewhere in 101 CMR 433.00 have the
			 meanings in
			 101 CMR 432.02:
Definitions
.
Service/Program
Unit of
							 Service
Rate
Lead Agency Tier 1
Month
$26,181
Lead Agency Tier 2
Month
$31,772
Lead Agency Tier 3
Month
$37,060
Lead Agency Tier 4
Month
$40,706
Lead Agency Tier 5
Month
$55,781
Lead Agency Tier 6
Month
$73,749
Case Manager/Education Coordinator 0.50 FTE
							 Add-on
Month
$2,916
Case Manager/Education Coordinator 1.0 FTE
							 Add-on
Month
$5,832