101 CMR, § 433.03

Current through Register 1538, January 3, 2025

Section 433.03 - 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 program 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 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)Approved Rates with Applicable Dates of Service Provided on or after July 1, 2021. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 433.03(4).

(a)Certain Substance Use Disorder Programs. Terms used in 101 CMR 433.03(4)(a) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 346.02: Definitions.

Service/Program	Code	Unit of Service	Rate
Youth Residential Substance Use Disorder Treatment	H0019-HF	Per Diem	$323.55
Clinically Intensive Youth Residential Substance Use Disorder Treatment	H0019-HA	Per Diem	$425.39
Residential Services	H0019	Per Diem	$149.20
Residential Rehab Pregnant Enhancement	H0019-TH	Per Diem	$41.58
Residential Rehab Postpartum Enhancement	H0019-HD	Per Diem	$93.35
Residential Rehab Child Enhancement	H0019-HV	Per Diem	$46.67
Medically Monitored Inpatient Detoxification	H0011	Per Diem	$420.77
Clinically Managed Inpatient Detoxification	H0010	Per Diem	$350.93
Transitional Support Services	H0018	Per Diem	$185.21
Second Offender Drive Alcohol Education Residential	H0018-H9	Per Diem	$148.82
Jail Diversion - Phase 1	H0019-H9	Per Diem	$222.81
Jail Diversion - Phase 2	H0006-H9	Per Hour	$61.53
Family Supportive Housing	H0019-HR	Per Diem	$197.63
Family Residential Treatment	H01019-HR	Per Diem	$327.92
Supportive Case Management - Permanent Adult	N/A	Enrolled Client Day	$12.43
Supportive Case Management - Permanent Families	N/A	Enrolled Client Day	$25.06
Supportive Case Management - Permanent Young Adult	N/A	Enrolled Client Day	$34.46
Supportive Case Management - Transitional Adult	N/A	Enrolled Client Day	$14.80
Supportive Case Management - Transitional Families	N/A	Enrolled Client Day	$29.79
Supportive Case Management - Transitional Young Adult	N/A	Enrolled Client Day	$40.17
Supportive Case Management - House Manager Add-on	N/A	Month	$2,917.00
Supportive Case Management - Outreach and Staffing Supports	N/A	Month	$3,997.00
Supportive Case Management - Low Threshold	N/A	Enrolled Client Day	$51.43
Supportive Case Management - School Based Targeted Prevention	N/A	Month	$16,882.00
Triage, Engagement & Assessment Services - Model A -Base Rate	N/A	Monthly Per Slot	$952.00
Triage, Engagement & Assessment Services - Model A -Engagement Staff Rate	N/A	Monthly Per Slot	$534.00
Triage, Engagement & Assessment Services - Model A -Engagement Staff Rate Day Program Only	N/A	Monthly Per Slot	$273.00
Triage, Engagement & Assessment Services - Model B -Base Rate	N/A	Monthly Per Slot	$1,141.00
Triage, Engagement & Assessment Services - Model B -Engagement Staff Rate	N/A	Monthly Per Slot	$720.00
Triage, Engagement & Assessment Services - Model B -Engagement Staff Rate Day Program Only	N/A	Monthly Per Slot	$447.00
Triage, Engagement & Assessment Services - Peer Service Coordinator Add-on	N/A	Per Diem	$22.04
Triage, Engagement & Assessment Services - Social Worker LICSW Add-on	N/A	Per Diem	$38.08
Triage, Engagement & Assessment Services - Care Coordinator Add-on	N/A	Per Diem	$22.04
Triage, Engagement & Assessment Services - Direct Care Staff Add-on	N/A	Per Diem	$22.04
Triage, Engagement & Assessment Services - Support Staff Add-on	N/A	Per Diem	$22.04
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 1	N/A	Monthly	$2,562.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 2	N/A	Monthly	$3,611.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 3	N/A	Monthly	$4,659.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 4	N/A	Monthly	$5,708.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 5	N/A	Monthly	$6,757.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 6	N/A	Monthly	$8,108.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 7	N/A	Monthly	$9,459.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 8	N/A	Monthly	$10,810.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 9	N/A	Monthly	$12,162.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 10	N/A	Monthly	$13,513.00
Office Based Opioid Treatment (FQHCs) Wraparound Services - 25 Client Add-on	N/A	Monthly	$1,351.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 1	N/A	Monthly	$4,714.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 2	N/A	Monthly	$5,763.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 3	N/A	Monthly	$6,811.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 4	N/A	Monthly	$7,860.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 5	N/A	Monthly	$8,908.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 6	N/A	Monthly	$10,690.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 7	N/A	Monthly	$12,472.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 8	N/A	Monthly	$14,253.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 9	N/A	Monthly	$16,035.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 10	N/A	Monthly	$17,817.00
Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - 25 Client Add-on	N/A	Monthly	$3,503.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 1	N/A	Monthly	$4,968.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 2	N/A	Monthly	$8,495.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 3	N/A	Monthly	$11,985.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 4	N/A	Monthly	$15,501.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 5	N/A	Monthly	$19,018.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 6	N/A	Monthly	$22,821.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 7	N/A	Monthly	$26,625.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 8	N/A	Monthly	$30,428.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 9	N/A	Monthly	$34,232.00
Office Based Opioid Treatment - Hospital Wraparound Services - Tier 10	N/A	Monthly	$38,035.00
Office Based Opioid Treatment - Hospital Wraparound Services - 25 Client Add-on	N/A	Monthly	$2,562.00
Office Based Opioid Treatment (FQHCs) Start-up - Level 1	N/A	Monthly	$8,659.00
Office Based Opioid Treatment (FQHCs) Start-up -Level 2	N/A	Monthly	$12,669.00

