General Provisions

(1) Scope and Purpose. 101 CMR 305.00 governs the rates to be used by all governmental units and worker’s compensation insurers for outpatient behavioral health services and behavioral health emergency services provided by community behavioral health centers (CBHCs). (2) Applicable Dates of Service. Rates in 101 CMR 305.00 apply for dates of service provided on or after August 15, 2025. (3) Disclaimer of Authorization of Services. 101 CMR 305.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 305.00. Purchasing agencies and insurers are responsible for the definition, authorization, and approval of care and services extended to publicly aided clients. (4) Coding Updates and Corrections. The Executive Office of Health and Human Services (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 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 existing and 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 (IC) payment for these codes until appropriate rates can be developed. (5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 305.00.