101 CMR, § 361.01

Current through Register 1536, December 6, 2024

Section 361.01 - General Provisions

(1)Scope. 101 CMR 361.00 establishes rates of payment for continuous skilled nursing agency services and independent nursing services rendered by eligible providers to publicly aided individuals. The rates set forth in 101 CMR 361.00 also apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act).

(2)Applicable Dates of Service. Rates contained in 101 CMR 361.00 apply for dates of service on or after August 1, 2024, unless otherwise specifically noted.

(3)Coverage.

(a) Separate rates are specified for the following situations.

1. The eligible provider bills as an individual practitioner for professional services rendered, and the services are not covered by a facility rate.

2. The eligible provider bills as a provider agency and employs, either through contractual agreement or salary, qualified professionals who do not bill independently for professional services rendered and whose services are not covered by a facility rate.

(b) The allowable fees established pursuant to 101 CMR 361.00 for services provided to publicly aided individuals apply to all continuous skilled nursing services, registered nurse (RN) supervisory visits, and complex care assistant services, as defined in 101 CMR 361.02, regardless of the type of program under which MassHealth is purchasing the services. The allowable fees are full compensation for the continuous skilled nursing services, RN supervisory visits, and complex care assistant services rendered including, but not limited to, administrative or supervisory duties and costs in connection with service provision.

(4)Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 361.00 and to specify the information and documentation necessary to implement 101 CMR 361.00.

(5)Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and/or the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list:

(a) codes for which the code numbers change, with the corresponding cross-references between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed; and

(c) deleted codes for which there are no corresponding new codes.

(6)Disclaimer of Authorization of Services. 101 CMR 361.00 is not authorization for or approval of the substantive services, or lengths of time, for which rates are paid pursuant to 101 CMR 361.00. Governmental units or workers' compensation insurers that purchase services from eligible providers are responsible to define, authorize, and approve the services extended to covered individuals and the length of time for which the approval is applicable.