101 CMR, § 413.03

Current through Register 1533, October 25, 2024

Section 413.03 - 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 by the purchasing governmental unit(s).

(2)Reimbursement as Full Payment. Each eligible provider must, as a condition of payment by any purchasing governmental unit, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment by the purchasing governmental unit for services rendered to the client are reduced by the amount of any payment from any other source.

(3)Payment Limitations. No purchasing governmental unit may pay less than, or more than, the approved rate, except as cited in 101 CMR 413.03(2), (4), and (5).

(4)Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5)Approved Rates. Except for the rates established for substance use disorder treatment, the rates set forth in 101 CMR 413.03 govern the payment rates for services purchased by the Department of Children and Families, DMH, and DYS provided pursuant to contracts executed under the departments' FY 2013 or subsequent procurements. 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 413.03.

(a)Youth Residential Substance Use Disorder Treatment Rates Effective for Dates of Service Provided on or after January 1, 2024.

Program Name

Rate

HCPCS Code/Description

Youth Residential Substance

Use Disorder Treatment

$397.89

H0019-HF - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment service for transitional age youth and young adults: youth residential substance use disorder treatment).

Clinically Intensive Youth Residential Substance Use Disorder Treatment

$523.57

H0019-HA - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment services for youth: clinically intensive youth residential substance use disorder treatment).

(b)Adjudicated Youth Residential Treatment Base Rates Effective for Dates of Service Provided on or after January 1, 2024.

ADJUDICATED YOUTH RESIDENTIAL TREATMENT BASE RATES

PROVIDER LEASED	Utilization %	# of Clients
		12-14	15-17	18-22	23-26
	90%	$627.83	$525.21	$425.63	$386.26
	85%	$664.76	$556.11	$450.67	$408.98
	80%	$706.31	$590.86	$478.83	$434.54
	75%	$753.40	$630.25	$510.76	$463.51
	70%	$807.21	$675.27	$547.24	$496.62
	65%	$869.30	$727.22	$589.33	$534.82
	60%	$941.74	$787.82	$638.45	$579.39
	55%	$1,027.36	$859.44	$696.49	$632.06
	50%	$1,130.09	$945.38	$766.13	$695.26

PROVIDER OWNED	Utilization %	# of Clients
		12-14	15-17	18-22	23-26
	90%	$587.40	$484.78	$385.20	$345.83
	85%	$621.95	$513.30	$407.86	$366.17
	80%	$660.83	$545.38	$433.35	$389.06
	75%	$704.88	$581.74	$462.24	$414.99
	70%	$755.23	$623.29	$495.26	$444.64
	65%	$813.32	$671.24	$533.36	$478.84
	60%	$881.10	$727.18	$577.80	$518.74
	55%	$961.20	$793.28	$630.33	$565.90
	50%	$1,057.32	$872.61	$693.36	$622.49

STATE OWNED - SEPARATE	Utilization %	# of Clients
		12-14	15-17	18-22	23-26
	90%	$579.70	$477.08	$377.50	$357.80
	85%	$613.80	$505.15	$399.71	$378.84
	80%	$652.16	$536.72	$424.69	$402.52
	75%	$695.64	$572.50	$453.00	$429.36
	70%	$745.33	$613.39	$485.36	$460.02
	65%	$802.66	$660.58	$522.69	$495.41
	60%	$869.55	$715.62	$566.25	$536.69
	55%	$948.60	$780.68	$617.73	$585.49
	50%	$1,043.46	$858.75	$679.50	$644.03

STATE OWNED - CO-LOCATED	Utilization %	# of Clients
		12-14	15-17	18-22	23-26
	90%	$543.96	$451.26	$357.43	$338.74
	85%	$575.96	$477.81	$378.45	$358.66
	80%	$611.96	$507.67	$402.11	$381.08
	75%	$652.76	$541.51	$428.91	$406.48
	70%	$699.38	$580.19	$459.55	$435.52
	65%	$753.18	$624.82	$494.90	$469.02
	60%	$815.95	$676.89	$536.14	$508.11
	55%	$890.12	$738.43	$584.88	$554.30
	50%	$979.14	$812.27	$643.37	$609.73

Intensive Trans. Indep. Living (A)	Utilization %	# of Clients
		5-11	12-14	15-17	18-22
	90%	$468.70	$425.88	$420.04	$399.76
	85%	$496.27	$450.93	$444.75	$423.28
	80%	$527.29	$479.11	$472.55	$449.74
	75%	$562.44	$511.06	$504.05	$479.72
	70%	$602.61	$547.56	$540.05	$513.98
	65%	$648.97	$589.68	$581.59	$553.52
	60%	$703.05	$638.82	$630.06	$599.65
	55%	$766.96	$696.89	$687.34	$654.16
	50%	$843.66	$766.58	$756.07	$719.58