(b)Adult Housing and Community Support Services. Terms used in 101 CMR 433.03(4)(f) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 421.02: Definitions.

1.Program Rates.

Service/Program	Unit of Service	Rate
Outreach and Engagement	Month	$31,757
Safe Haven: ten to 12 beds	Enrolled day	$180.45
Safe Haven: seven to nine beds	Enrolled day	$200.40
Dual Diagnosis Shelter - donated space	Enrolled day	$163.66
Dual Diagnosis Shelter - with occupancy costs	Enrolled day	$184.38
Housing Options Program: Level 1	Enrolled month	$40.58
Housing Options Program: Level 2	Enrolled month	$165.45
Assertive Treatment and Relapse Prevention: Model A - nine to 12 clients	Enrolled day	$50.98
Assertive Treatment and Relapse Prevention: Model B - six to eight clients	Enrolled day	$48.57

2.Adult Housing and Community Support Service Add-on Rates.

Position Title	Per Diem	.25 FTE Monthly	.50 FTE Monthly	1.0 FTE Monthly
Direct Care	$166	$897	$1,793	$3,587
Direct Care III	$214	$1,161	$2,321	$4,643
LICSW	$302	$1,633	$3,267	$6,534

3.Congregate Care Hourly Add-on Rates.

Position	Hourly Rate
Direct Care	$22.04
Certified Nursing Assistant	$22.67
Direct Care III	$28.53
Occupational Therapist	$55.04
Occupational Therapist Assistant	$43.56
Case Manager, Social Worker, Clinician (MA level - not Independent Licensed)	$38.10
LPN	$41.91
Registered Nurse	$63.20
Clinician with Independent License	$44.53
Social/Caseworker (BA Level)	$31.75
Nurse Practitioner/APRN	$86.75

(c)Youth And Young Adult Support Services. Terms used in 101 CMR 433.03(4)(g) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 427.02: Definitions.

1.Alternative Lock-up Program Rates.

Service/Program	Unit of Service	Rate
A	Monthly	$11,547
B	Monthly	$20,111
C	Monthly	$25,703

2.Conflict of Interest Program Rates.

Service/Program	Unit of Service	Rate
One Family	Monthly	$1,090
Five Families	Monthly	$5,448

3.Teen Pregnancy Prevention Program Rates.

Service/Program	Unit of Service	Rate
In school	Curriculum Hour	$324.70
Outside school	Curriculum Hour	$405.88
Remote Add-on	Hour	$81.18
Peer Leadership & Youth Development	Contact Hour	$243.53
Partnership Development	Hour	$46.70

4.Therapeutic Day Services Program Rates.

Service/Program	Unit of Service	Rate
Model 1	Month	$28,418
Model 2	Month	$24,586
Model 3A	Month	$25,547
Model 3B	Month	$34,615
Model 4A	Month	$20,030
Model 4B	Month	$37,806

5.Therapeutic Day Services Add-on Rates.

Title	Unit of Service	.25 FTE	.5 FTE	.75 FTE	1 FTE
Clinical (LICSW)	Monthly	$1,633	$3,268	$4,900	$6,534
Peer/Direct Care	Monthly	$897	$1,794	$2,690	$3,587
Direct Care III	Monthly	$1,160	$2,321	$3,481	$4,641

6.Young Parent Support Program Rates.

Service/Program	Unit of Service	Rate
Model A	Month	$8,435
Model B	Month	$16,869
YPS Specialty Direct Care III Add-on (.5 FTE)	Month	$2,321
YPS Specialty Direct Care III Add-on (1 FTE)	Month	$4,641

(d)Independent Living Community Programs. Terms used in 101 CMR 433.03(4)(h) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 428.02: Definitions.

1.Deaf and Hard of Hearing Independent Living Service Program Rates.

Service/Program	Unit of Service	Rate
DHILs - Region 1	Monthly	$46,315
DHILs - Region 2	Monthly	$40,707
DHILs - Region 3	Monthly	$36,502
DHILs - Region 4	Monthly	$33,600
DHILs - Region 5	Monthly	$21,841
DHILs - Region 6	Monthly	$18,927
DHILs - Region 7	Monthly	$11,631
DHILs - Region 8	Monthly	$7,495

2.Recovery Learning Communities Program Rates.

