General Provisions

(1) Scope. 101 CMR 204.00 governs the payment rates for services provided by resident care facilities to publicly aided and industrial accident residents, including certain COVID-19 related costs as described in 101 CMR 204.00, and for services provided to publicly aided and industrial accident residents by residential care units in nursing facilities that do not have established rates for nursing facility services pursuant to 101 CMR 206.00: Standard Payments to Nursing Facilities. For those nursing facilities with established rates for nursing facility services pursuant to 101 CMR 206.00, payment rates for services provided by residential care units of those nursing facilities are governed by 101 CMR 206.00. (2) Applicable Dates of Service. Rates contained in 101 CMR 204.00 apply for services provided on or after December 1, 2025. (3) Disclaimer of Authorization of Services. 101 CMR 204.00 is not authorization for or approval of the substantive services or the time period for which rates are determined pursuant to 101 CMR 204.00. Governmental units and insurers that purchase services from eligible providers are responsible for the definition, authorization, and approval of services provided to publicly aided or industrial accident residents.