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 eligible 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 for services included in the scope of this regulation from any other source will be used to offset the amount of the purchasing governmental unit’s obligation for services rendered to the publicly assisted client. (3) Payment Limitations. Except as provided in 101 CMR 356.03(3), no purchasing governmental unit may pay less than, or more than, the approved program rate. (4) Rates of Payment. The approved rate is the lower of the provider’s charge or amount accepted as payment from another payer or the rate listed below. Service Rate Assistive Technology See 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment; 101 CMR 423.00: Rates for Certain In-home Basic Living Supports (Levels I and J) Community Engagement Navigation See 101 CMR 423.00: Rates for Certain In- home Basic Living Supports Transitional Assistance IC