101 CMR, § 312.01

Current through Register 1536, December 6, 2024

Section 312.01 - General Provisions

(1)Scope, Purpose and Effective Date. 101 CMR 312.00 governs the rates of payment used by all governmental units to pay eligible providers which provide family planning services to publicly aided individuals.

(2)Applicable Dates of Service. Rates in 101 CMR 312.00 apply for dates of service provided on or after January 1, 2023, unless otherwise indicated.

(3)Coverage. 101 CMR 312.00 and the rates of payment in 101 CMR 312.00 apply to family planning services rendered by eligible providers at a family planning agency setting. The rates of payment under 101 CMR 312.00 are full compensation for all services rendered.

(4)Disclaimer of Authorization of Services. 101 CMR 312.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 312.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of the care and services extended to publicly-aided individuals.

(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;

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

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(6)Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 312.00, and as otherwise specified in 101 CMR 312.00.