101 CMR, § 414.03

Current through Register 1536, December 6, 2024

Section 414.03 - 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 made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the participant.

(3)Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4)Services Provided in Dukes or Nantucket County. In accordance with the provisions of St. 2016, c. 133, payment for services provided in programs located in Dukes or Nantucket County is the rate for the service contained in 101 CMR 414.03(6) times a factor of 1.07.

(5)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.

(6)Approved Rates. 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 414.03(6).

Service	Center Size	Unit of Service	Agency Rate
Adolescent Support Network		Enrolled day	$26.75
Adult Companion		15 minutes	$9.75
Adult Companion Group Services Group of 2		15 minutes	$4.88
Adult Companion Group Services Group of 3		15 minutes	$3.25
After-school Respite		Half day	$64.30
After-school Respite		Full day	$110.58
Autism Support Center/Family Support Center	0.5	Month	$5,827.56
Autism Support Center/Family Support Center	1	Month	$11,655.12
Autism Support Center/Family Support Center	1.5	Month	$17,482.68
Autism Support Center/Family Support Center	2	Month	$23,310.25
Autism Support Center/Family Support Center	2.5	Month	$27,676.70
Autism Support Center/Family Support Center	3	Month	$32,540.52
Autism Support Center/Family Support Center	3.5	Month	$37,348.43
Autism Support Center/Family Support Center	4	Month	$42,098.18
Autism Support Center/Family Support Center	4.5	Month	$46,797.24
Autism Support Center/Family Support Center	5	Month	$51,462.55
Autism Support Center/Family Support Center	5.5	Month	$56,101.18
Autism Support Center/Family Support Center	6	Month	$60,854.56
Autism Support Center/Family Support Center	6.5	Month	$65,610.75
Autism Support Center/Family Support Center	7	Month	$70,322.03
Autism Support Center/Family Support Center	7.5	Month	$75,044.46
Autism Support Center/Family Support Center	8	Month	$79,686.55
Autism Support Center/Family Support Center	8.5	Month	$84,218.28
Autism Support Center/Family Support Center	9	Month	$88,710.24
Autism Support Center/Family Support Center	9.5	Month	$93,202.21
Autism Support Center/Family Support Center	10	Month	$97,659.00
Autism Support Center/Family Support Center	10.5	Month	$102,123.03
Autism Support Center/Family Support Center	11	Month	$106,569.56
Autism Support Center/Family Support Center	11.5	Month	$111,034.12
Autism Support Center/Family Support Center	12	Month	$115,507.30
Agency with Choice		N/A	I.C.
Agency with Choice Admin Fee		Month	$375.74
Behavioral Support Services Bachelor's		15 minutes	$20.92
Behavioral Support Services Master's		15 minutes	$33.14
Behavioral Support Services PhD		15 minutes	$41.95
Client Financial Assistance/Flex Funding		N/A	I.C.
Client Financial Assistance/Flex Funding Administration		Transaction	$18.65
Community-based After-school Social and Recreation Programs		Group Hour	$42.38
Combined Hourly Services:
Nonclinical		Hour	$68.84
Clinical		Hour	$103.65
Comprehensive Services:
Model A-1 Direct Care - Nonclinical, Less Intensive		Enrolled day	$47.98
Model A-2 Direct Care - Nonclinical, More Intensive		Enrolled day	$72.54
Model B Direct Care and Clinical, Less Intensive		Enrolled day	$91.20
Model C Direct Care and Clinical, More Intensive		Enrolled day	$92.52
Model D Clinical		Enrolled day	$91.29
Model E Direct Care and Clinical High Intensive		Enrolled day	$132.37
Model F Direct Care and Clinical Highest Intensive		Enrolled day	$220.98
Model G Direct Care and Clinical Higher Intensive		Enrolled day	$163.54
Educational Coordination		Enrolled day	$22.66
Family Navigation		15 minutes	$18.70
Family Resource Center		Month	$61,097
Micro Family Resource Center		Month	$24,785
Micro Family Resource Center Add-on		Month	$7,105
Family Resource Center Per Diem Add-on: Family Support Worker		Per Diem	$266.24
Family Resource Center Per Diem Add-on: Clinician (LCSW)		Per Diem	$372.56
Family Resource Center Per Diem Add-on: Clinician (LICSW)		Per Diem	$428.56
Family Resource Center Per Diem Add-on: Family Partner		Per Diem	$208.67
Family Resource Center Per Diem Add-on: School Liaison		Per Diem	$296.93
Family Training Groups:
Specialty Family Skills Development Program Model		Session	$2,952.38
Add-ons for a Specialty Family Skills Development Program Model:
Occupancy Purchase of Space		Session	$140.77
Family Skills Development Program Model		Session	$2,059.32
Add-ons for a Specialty Family Skills Development Program Model:
Occupancy Purchase of Space		Session	$140.77
Family Skills Development Program Model		Session	$2,059.32
Add-ons for a Family Skills Deve	opment Program Model:
Facilitator/Coordinator		Session	$70.58
Meals		Session	$173.10
Child Care		Session	$49.91
Occupancy Purchase of Space		Session	$140.77
Transportation		Session	$168.94
Parent Skill Development Program Model		Session	$1,532.93
Add-ons for a Parent Skill Development Program Model:
Facilitator/Coordinator		Session	$70.58
Meals		Session	$173.10
Child Care		Session	$49.91
Occupancy Purchase of Space		Session	$140.77
Transportation		Session	$168.94
Family Training		15 minutes	$13.25
Family Training Group of 2		15 minutes	$6.63
Family Training Group of 5		15 minutes	$2.65
Intensive Flexible Family Support Services		Enrolled day	$25.39
Medically Complex Programs		Month	$415.30
Peer Support		15 minutes	$9.75
Peer Support Group of 2		15 minutes	$4.88
Peer Support Group of 5		15 minutes	$1.95
Planned Site-based Respite for Children		Day	$437.82
Planned Site-based Respite for Children, High-intensity Support Needs		Day	$569.44
Planned Site-based Respite for Children		30 minutes	$27.37
Planned Site-based Respite for Children, High-intensity Support Needs		30 minutes	$35.59
Respite in Caregiver's Home, Level 1		Day	$145.19
Respite in Caregiver's Home, Level 2		Day	$176.03
Respite in Caregiver's Home, Level 3		Day	$206.86
Respite in Recipient's Home, 1:1		15 minutes	$9.75
Respite in Recipient's Home, 1:2		15 minutes	$4.88
Respite in Recipient's Home, 1:3		15 minutes	$3.25
Respite in Recipient's Home		Day	$351.00
Site-based Respite		Day	$302.19
Site-based Respite with Nursing		Day	$380.96
Unbundled Intensive Foster Care Special Support		Child day	$63.32
Family Navigation Administrative Service		Transaction	$40.87

