Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 445.00 › Section 445.03 - 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 provider must, as
			 a condition of acceptance of payment by a purchasing agency for services
			 provided to a client, accept the payment rates established by 101 CMR 445.00 as
			 full payment and discharge of all obligations for the services provided. The
			 provider may not seek additional or supplemental payment from clients or other
			 third parties for services for which rates are established by 101 CMR 445.00.
			 If a provider receives any client funds or third-party payments for services
			 provided to a client, the purchasing agency's obligation for services to the
			 client will be offset by the amount received.
(a)
Rates with Applicable Dates
			 of Service Provided on or after December 1, 2020
.
Service Description
Code
Unit
Rate
Adult Day Health - Basic Level of
							 Care
S5102
Per Diem
$87.74
Adult Day Health - Complex Level of
							 Care
S5102 TG
Per Diem
$111.10
Adult Day Health - Basic Level of
							 Care
S5100
Per 15 Min.
$3.65
Adult Day Health - Basic Level of
							 Care
S5101
Per 3 Hours
$43.85
Adult Day Health - Complex Level of
							 Care
S5100 TG
Per 15 Min.
$4.62
Adult Day Health - Complex Level of
							 Care
S5101 TG
Per 3 Hours
$55.44
Day Habilitation - Skills training and development,
							 per 15 minutes (community program, low need)
H2014
Per 15 Min.
$4.09
Day Habilitation - Skills training and development,
							 per 3 hours (community program, low need)
S5101
Per 3 Hours
$49.06
Day Habilitation - Skills training and development,
							 per 6 hours (community program, low need)
S5102
Per 6 Hours
$98.11
Day Habilitation - Skills training and development
							 per 15 minutes, intermediate level of care (community program, moderate
							 need)
H2014-TF
Per 15 Min.
$4.62
Day Habilitation - Skills training and development
							 per 3 hours, intermediate level of care (community program, moderate
							 need)
S5101-TF
Per 3 Hours
$55.44
Day Habilitation - Skills training and development
							 per 6 hours, intermediate level of care (community program, moderate
							 need)
S5012-TF
Per 6 Hours
$111.10
Day Habilitation - Skills training and development,
							 per 15 minutes, complex/high tech level of care (community program, high
							 need)
H2014-TG
Per 15 Min.
$5.99
Day Habilitation - Skills training and development,
							 per 3 hours complex/high tech level of care (community program, high
							 need)
S5101-TG
Per 3 Hours
$71.90
Day Habilitation - Skills training and development,
							 per 6 hours complex/high tech level of care (community program, high
							 need)
S5102-TG
Per 6 Hours
$143.81
Day Habilitation - Skills training and development
							 per 15 minutes (nursing facility, one-to-two or one to three staffing
							 level)
H2014-U1
Per 15 Min.
$5.77
Day Habilitation - Skills training and development
							 per 3 hours (nursing facility, one-to-two or one to three staffing
							 level)
S5101-U1
Per 3 Hours
$69.22
Day Habilitation - Skills training and development
							 per 6 hours (nursing facility, one-to-two or one to three staffing
							 level)
S5102-U1
Per 6 Hours
$138.43
Day Habilitation - Skills training and development,
							 per 15 minutes (nursing facility, one-to-one staffing level)
H2014-U2
Per 15 Min.
$10.40
Day Habilitation - Skills training and development,
							 per 3 hours (nursing facility, one-to-one staffing level)
S5101-U2
Per 3 Hours
$124.82
Day Habilitation - Skills training and development,
							 per 6 hours (nursing facility, one-to-one staffing level)
S5102-U2
Per 6 Hours
$249.65
Day Habilitation - Skills training and development,
							 per 15 minutes, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
H2014-22
Per 15 Min.
$4.77
Day Habilitation - Skills training and development,
							 per 3 hours, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
S5101-22
Per 3 Hours
$57.29
Day Habilitation - Skills training and development,
							 per 6 hours, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
S5102-22
Per 6 Hours
$114.58
Day Habilitation - Nonemergency transportation;
							 encounter/trip (used only when serving four or more individuals in a nursing
							 facility)
T2003
Per Trip/ Encounter
$5.11
Day Services - HCBS (ABI/MFP)
Multiple
Per Diem
$147.14
Day Services - HCBS (ABI/MFP) - partial
							 day
Multiple
Per 3 Hours
$73.57
Individual Supported Employment
Multiple
Per 15 Min.
