130 CMR, § 429.408

Current through Register 1533, October 25, 2024

Section 429.408 - In-State Providers: Maximum Allowable Fees

(A) The MassHealth agency pays for mental health center services with rates set by EOHHS, subject to the conditions, exclusions, and limitations set forth in 130 CMR 429.000. EOHHS fees for mental health center services are contained in 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health and Mental Health Centers.

(1) In the event that the center has a sliding scale charge structure, the maximum published charges will be considered the center's usual charge to the general public, provided the following conditions are met:

(a) the center's full charges must be published in a fee schedule;

(b) the center's revenues must be based on the application of full charges with allowances noted for reduction of fees;

(c) the center's procedure for reduction of fees must be in accordance with written policies; and

(d) the center must maintain sufficient information to document the amount of the reductions.

(2) Centers designated as Behavioral Health Urgent Care Providers pursuant to 130 CMR 429.404(A) may bill for the provision of these services according to rates set forth in 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers.

(B)Administrative Operations. Payment by the MassHealth agency for mental health center services includes payment for administrative operations and for all aspects of service delivery not explicitly included in 130 CMR 429.000, such as, but not limited to:

(1) completion of member registration and intake, which may be completed on a telephonic or walk-in basis, and shall include accumulating and recording at least the minimally required member information necessary to facilitate diagnostic evaluation services, including the members' presenting concern, and for referral to an appropriate provider or service;

(2) communication with members or other parties that may include processes for appointment reminders or coordination of care;

(3) staff supervision or consultation with another staff member within the mental health center;