Service/Program	Unit of Service	Rate
Recovery Learning Communities	Monthly	$76,935

3.Vocational Rehabilitation Independent Living Service Program Rates.

Service/Program	Unit of Service	Rate
VRIL Service Add-on	Per Hour	$129
VRIL Assessment	Per Component	$515
Independent Living Skills Training	Per Component	$1,931
Community Resource Access	Per Component	$1,931
PASS Plan	Per Component	$1,931
Single Service Purchase	Per Component	$901
VRIL Group Training Add-on	Per Client per Class	$43.49

4.Independent Living Communities Add-on Rates.

Position	Unit of Service	Rate
Direct Care 0.25 FTE Add-on	Monthly	$1,161
Direct Care 0.5 FTE Add-on	Monthly	$2,321
Direct Care 0.75 FTE Add-on	Monthly	$3,482
Direct Care 1.0 FTE Add-on	Monthly	$4,643

(e)Sexual and Domestic Violence Services. Terms used in 101 CMR 433.03(4)(i) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 429.02: Definitions.

Service/Program	Unit of Service	Rate
Domestic Violence Community-based Services	.25 Direct Care FTE	$1,952
Child Exposed to Domestic Violence Services	.25 Direct Care FTE	$2,097
Supervised Visitation Services	.25 Direct Care FTE	$1,990
Sexual and Domestic Violence Equity Services	.25 Direct Care FTE	$1,952
Sexual and Domestic Violence Equity Legal Services	.25 Direct Care FTE	$3,028
Intimate Partner Abuse Education Services	Per Cohort	$2,658
Intimate Partner Abuse Education Services - Outreach and Development	Monthly	$443
Rape Crisis Centers - Dual Agency Tier 1	Monthly	$67,141
Rape Crisis Centers - Dual Agency Tier 2	Monthly	$58,974
Rape Crisis Centers - Dual Agency Tier 3	Monthly	$50,807
Rape Crisis Centers - Dual Agency Tier 4	Monthly	$42,640
Rape Crisis Centers - Dual Agency Tier 5	Monthly	$34,473
Rape Crisis Centers - Dual Agency Tier 6	Monthly	$26,306
Rape Crisis Centers - Dual Agency Tier 7	Monthly	$18,139
Rape Crisis Centers - Dual Agency Tier 8	Monthly	$9,972
Rape Crisis Centers - Stand-alone Agency Tier 1	Monthly	$70,328
Rape Crisis Centers - Stand-alone Agency Tier 2	Monthly	$61,771
Rape Crisis Centers - Stand-alone Agency Tier 3	Monthly	$53,214
Rape Crisis Centers - Stand-alone Agency Tier 4	Monthly	$44,658
Rape Crisis Centers - Stand-alone Agency Tier 5	Monthly	$36,101
Rape Crisis Centers - Stand-alone Agency Tier 6	Monthly	$27,544
Rape Crisis Centers - Stand-alone Agency Tier 7	Monthly	$18,987
Rape Crisis Centers - Stand-alone Agency Tier 8	Monthly	$10,430
Rape Crisis Satellite Center Add-on	Hourly	$40.40
Rape Crisis Direct Care 0.25 FTE Add-on	Monthly	$1,952

(f)Program of Assertive Community Treatment. Terms used in 101 CMR 433.03(4)(j) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 430.02: Definitions.

Service/Program	Unit of Service	Rate
Program of Assertive Community Treatment - PACT50	Enrollment Day	$54.02
Program of Assertive Community Treatment - PACT80	Enrollment Day	$49.83
Program of Assertive Community Treatment - Forensic PACT	Enrollment Day	$78.54
Program of Assertive Community Treatment - Forensic GLE	Bed Day	$323.39

(g)Certain Respite Services. Terms used in 101 CMR 433.03(4)(k) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 431.02: Definitions.

Service/Program	Unit of Service	Rate
Respite - A	Month	$60,629
Respite - B	Month	$83,628
Respite - C	Month	$172,054
Respite - Peer Model	Month	$43,271
Respite - Site Only	Per Diem	$262.40
Respite - Mobile Only	Per Diem	$130.52

(h)Lead Agency Services. Terms used in 101 CMR 433.03(4)(l) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 432.02: Definitions.

Service/Program	Unit of Service	Rate
Lead Agency Tier 1	Month	$26,181
Lead Agency Tier 2	Month	$31,772
Lead Agency Tier 3	Month	$37,060
Lead Agency Tier 4	Month	$40,706
Lead Agency Tier 5	Month	$55,781
Lead Agency Tier 6	Month	$73,749
Case Manager/Education Coordinator 0.50 FTE Add-on	Month	$2,916
Case Manager/Education Coordinator 1.0 FTE Add-on	Month	$5,832

101 CMR, § 433.03

Adopted by Mass Register Issue 1450, eff. 7/27/2021.

Amended by Mass Register Issue 1453, eff. 10/1/2021.

Amended by Mass Register Issue 1459, eff. 12/24/2021.