101 CMR, § 421.03

Current through Register 1533, October 25, 2024

Section 421.03 - Rate Provisions

(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 eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for the services rendered to the publicly assisted client.

(3)Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4)Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5)Approved Rates. The approved rate is the lower of a provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 421.03(5).

Program/Service Type	Rate	Unit
Outreach and Engagement	$35,983	Month
Safe Haven: ten to 12 beds	$207.14	Enrolled day
Safe Haven: seven to nine beds	$229.46	Enrolled day
Dual Diagnosis Shelter - donated space	$189.38	Enrolled day
Dual Diagnosis Shelter - with occupancy costs	$210.62	Enrolled day
Housing Options Program: Level 1	$45.43	Enrolled month
Housing Options Program: Level 2	$189.97	Enrolled month
Assertive Treatment and Relapse Prevention: Model A - nine to 12 clients	$58.01	Enrolled day
Assertive Treatment and Relapse Prevention: Model B - six to eight clients	$55.62	Enrolled day

Program Staffing Supports	Rates
FTE Basis
0.25	0.5	1
Position Titles	Per Diem	Monthly
Direct Care	$184.00	$1,061.00	$2,122.00	$4,244.00
Direct Care III	$234.00	$1,354.00	$2,708.00	$5,415.00
LICSW	$340.00	$1,965.00	$3,929.00	$7,858.00