$18.16
Prevocational Services
T2019
Per 15 Min.
$13.09
(b)
Rates with Applicable Dates of Service Provided on or after March
			 1, 2021
.
Service Description
Code
Unit
Rate
Adult Day Health - Basic Level of
							 Care
S5102
Per Diem
$78.34
Adult Day Health - Complex Level of
							 Care
S5102 TG
Per Diem
$99.20
Adult Day Health - Basic Level of
							 Care
S5100
Per 15 Min.
$3.26
Adult Day Health - Basic Level of
							 Care
S5101
Per 3 Hours
$39.15
Adult Day Health - Complex Level of
							 Care
S5100 TG
Per 15 Min.
$4.13
Adult Day Health - Complex Level of
							 Care
S5101 TG
Per 3 Hours
$49.50
Day Habilitation - Skills training and development,
							 per 15 minutes (community program, low need)
H2014
Per 15 Min.
$3.65
Day Habilitation - Skills training and development,
							 per 3 hours (community program, low need)
S5101
Per 3 Hours
$43.80
Day Habilitation - Skills training and development,
							 per 6 hours (community program, low need)
S5102
Per 6 Hours
$87.60
Day Habilitation - Skills training and development
							 per 15 minutes, intermediate level of care (community program, moderate
							 need)
H2014-TF
Per 15 Min.
$4.13
Day Habilitation - Skills training and development
							 per 3 hours, intermediate level of care (community program, moderate
							 need)
S5101-TF
Per 3 Hours
$49.50
Day Habilitation - Skills training and development
							 per 6 hours, intermediate level of care (community program, moderate
							 need)
S5102-TF
Per 6 Hours
$99.00
Day Habilitation - Skills training and development,
							 per 15 minutes, complex/high tech level of care (community program, high
							 need)
H2014-TG
Per 15 Min.
$5.35
Day Habilitation - Skills training and development,
							 per 3 hours complex/high tech level of care (community program, high
							 need)
S5101-TG
Per 3 Hours
$64.20
Day Habilitation - Skills training and development,
							 per 6 hours complex/high tech level of care (community program, high
							 need)
S5102-TG
Per 6 Hours
$128.40
Day Habilitation - Skills training and development
							 per 15 minutes (nursing facility, one-to-two or one to three staffing
							 level)
H2014-U1
Per 15 Min.
$5.15
Day Habilitation - Skills training and development
							 per 3 hours (nursing facility, one-to-two or one to three staffing
							 level)
S5101-U1
Per 3 Hours
$61.80
Day Habilitation - Skills training and development
							 per 6 hours (nursing facility, one-to-two or one to three staffing
							 level)
S5102-U1
Per 6 Hours
$123.60
Day Habilitation - Skills training and development,
							 per 15 minutes (nursing facility, one-to-one staffing level)
H2014-U2
Per 15 Min.
$9.29
Day Habilitation - Skills training and development,
							 per 3 hours (nursing facility, one-to-one staffing level)
S5101-U2
Per 3 Hours
$111.45
Day Habilitation - Skills training and development,
							 per 6 hours (nursing facility, one-to-one staffing level)
S5102-U2
Per 6 Hours
$222.90
Day Habilitation - Skills training and development,
							 per 15 minutes, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
H2014-22
Per 15 Min.
$4.26
Day Habilitation - Skills training and development,
							 per 3 hours, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
S5101-22
Per 3 Hours
$51.15
Day Habilitation - Skills training and development,
							 per 6 hours, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
S5102-22
Per 6 Hours
$102.30
Day Habilitation - Nonemergency transportation;
							 encounter/trip (used only when serving four or more individuals in a nursing
							 facility)
T2003
Per Trip/ Encounter
$4.56
Day Services - HCBS (ABI/MFP)
Multiple
Per Diem
$131.38
Day Services - HCBS (ABI/MFP) - partial
							 day
Multiple
Per 3 Hours
$65.69
Individual Supported Employment
Multiple
Per 15 Min.
$16.21
Prevocational Services
T2019
Per 15 Min.
