101 CMR, § 445.03

Current through Register 1533, October 25, 2024

Section 445.03 - 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 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

101 CMR, § 445.03

Adopted by Mass Register Issue 1431, eff. 8/14/2020.

Amended by Mass Register Issue 1441, eff. 1/8/2021.

Amended by Mass Register Issue 1446, eff. 6/25/2021.