Trans. Indep. Living (B)	Utilization %	# of Clients
		5-11	12-14	15-17	18-22
	90%	$183.69	$131.16	$145.15	$129.30
	85%	$194.50	$138.88	$153.69	$136.91
	80%	$206.66	$147.56	$163.29	$145.46
	75%	$220.43	$157.40	$174.18	$155.16
	70%	$236.18	$168.64	$186.62	$166.25
	65%	$254.35	$181.61	$200.98	$179.03
	60%	$275.54	$196.74	$217.73	$193.95
	55%	$300.59	$214.63	$237.52	$211.59
	50%	$330.65	$236.09	$261.27	$232.74

STATE OWNED - CO-LOCATED	Utilization %	# of Clients:
		12-14	15-17	18-22	23-26
	90%	$427.64	$358.65	$321.72	$299.45
	85%	$452.80	$379.75	$340.63	$317.07
	80%	$481.09	$403.49	$361.93	$336.87
	75%	$513.17	$430.39	$386.06	$359.34
	70%	$549.83	$461.13	$413.63	$385.01
	65%	$592.12	$496.60	$445.45	$414.61
	60%	$641.46	$537.98	$482.56	$449.17
	55%	$699.77	$586.89	$526.44	$490.00
	50%	$769.75	$645.59	$579.08	$539.00

(c)Residential, Community-based, and Specialty Services (Formerly Known as Caring Together) Rates Effective for Dates of Service Provided on or after January 1, 2024.

RESIDENTIAL SERVICES (Formerly known as Caring Together)

Program Type	Model	Rate per Month
CIRT	Clinically Intensive Residential Treatment	$222,265
IRTP	Intensive Residential Treatment Program, co-located	$283,502
IRTP	Intensive Residential Treatment Program, not co-located	$288,141
STARR	Six Beds	$66,404
	Nine Beds	$87,476
	12 Beds	$116,238
	15 Beds	$139,510
Teen Parenting	TLP 1:5 (per slot)	$6,358
	House Parent (per slot)	$6,420
	STEP (per slot)	$3,024

RESIDENTIAL SERVICES (Formerly known as Caring Together)

Program Type	Model	Rate per Diem
Group Home	Intensive 1:3	$354.02
	Group Home 1:4	$297.74
	Pre-independent Living	$255.54
	Independent Living	$110.35
STARR	Six Bed	$418.50
	Nine Beds	$367.73
	12 Beds	$345.74
	15 Beds	$332.25
Teen Parenting	Enhanced 1:4	$295.59

COMMUNITY-BASED SERVICES (Formerly known as Caring Together)

Program Type	Model	Rate per Diem
Continuum	Community Wrap	$119.02
	Adjusted GH 1:3	$357.77
	Adjusted GH 1:4	$297.07
	Follow Along	$69.63
	Stepping Out	$48.45

Specialty Services (Formerly known as Caring Together)
Service	Rate per Diem
Transitional Age Youth: Adult Continuum	$164.03
Transitional Age Youth: Young Adult Group Living Environment	$355.74
Intensive 1:1 Supported Living	$697.09
Intensive 1:2 Group Home	$434.50
Intensive 1:3 Group Home with expanded nursing	$417.31
Medically Complex Needs GH, nine beds	$494.08
Medically Complex Needs GH, nine beds with expanded nursing	$585.04
Medically Complex Needs GH, six beds	$516.57
Medically Complex Needs GH, six beds with expanded nursing	$658.53
Medically Complex Needs GH, 12 beds	$462.24
Medically Complex Needs GH, 12 beds with expanded nursing	$523.59
Transition to IFC Add-on	$41.66
Teen Parenting Emergency Beds Add-on (per day)	$15.24
Teen Parenting Emergency Beds Add-on (per month)	$463.50

(d)Congregate Care Program Rates Effective for Dates of Service Provided on or after July 1, 2023.