$11.69
(c)
Rates with Applicable Dates of Service Provided on or after July 1,
			 2021
.
Service Description
Code
Unit
Rate
(Refer to the rate listed in the cited
							 regulation.)
Adult Day Health - Basic Level of
							 Care
S5102
Per Diem
101 CMR 310.00:
Adult Day Health Services
Adult Day Health - Complex Level of
							 Care
S5102 TG
Per Diem
Adult Day Health - Basic Level of
							 Care
S5100
Per 15 Min.
101 CMR 310.00:
Adult Day Health Services
Adult Day Health - Basic Level of
							 Care
S5101
Per 3 Hours
Adult Day Health - Complex Level of
							 Care
S5100 TG
Per 15 Min.
Adult Day Health - Complex Level of
							 Care
S5101 TG
Per 3 Hours
Day Habilitation - Skills training and development,
							 per 15 minutes (community program, low need)
H2014
Per 15 Min.
101 CMR 348.00:
Day
							 Habilitation Program Services
Day Habilitation - Skills training and development,
							 per 3 hours (community program, low need)
S5101
Per 3 Hours
Day Habilitation - Skills training and development,
							 per 6 hours (community program, low need)
S5102
Per 6 Hours
Day Habilitation - Skills training and development
							 per 15 minutes, intermediate level of care (community program, moderate
							 need)
H2014-TF
Per 15 Min.
Day Habilitation - Skills training and development
							 per 3 hours, intermediate level of care (community program, moderate
							 need)
S5101-TF
Per 3 Hours
Day Habilitation - Skills training and development
							 per 6 hours, intermediate level of care (community program, moderate
							 need)
S5102-TF
Per 6 Hours
Day Habilitation - Skills training and development,
							 per 15 minutes, complex/high tech level of care (community program, high
							 need)
H2014-TG
Per 15 Min.
Day Habilitation - Skills training and development,
							 per 3 hours complex/high tech level of care (community program, high
							 need)
S5101-TG
Per 3 Hours
Day Habilitation - Skills training and development,
							 per 6 hours complex/high tech level of care (community program, high
							 need)
S5102-TG
Per 6 Hours
Day Habilitation - Skills training and development
							 per 15 minutes (nursing facility, one-to-two or one to three staffing
							 level)
H2014-U1
Per 15 Min.
Day Habilitation - Skills training and development
							 per 3 hours (nursing facility, one-to-two or one to three staffing
							 level)
S5101-U1
Per 3 Hours
Day Habilitation - Skills training and development
							 per 6 hours (nursing facility, one-to-two or one to three staffing
							 level)
S5102-U1
Per 6 Hours
Day Habilitation - Skills training and development,
							 per 15 minutes (nursing facility, one-to-one staffing level)
H2014-U2
Per 15 Min.
Day Habilitation - Skills training and development,
							 per 3 hours (nursing facility, one-to-one staffing level)
S5101-U2
Per 3 Hours
101 CMR 348.00:
Day
							 Habilitation Program Services
Day Habilitation - Skills training and development,
							 per 6 hours (nursing facility, one-to-one staffing level)
S5102-U2
Per 6 Hours
Day Habilitation - Skills training and development,
							 per 15 minutes, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
H2014-22
Per 15 Min.
Day Habilitation - Skills training and development,
							 per 3 hours, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
S5101-22
Per 3 Hours
Day Habilitation - Skills training and development,
							 per 6 hours, unusual procedural service, when the service(s) provided is
							 greater than that usually listed for the listed procedure (supplemental
							 staffing for nursing facility residents in community day
							 habilitation)
S5102-22
Per 6 Hours
Day Habilitation - Non-emergency transportation;
							 encounter/trip (used only when serving four or more individuals in a nursing
							 facility)
T2003
Per Trip/ Encounter
Day Services - HCBS (ABI/MFP)
Multiple
Per Diem
101 CMR 359.00:
Rates for Home and Communitybased Services Waivers
Day Services - HCBS (ABI/MFP) - partial
							 day
Multiple
Per 3 Hours
Individual Supported Employment
Multiple
Per 15 Min.
101 CMR 419.00:
Rates for Supported Employment Services
Prevocational Services
T2019
Per 15 Min.
101 CMR
359.00: Rates for Home and
							 Communitybased Services Waivers