Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 343.00 - Rates for Hospice Services › Section 343.04 - General Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Effect of
			 101 CMR
			 343.00
. The rates of payment under
			 101 CMR
			 343.00 constitute full compensation for hospice
			 services provided to publicly aided individuals, including necessary
			 administration and professional supervision. These established rates of payment
			 for authorized services, with the exception of payment for room and board,
			 shall be set in accordance with Centers for Medicare and Medicaid Services
			 (CMS) regulation at
			 42 CFR
			 418.302.
(2)
Rate
			 Determination
. Each payment rate is determined by CMS to reflect
			 the cost incurred by a hospice in efficiently providing the core and
			 supplemental services associated with that type of hospice care to Medicaid
			 beneficiaries. The allowable Medicaid hospice rates are determined in
			 accordance with
			 42 CFR
			 418.302. The Medicaid rates are determined by
			 adding the unweighted amount to the wage component, as adjusted to reflect
			 local differences in wages, in accordance with
			 42
			 CFR 418.306.
(3)
Rates
. Allowable
			 rates for hospice services are outlined in 101 CMR 343.04(3)(a) and (b).
(a) Providers shall be paid at the compliant
			 or noncompliant rates established by CMS based on compliance with federal
			 quality reporting requirements.
(b)
			 If CMS amends the amounts listed in
			 42
			 CFR 418.306, the Medicaid rates will change
			 accordingly. Said changes will be listed in an EOHHS administrative
			 bulletin.
(c) For those hospice
			 clients residing in nursing facilities, the
per diem
rate
			 shall equal 95% of the rate that would have been paid by the Commonwealth to a
			 particular nursing facility for a non-hospice Medicaid beneficiary.
(d) Use modifier transmittal number TN for
			 codes T2042 and T2043 when billing for members outside the county in which the
			 provider is located.
(e)
			 MassHealth-enrolled hospice providers located out of state must bill MassHealth
			 using the TN modifier for all codes using the TN modifier. The rates of payment
			 will be based on the rate applicable to the county in which the member resides.
			 Absent use of the TN modifier, the rate of payment for hospice services
			 provided by an out-of-state hospice provider is the lowest applicable rate
			 listed in 101 CMR 343.04(3)(f).
(f)
			 The rates of payment for authorized hospice services effective October 1, 2021,
			 are the rates listed in 101 CMR 343.04(3)(f).
Barnstable
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$231.86
$227.32
T2042 UD
Routine Home Care (61+ days)
Per Diem
$183.24
$179.63
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$70.58
$69.20
T2043
Continuous Home Care
Per Hour
$70.58
$69.20
T2044
Inpatient Respite
Per Diem
$562.50
$551.48
T2045
General Inpatient
Per Diem
$1,210.60
$1,186.86
Berkshire
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$209.12
$205.02
T2042 UD
Routine Home Care (61+ days)
Per Diem
$165.26
$162.01
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$62.82
$61.59
T2043
Continuous Home Care
Per Hour
$62.82
$61.59
T2044
Inpatient Respite
Per Diem
$511.03
$501.02
T2045
General Inpatient
Per Diem
$1,095.82
$1,074.33
Bristol
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$207.18
$203.12
T2042 UD
Routine Home Care (61+ days)
Per Diem
$163.73
$160.51
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$62.16
$60.95
T2043
Continuous Home Care
Per Hour
$62.16
$60.94
T2044
Inpatient Respite
Per Diem
$506.65
$496.72
T2045
General Inpatient
Per Diem
$1,086.05
$1,064.75
Essex/Middlesex
Compliant
							 Rate
Noncompliant Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$215.13
$210.91
T2042 UD
Routine Home Care (61+ days)
Per Diem
$170.01
$166.66
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$64.87
$63.60
T2043
Continuous Home Care
Per Hour
$64.87
$63.60
T2044
Inpatient Respite
Per Diem
$524.63
$514.35
T2045
General Inpatient
Per Diem
$1,126.14
$1,104.06
Franklin/Hampden/Hampshire
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$203.66
$199.67
T2042 UD
Routine Home Care (61+ days)
Per Diem
$160.95
$157.78
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$60.96
$59.77
T2043
Continuous Home Care
Per Hour
$60.96
$59.77
T2044
Inpatient Respite
Per Diem
$498.68
$488.91
T2045
General Inpatient
Per Diem
$1,068.28
$1,047.33
Norfolk/Plymouth/Suffolk
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$230.56
$226.04
T2042 UD
Routine Home Care (61+ days)
Per Diem
$182.21
$178.62
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$70.13
$68.76
T2043
Continuous Home Care
Per Hour
$70.14
$68.76
T2044
Inpatient Respite
Per Diem
$559.55
$548.59
T2045
General Inpatient
Per Diem
$1,204.02
$1,180.41
Worcester
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$215.83
$211.60
T2042 UD
Routine Home Care (61+ days)
Per Diem
$170.56
$167.20
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$65.11
$63.84
T2043
Continuous Home Care
Per Hour
$65.11
$63.83
T2044
Inpatient Respite
Per Diem
$526.21
$515.90
T2045
General Inpatient
Per Diem
$1,129.67
$1,107.52
Rural: Dukes and
							 Nantucket
Compliant
							 Rate
Noncompliant
							 Rate
T2042
Routine Home Care (one-60 days)
Per Diem
$245.56
$240.75
T2042 UD
Routine Home Care (61+ days)
Per Diem
$194.06
$190.24
G0299 (RN services)
G0155 (Social Worker services)
Service Intensity Add-on
Per Hour/Max four hours
$75.25
$73.78
T2043
Continuous Home Care
Per Hour
$75.25
$73.78
T2044
Inpatient Respite
Per Diem
$593.50
$581.87
T2045
General Inpatient
Per Diem
$1,279.72
$1,254.63
Use modifier TN for T2042 and T2043 when billing for members
				outside the county in which the provider is located.