General Provisions

(1) Scope and Purpose. 101 CMR 309.00 governs the rates of payment to be used by all governmental units for the personal care attendant (PCA) program. 101 CMR 309.00 also governs payments for PCA services provided to individuals covered by M.G.L. c. 152 (the Worker’s Compensation Act). Rates for transitional living program services are approved under 114.5 CMR 4.00: Rates for Certain Social, Rehabilitation and Health Care Services. (2) Applicable Dates of Service. Rates contained in 101 CMR 309.00 apply for dates of service described in 101 CMR 309.03. (3) Coverage. The payment rates established by 101 CMR 309.00 apply to certain services for the PCA program provided by eligible PCA providers and personal care management (PCM) agencies to enable publicly aided persons with permanent or chronic disabilities to live independently in the community. The payment rates established by 101 CMR 309.00 are full compensation for services rendered and for certain related administrative or supervisory duties rendered in the provision of services. (4) Disclaimer of Authorization of Services. 101 CMR 309.00 is not authorization for or approval of the services for which rates are established by 101 CMR 309.00. Governmental units that purchase PCA services are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals. (5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections by administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association’s Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS) maintained by the Centers for Medicare & Medicaid Services (CMS). The publication of such updates and corrections will list (a) codes for which only the code numbers change, with the corresponding cross-references between existing and new codes; (b) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing. These codes will be paid on an individual consideration basis until rates are established. (6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify the substantive provisions of 101 CMR 309.00 and to notify interested parties of payment updates pursuant to 101 CMR 309.01(5).