Congregate Care Program	Rate	Unit
Clinically Intensive Residential Treatment	$388,523	monthly program rate
Community Treatment Residence (Non-ERTP)	$522.47	per bed day
Community Treatment Residence (ERTP)	$545.04	per bed day
Intensive Home Based Therapeutic Care	$189.18	per day per person
Emergency Residence	$636.00	per bed day
Intensive Emergency Residence	$755.87	per bed day
Intensive Residential Treatment Program	$497,888	monthly program rate
Intensive Treatment Residence (Non-ERTP)	$777.62	per bed day
Intensive Treatment Residence (ERTP)	$794.19	per bed day
Intensive Treatment Residence Emergency Intake-Add-on	$119.42	per bed day
Medically Complex & Behavioral Residence (Non-ERTP)	$737.48	per bed day
Medically Complex & Behavioral Residence (ERTP)	$754.05	per bed day
Medically Complex Residence (Non-ERTP)	$759.25	per bed day
Medically Complex Residence (ERTP)	$771.68	per bed day
Specialty Treatment Residence (Commercially Sexually Exploited Children)	$668.66	per bed day
Specialty Treatment Residence (Non-ERTP)	$660.85	per bed day
Specialty Treatment Residence (ERTP)	$674.03	per bed day
Therapeutic Group Care - 6 beds	$99,178	monthly program rate
Therapeutic Group Care - 9 beds	$135,891	monthly program rate
Therapeutic Group Care - 12 beds	$170,267	monthly program rate
Young Adult Supported Living	$195.39	per bed day
Young Adult Therapeutic Care -Outreach	$63.21	daily slot rate
Young Adult Therapeutic Care -Staffed Apartments	$87,633	monthly program rate
Young Adult Therapeutic Care -Staffed Apartments	$14,605	monthly single apt.
Young Adult Therapeutic Care -Supported Apartments	$6,236	monthly single apt.
Young Adult Therapeutic Care -Supported Apartments Hold	$65.52	daily rate
Young Parent Assessment	$406.33	per assessment
Young Parent Living Program	$9,481.57	monthly bed rate
Youth & Young Adult Group Residence	$408.96	per bed day
Youth & Young Adult Supported Living Community	$378.49	per bed day

(e)Add-on Rates Effective for Dates of Service Provided on or after January 1, 2024.

Add-on Rates (Monthly)
Position	1.0 FTE	0.75 FTE	0.50 FTE	0.25 FTE
Direct Care	$4,244	$3,183	$2,122	$1,061
Certified Nursing Assistant	$4,023	$3,017	$2,011	$1,006
Direct Care III	$5,415	$4,061	$2,708	$1,354
Occupational Therapist	$8,634	$6,475	$4,317	$2,158
Occupational Therapist Assistant	$7,137	$5,353	$3,568	$1,784
Case Manager, Social Worker, Clinician (MA level-not Independent Licensed)	$6,829	$5,122	$3,414	$1,707
LPN	$6,497	$4,873	$3,248	$1,624
Registered Nurse	$10,523	$7,893	$5,262	$2,631
Clinician w/Independent License	$7,858	$5,894	$3,929	$1,965
Social/Caseworker (BA Level)	$5,448	$4,086	$2,724	$1,362

Add-on Rates (Hourly)
Position	Rate
Direct Care	$26.10
Certified Nursing Assistant	$24.73
Direct Care III	$33.29
Occupational Therapist	$58.86
Occupational Therapist Assistant	$48.68
Case Manager, Social Worker, Clinician (MA level - not Independent Licensed)	$46.57
LPN	$44.30
Registered Nurse	$71.77
Clinician w/Independent License	$53.60
Social/Caseworker (BA Level)	$37.17
Nurse Practitioner/APRN	$94.45
Psychologist/Psychiatrist (PhD)	$152.17
Forensic Psychiatrist	$181.00

Other Add-on Rates
Service	Rate
Canine Therapy	$10,000 per dog
Extraordinary Circumstances/Flex Funding	Individual Consideration (I.C.)

Adjudicated Youth Residential Treatment Add-on Rates
Position - Add-on	Unit	Rate
Clinical Director	Per Youth, Per Day	$37.69
Clinician (LICSW)	Per Youth, Per Day	$29.96
Direct Care	Per Youth, Per Day	$15.46

(f)Community Service Network (CSN)/READY Rates Effective for Dates of Service Provided on or after January 1, 2024.

Community Service Network (CSN)/READY Rates are based on region, and reflect per client per enrollment day.
Model	Rate per Client per Enrollment Day
Central Region	$44.05
Metro Boston Region	$62.81
Northeast Region	$32.22
Southeast Region	$38.65
West Region	$41.16

Community Service Network (CSN) Add-on Rates
Add-on	Unit	Rate
Occupancy Add-on:	Monthly	$10,000.00
Youth Service Coordinator Add-on: 0.50 FTE	Monthly	$2,900
Youth Service Coordinator Add-on: 1.0 FTE	Monthly	$5,801
Administrative Assistant/Transporter Add-on: 0.50 FTE	Monthly	$2,268
Administrative Assistant/Transporter Add-on: 1.0 FTE	Monthly	$4,536
READY Program: 1.0 FTE	Enrolled Day	$19.61

(6)Geographic Regions for Community Service Network.

