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 or units. (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 from any other source is used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client. (3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate, except as cited in 101 CMR 411.03. (4) Blended Contract Rate Calculation. Purchasing governmental units may pay a Blended Contract Rate for the purchase of programs serving two or more clients. The blended rate will be calculated according to the following formula: {Sum of [(Operational Rate 1 * Units purchased of Operational Rate 1) plus (Stipend Rate 1 * Units Purchased of Stipend Rate 1)], plus [(Operational Rate 2 * Units purchased of Operational Rate 2) plus (Stipend Rate 2 * Units Purchased of Stipend Rate 2)], plus [(Operational Rate 3 * Units purchased of Operational Rate 3) plus (Stipend Rate 3) * (Units Purchased of Stipend Rate 3)],..., plus [Total funding for Add-ons] minus [Total Offsetting Revenue]} Divided by the sum of the Operational Rate Units purchased for all clients in the contract. (5) Approved Program Rates. For all purchases, 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 411.03(5). (a) Intensive Foster Care. Service Operational Stipend Total Rate Unit Community-based Alternative to Detention Bed Hold N/A Per Day Sibling Per Placement Per Day Intensive Foster Care One Per Placement Per Day Intensive Foster Care Two Per Placement Per Day Community-based Alternative to Detention Per Placement Per Day Teen Parent Per Placement Per Day Enhanced Intensive Foster Care Per Placement Per Day (b) Intensive Foster Care Specialty. Service Operational Stipend Total Rate Unit Transitions to Adulthood Per Placement Per Day Emergency Shelter Homes Per Placement Per Day Child Home-based Rehabilitation Per Placement Per Day Transitions to Adult Services Per Placement Per Day Multiple Acute Level A Per Placement Per Day Multiple Acute Level B Per Placement Per Day Sexually Exploited Youth Per Placement Per Day Family Residential N/A Per Placement Per Day (c) AMSS. All rates are paid upon completion of the particular product-based service. AMSS Product-based Services Rate 1. Adoption Consultation Services: Adoption Assessment of a Child Adoption Assessment/Home Study of a Foster/relative family (with whom the child is placed) Adoption Assessment/Home Study of a relative (child is not in the home) MAPP training/Home Study of a referred person or couple Appearance fee MAPP Training only 2. Adoption Placement Case Management Services: Case acceptance/assignment Adoption Assessment of a child Adoption Assessment/Home Study of a family with whom the child is placed Placement Mild Moderate Severe Family Development Mild Moderate Severe Reevaluations Mild Moderate Severe Child(ren)/Legalization Mild Moderate Severe Adjustment for a case held at least three years, but less than five. Sibling Bonus in Same Home/Legalization Two siblings Three siblings Four siblings Five or more siblings AMSS Product-based Services Rate Family Bonus for Provider's Home at Legalization per child, minimum of two children Closure Case Maintenance Delayed Adoption-legal Delay/Appeal Conflict of Interest Family Resource Transfer of case 3. Adoption Family Development Services: Purchase of Home Reuse of a Closed Home 4. Recruitment: Child-specific recruitment Child-specific recruitment renewal 5. Intervention Services (per hour) 6. Interstate Cases: Home Study Assignment Case Supervision 7. Puerto Rico Cases: Family Evaluation Home Study in Puerto Rico Family Evaluation Home Study in Puerto Rico (Daily Rate) 8. International Cases: International Family Evaluation Home Study IC (d) Additional Support Services. Support Contracts Rate Unit Youth Permanency Connections Per Client Per Day Rate Multiple Pre-adoption Services Accommodation Rate Per Month Complex Foster Care Medical Per Client Per Day Rate Multiple Post-adoption Services Accommodation Rate Per Month Multiple Foster Parent Support Services Accommodation Rate Per Month (e) Shared Living. 1. Operational Rates. Service Operational Units A Per Placement Per Day B Per Placement Per Day C Per Placement Per Day Direct Care Add-on Rate Per Hour Clinician (LICSW) Add-on Rate Per Hour Registered Nurse (RN) Per Hour Licensed Practical Nurse (LPN) Per Hour 2. Stipend Rates. a. Stipend amounts for caregivers are established at a rate within the applicable rate limit for a given Operational Rate tier, as noted in the chart in 101 CMR 411.403(5)(e)2.a. Operational Rate Level Maximum Stipend Level A B C b. Purchasing governmental units may approve exceptions to the maximum stipend level in 101 CMR 411.03(5)(e)2.a. for caregivers providing services as of September 30, 2016. In these cases, the stipend rate is no higher than the amount paid as of September 30, 2016, as may be adjusted to reflect applicable stipend inclusions and exclusions, in keeping with provisions contained in the procurement for these services. This payment level continues at the current level until such time as material changes in client circumstances occur to warrant a reassessment of the stipend level or a change in caregiver takes place, at which point revised stipend levels may not exceed applicable maximum amounts. Stipend levels 18 through 21 are available only by special application to the purchasing governmental unit. Shared Living Stipend Levels Level Daily Stipend Rate Stipend Level Shared Living Stipend Levels Level Daily Stipend Rate Stipend Level Remote Direct Supports Per Hour Remote Direct Supports