Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 359.00 - Rates for Home and Community Based Services › Section 359.03 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Services Included in the Rate
. The approved rate will
			 include payment for all care and services that are part of the program of
			 services of a Provider, as explicitly set forth in the terms of the purchase
			 agreement between the Provider and the purchasing governmental
			 unit(s).
(2)
Reimbursement as Full Payment
. Each 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 for services
			 included in the scope of
			 101 CMR
			 359.00 from any other source must be used to offset
			 the amount of the purchasing governmental unit's obligation for services
			 rendered to the participant.
(3)
Payment Limitations
.
(a) No purchasing governmental unit may pay
			 less than or more than the approved program rate, except that a participant
			 contribution may be applied towards the Residential Habilitation room and board
			 payment in accordance with policies and procedures established by the
			 purchasing governmental unit.
(b)
			 Where more than one payment rate is available for a covered service, the
			 service is covered at the lowest available payment rate, unless a higher rate
			 is approved by the purchasing governmental unit, except as provided in
			 101
			 CMR 359.03(3)(c).
(c) Notwithstanding the requirement of
			 101
			 CMR 359.03(3)(b), payment
			 rates for certain HCBS waiver services will be determined as follows:
1.
Residential Habilitation rates
			 will be determined in the following manner
:
a.
Service Model
			 Rate
. The purchasing Governmental Unit will designate the
			 applicable rate from among the basic lower intensity, basic, or Intermediate
			 categories, or at medical/clinical level 1, medical/clinical level 2, or
			 medical/clinical level 3 as outlined and defined in
			 101 CMR
			 420.00:
Rates for Adult Long-term Residential
			 Services
.
b.
Room and Board
. The purchasing Governmental Unit will
			 designate the applicable rate for room and board from among the site rates
			 outlined in
			 101 CMR
			 420.00:
Rates for Adult Long-term Residential
			 Services
.
2.
Orientation and Mobility
. Orientation and Mobility
			 rates will be determined: based on one-way distance traveled to initiate the
			 service in the following manner:
a. Level I:
			 one to 30 miles;
b. Level II: 31 to
			 60 miles; and
c. Level III: over 60
			 miles.
3.
Shared Home Supports
. The purchasing Governmental Unit
			 will designate the applicable stipend rate at level 1, 2 or 3, as outlined and
			 defined in
			 101 CMR
			 411.00:
Rates for Certain Placement, Support,
			 and Shared Living Services
.
4.
Shared Living - 24 Hour
			 Supports
. Shared Living - 24-hour support rates will be determined
			 in the following manner
a.
Operational Rate
: The purchasing Governmental Unit
			 will designate the applicable rate from among the available operational rate
			 levels as outlined and defined in
			 101 CMR
			 411.00:
Rates for Certain Placement, Support,
			 and Shared Living Services
.
b.
Stipend Rate
: The
			 purchasing Governmental Unit will designate the applicable rate from among the
			 available Stipend Levels, corresponding to the designated operational rate
			 Level as outlined and defined in
			 101 CMR
			 411.00:
Rates for Certain Placement, Support,
			 and Shared Living Services
.