(a)Central: Ashburnham, Ashby, Ashland, Athol, Auburn, Ayer, Barre, Bellingham, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dover, Dudley, East Brookfield, Fitchburg, Framingham, Franklin, Gardner, Grafton, Groton, Hardwick, Harvard, Holden, Holliston, Hopedale, Hopkinton, Hubbardston, Hudson, Lancaster, Leicester, Leominster, Lunenburg, Marlborough, Medway, Mendon, Milford, Millbury, Millville, Natick, Needham, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Pepperell, Petersham, Phillipston, Princeton, Royalston, Rutland, Sherborn, Shirley, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sudbury, Sutton, Templeton, Townsend, Upton, Uxbridge, Warren, Wayland, Webster, Wellesley, West Boylston, West Brookfield, Westborough, Westminster, Weston, Winchendon, Worcester.

(b)Metropolitan Boston: Belmont, Boston, Brookline, Cambridge, Chelsea, Newton, Revere, Somerville, Waltham, Watertown, Winthrop.

(c)Northeast: Acton, Amesbury, Andover, Arlington, Bedford, Beverly, Billerica, Boxborough, Boxford, Burlington, Carlisle, Chelmsford, Concord, Danvers, Dracut, Dunstable, Essex, Everett, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lexington, Lincoln, Littleton, Lowell, Lynn, Lynnfield, Malden, Manchester-by-the-Sea, Marblehead, Maynard, Medford, Melrose, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover, North Reading, Peabody, Reading, Rockport, Rowley, Salem, Salisbury, Saugus, Stoneham, Stow, Swampscott, Tewksbury, Topsfield, Tyngsborough, Wakefield, Wenham, Westford, West Newbury, Wilmington, Winchester, Woburn.

(d)Southeast: Abington, Acushnet, Aquinnah, Attleboro, Avon, Barnstable, Berkeley, Bourne, Braintree, Brewster, Bridgewater, Brockton, Canton, Carver, Chatham, Chilmark, Cohasset, Dartmouth, Dedham, Dennis, Dighton, Duxbury, East Bridgewater, Eastham, Easton, Edgartown, Fairhaven, Fall River, Falmouth, Foxborough, Freetown, Gosnold, Halifax, Hanover, Hanson, Harwich, Hingham, Holbrook, Hull, Kingston, Lakeville, Mansfield, Marion, Marshfield, Mashpee, Mattapoisett, Medfield, Middleborough, Millis, Milton, Nantucket, New Bedford, Norfolk, North Attleboro, Norton, Norwell, Norwood, Oak Bluffs, Orleans, Pembroke, Plainville, Plymouth, Plympton, Provincetown, Quincy, Randolph, Raynham, Rehoboth, Rochester, Rockland, Sandwich, Scituate, Seekonk, Sharon, Somerset, Stoughton, Swansea, Taunton, Tisbury, Truro, Walpole, Wareham, Wellfleet, West Bridgewater, Westport, West Tisbury, Westwood, Weymouth, Whitman, Wrentham, Yarmouth.

(e)West: Adams, Agawam, Alford, Amherst, Ashfield, Becket, Belchertown, Bernardston, Blandford, Brimfield, Buckland, Charlemont, Cheshire, Chester, Chesterfield, Chicopee, Clarksburg, Colrain, Conway, Cummington, Dalton, Deerfield, Easthampton, East Longmeadow, Egremont, Erving, Florida, Gill, Goshen, Granby, Granville, Great Barrington, Greenfield, Hadley, Hampden, Hancock, Hatfield, Hawley, Heath, Hinsdale, Holland, Holyoke, Huntington, Lanesborough, Lee, Lenox, Leverett, Leyden, Longmeadow, Ludlow, Middlefield, Monroe, Monson, Montague, Monterey, Montgomery, Mount Washington, New Ashford, New Marlborough, New Salem, North Adams, Northampton, Northfield, Orange, Otis, Palmer, Pelham, Peru, Pittsfield, Plainfield, Richmond, Rowe, Russell, Sandisfield, Savoy, Sheffield, Shelburne Falls, Shutesbury, Southampton, South Hadley, Southwick, Springfield, Stockbridge, Sunderland, Tolland, Tyringham, Wales, Ware, Warwick, Washington, Wendell, Westhampton, Westfield, West Springfield, West Stockbridge, Whately, Wilbraham, Williamsburg, Williamstown, Windsor, Worthington.