Flexible Supports Service	Level	Hourly Rate	Monthly Rate 1.0 FTE	Monthly Rate 0.75 FTE	Monthly Rate 0.5 FTE	Monthly Rate 0.25 FTE
Program Manager	1	N/A	$9,329	$6,997	$4,664	$2,332
Program Manager	2	N/A	$9,420	$7,065	$4,710	$2,355
Clinician	1	$94.66	$8,086	$6,064	$4,043	$2,021
Clinician	2	$111.30	$9,507	$7,130	$4,754	$2,377
Family Partner	1	$74.20	$5,880	$4,410	$2,940	$1,470
Family Partner	2	$88.72	$7,031	$5,273	$3,516	$1,758
Peer Mentor/Therapeutic Support Specialist	1	$70.90	$5,702	$4,276	$2,851	$1,425
Peer Mentor/Therapeutic Support Specialist	2	$85.22	$6,853	$5,140	$3,426	$1,713

101 CMR, § 414.03

Amended by Mass Register Issue 1272, eff. 10/24/2014.

Amended by Mass Register Issue 1315, eff. 6/17/2016.

Amended by Mass Register Issue S1331, eff. 1/27/2017.

Amended by Mass Register Issue 1353, eff. 12/1/2017.

Amended by Mass Register Issue 1370, eff. 7/27/2018.

Amended by Mass Register Issue 1387, eff. 3/22/2019.

Amended by Mass Register Issue 1409, eff. 1/24/2020.

Amended by Mass Register Issue 1420, eff. 6/26/2020.

Amended by Mass Register Issue 1433, eff. 12/25/2020.

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

Amended by Mass Register Issue 1459, eff. 12/24/2021.

Amended by Mass Register Issue 1461, eff. 12/24/2021.

Amended by Mass Register Issue 1486, eff. 1/6/2023.

Amended by Mass Register Issue 1505, eff. 9/29/2023.

Amended by Mass Register Issue 1519, eff. 4/12/2024.

Amended by Mass Register Issue 1531, eff. 9/27/2024.