101 CMR, § 337.01

Current through Register 1535, November 22, 2024

Section 337.01 - General Provisions

(1)Scope and Purpose. 101 CMR 337.00 governs the payment rates to be used by all governmental units and purchasers under M.G.L. c. 152, § 1 (the Workers' Compensation Act) for dialysis treatments, treatment for acute kidney injuries (AKIs), and home dialysis supplies provided to publicly aided and industrial accident patients.

(2)Applicable Dates of Service. Rates contained in 101 CMR 337.00 apply for dates of service provided on or after April 1, 2024.

(3)Disclaimer of Authorization of Services. 101 CMR 337.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 337.00. The governmental purchasers and purchasers under M.G.L. c. 152 of these services are responsible for

(a) the definitions and authorization of services for their beneficiaries; and

(b) providing information as to program policies and benefit limitations.

(4)Rate as Full Payment. The rates of payment under 101 CMR 337.00 are full compensation for all services rendered by the provider in connection with the provision of dialysis treatments and home dialysis supplies. Any patient resources or third-party payments on behalf of a publicly aided patient, e.g., Medicare payments, will reduce the amount of the obligation for these services to the governmental purchaser or purchaser under M.G.L. c. 152.

(5)Coding Updates and Corrections. EOHHS may publish service 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). 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 clarify its policy on, and interpretation of, substantive provisions of 101 CMR 337.00.