101 CMR, § 349.04

Current through Register 1533, October 25, 2024

Section 349.04 - Rate Provisions

(1)Services Included in the Rate. The approved rates include payment for all care and services that are or have been customarily part of the Early Intervention program of the eligible provider, including necessary administration, supervision, travel, transportation, and support services, subject only to the terms of the purchase agreement between the eligible provider and the purchasing governmental units.

(2)Payment Terms.

(a)Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by one or more purchasing governmental units for services rendered, accept the approved program rates as full payment and discharge of all obligations for the services rendered, subject only to appellate rights as set forth in M.G.L. c. 118E. There must be no duplication of or supplemental payment in excess of the approved program rates from sources other than those expressly recognized or anticipated in the computation of the rates. Any client resources not expressly recognized or anticipated in the computation of the rate will reduce, by that amount, the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(b)Payment Limitations. Except as provided in 101 CMR 349.03(3), 349.04(2)(a), and 349.04(3), no purchasing governmental unit may pay less than, or more than, the approved program rate.

(3)Approved Program Rates. The rates of payment for authorized services are the lowest of the eligible provider's usual charge to the general public for Early Intervention services, the amount accepted as payment from another payer, or the rate listed in 101 CMR 349.04(3).

(a)Early Intervention Program Service Rates Effective July 1, 2022.

Service Code	Service Description	Per Unit
H2015	Child visit - day care	$27.05
H2015	Child visit - hospital	$27.05
H2015	Child visit	$27.05
T1015	Center-based individual	$22.63
96165-U1	EI-only child group (15 minutes)	$7.88
96164-U1	EI-only child group (30 minutes)	$15.77
96165-U2	Community child group (15 minutes)	$10.36
96164-U2	Community child group (30 minutes)	$20.72
T1027	Parent-focused group	$10.12
T1023	Screening	$31.54
T1024	Assessment	$36.21

(b)Early Intervention Program Service Rates Effective July 1, 2024.

Service Code	Service Description	Per Unit
H2015	Child visit - day care	$35.95
H2015	Child visit - hospital	$35.95
H2015	Child visit	$35.95
T1015	Center-based individual	$30.07
96165-U1	El-only child group (15 minutes)	$10.48
96164-U1	El-only child group (30 minutes)	$20.96
96165-U2	Community child group (15 minutes)	$13.77
96164-U2	Community child group (30 minutes)	$27.53
T1027	Parent-focused group	$13.44
T1023	Screening	$41.92
T1024	Assessment	$48.12

(c)Specialty Services. For therapeutic behavioral services, refer to 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis for the appropriate rate schedule.