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 by the purchasing governmental unit(s). (2) Reimbursement as Full Payment. Each eligible provider must, as a condition of payment by any purchasing governmental unit, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment by the purchasing governmental unit for services rendered to the client are reduced by the amount of any payment from any other source. (3) Payment Limitations. No purchasing governmental unit may pay less than, or more than, the approved rate, except as cited in 101 CMR 413.03(2), (4), and (5). (4) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment. (5) Approved Rates. Except for the rates established for substance use disorder treatment, the rates set forth in 101 CMR 413.03 govern the payment rates for services purchased by the Department of Children and Families, the Department of Mental Health, and the Department of Youth Services provided pursuant to contracts executed under the departments’ FY 2013 or subsequent procurements. 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 413.03. (a) Youth Residential Substance Use Disorder Treatment Rates Effective for Dates of Service Provided on or after July 1, 2025. Program Name Rate HCPCS Code/Description Youth Residential Substance Use Disorder Treatment H0019-HF - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment service for transitional age youth and young adults: youth residential substance use disorder treatment). Program Name Rate HCPCS Code/Description Clinically Intensive Youth Residential Substance Use Disorder Treatment H0019-HA - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment services for youth: clinically intensive youth residential substance use disorder treatment). (b) Adjudicated Youth Residential Treatment Base Rates Effective for Dates of Service Provided on or after January 1, 2026. PROVIDER LEASED Utilization % # of Clients: PROVIDER OWNED Utilization % # of Clients: STATE OWNED - SEPARATE Utilization % # of Clients: STATE OWNED – CO-LOCATED Utilization % # of Clients: Intensive Trans. Indep. Living (A) Utilization % # of Clients Trans. Indep. Living (B) Utilization % # of Clients (c) Congregate Care Program Rates Effective for Dates of Service Provided on or after July 1, 2025. Congregate Care Program Rate Unit Clinically Intensive Residential Treatment monthly program rate Community Treatment Residence (Non-ERTP) per bed day Community Treatment Residence (ERTP) per bed day Intensive Home Based Therapeutic Care per day per person Emergency Residence per bed day Intensive Emergency Residence per bed day Intensive Residential Treatment Program monthly program rate Intensive Treatment Residence (Non-ERTP) per bed day Intensive Treatment Residence (ERTP) per bed day Intensive Treatment Residence Emergency Intake – Add-on per bed day Medically Complex & Behavioral Residence (Non- ERTP) per bed day Medically Complex & Behavioral Residence (ERTP) per bed day Medically Complex Residence (Non-ERTP) per bed day Medically Complex Residence (ERTP) per bed day Specialty Treatment Residence (Commercially Sexually Exploited Children) per bed day Specialty Treatment Residence (Non-ERTP) per bed day Specialty Treatment Residence (ERTP) per bed day Therapeutic Group Care - 6 beds monthly program rate Therapeutic Group Care - 9 beds monthly program rate Therapeutic Group Care - 12 beds monthly program rate Young Adult Supported Living per bed day Congregate Care Program Rate Unit Young Adult Therapeutic Care - Outreach daily slot rate Young Adult Therapeutic Care - Staffed Apartments monthly program rate Young Adult Therapeutic Care - Staffed Apartments monthly single apt. Young Adult Therapeutic Care - Supported Apartments monthly single apt. Young Adult Therapeutic Care - Supported Apartments Hold daily rate Young Parent Assessment per assessment Young Parent Living Program monthly bed rate Youth & Young Adult Group Residence per bed day Youth & Young Adult Supported Living Community per bed day (d) Add-on Rates Effective for Dates of Service Provided on or after July 1, 2025. Add-on Rates (Monthly) Position 1.0 FTE 0.75 FTE 0.50 FTE 0.25 FTE Direct Care Certified Nursing Assistant Direct Care III Occupational Therapist Occupational Therapist Assistant Case Manager, Social Worker, Clinician (MA level-not Independent Licensed) LPN Registered Nurse Clinician w/Independent License Social/Caseworker (BA Level) Add-on Rates (Hourly) Position Rate Direct Care Certified Nursing Assistant Direct Care III Occupational Therapist Occupational Therapist Assistant Case Manager, Social Worker, Clinician (MA level-not Independent Licensed) LPN Registered Nurse Add-on Rates (Hourly) Position Rate Clinician w/Independent License Social/Caseworker (BA Level) Nurse Practitioner/APRN Psychologist/Psychiatrist (PhD) Forensic Psychiatrist Other Add-on Rates Service Rate Canine Therapy $10,000 per dog Extraordinary Circumstances/Flex Funding Individual Consideration (IC) Adjudicated Youth Residential Treatment Add-on Rates Position - Add-on Unit Rate Clinical Director Per Youth, Per Day Clinician (LICSW) Per Youth, Per Day Direct Care Per Youth, Per Day (e) Community Service Network (CSN)/READY Rates Effective for Dates of Service Provided on or after January 1, 2024. Community Service Network (CSN)/READY Rates are based on region, and reflect per client per enrollment day. Model Rate per Client per Enrollment Day Central Region Metro Boston Region Northeast Region Southeast Region West Region Community Service Network (CSN) Add-on Rates Add-on Unit Rate Occupancy Add-on Monthly Youth Service Coordinator Add-on: 0.50 FTE Monthly Youth Service Coordinator Add-on: 1.0 FTE Monthly Administrative Assistant/Transporter Add-on: 0.50 FTE Monthly Community Service Network (CSN) Add-on Rates Add-on Unit Rate Administrative Assistant/Transporter Add-on: 1.0 FTE Monthly READY Program: 1.0 FTE Enrolled Day (6) Geographic Regions for Community Service Network. (a) Central: Ashburnham, Ashby, Ashland, Athol, Auburn, Ayer, Barre, Bellingham, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dover, Dudley, East Brookfield, Fitchburg, Framingham, Franklin, Gardner, Grafton, Groton, Hardwick, Harvard, Holden, Holliston, Hopedale, Hopkinton, Hubbardston, Hudson, Lancaster, Leicester, Leominster, Lunenburg, Marlborough, Medway, Mendon, Milford, Millbury, Millville, Natick, Needham, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Pepperell, Petersham, Phillipston, Princeton, Royalston, Rutland, Sherborn, Shirley, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sudbury, Sutton, Templeton, Townsend, Upton, Uxbridge, Warren, Wayland, Webster, Wellesley, West Boylston, West Brookfield, Westborough, Westminster, Weston, Winchendon, Worcester. (b) Metropolitan Boston: Belmont, Boston, Brookline, Cambridge, Chelsea, Newton, Revere, Somerville, Waltham, Watertown, Winthrop. (c) Northeast: Acton, Amesbury, Andover, Arlington, Bedford, Beverly, Billerica, Boxborough, Boxford, Burlington, Carlisle, Chelmsford, Concord, Danvers, Dracut, Dunstable, Essex, Everett, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lexington, Lincoln, Littleton, Lowell, Lynn, Lynnfield, Malden, Manchester-by-the-Sea, Marblehead, Maynard, Medford, Melrose, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover, North Reading, Peabody, Reading, Rockport, Rowley, Salem, Salisbury, Saugus, Stoneham, Stow, Swampscott, Tewksbury, Topsfield, Tyngsborough, Wakefield, Wenham, Westford, West Newbury, Wilmington, Winchester, Woburn. (d) Southeast: Abington, Acushnet, Aquinnah, Attleboro, Avon, Barnstable, Berkeley, Bourne, Braintree, Brewster, Bridgewater, Brockton, Canton, Carver, Chatham, Chilmark, Cohasset, Dartmouth, Dedham, Dennis, Dighton, Duxbury, East Bridgewater, Eastham, Easton, Edgartown, Fairhaven, Fall River, Falmouth, Foxborough, Freetown, Gosnold, Halifax, Hanover, Hanson, Harwich, Hingham, Holbrook, Hull, Kingston, Lakeville, Mansfield, Marion, Marshfield, Mashpee, Mattapoisett, Medfield, Middleborough, Millis, Milton, Nantucket, New Bedford, Norfolk, North Attleboro, Norton, Norwell, Norwood, Oak Bluffs, Orleans, Pembroke, Plainville, Plymouth, Plympton, Provincetown, Quincy, Randolph, Raynham, Rehoboth, Rochester, Rockland, Sandwich, Scituate, Seekonk, Sharon, Somerset, Stoughton, Swansea, Taunton, Tisbury, Truro, Walpole, Wareham, Wellfleet, West Bridgewater, Westport, West Tisbury, Westwood, Weymouth, Whitman, Wrentham, Yarmouth. (e) West: Adams, Agawam, Alford, Amherst, Ashfield, Becket, Belchertown, Bernardston, Blandford, Brimfield, Buckland, Charlemont, Cheshire, Chester, Chesterfield, Chicopee, Clarksburg, Colrain, Conway, Cummington, Dalton, Deerfield, Easthampton, East Longmeadow, Egremont, Erving, Florida, Gill, Goshen, Granby, Granville, Great Barrington, Greenfield, Hadley, Hampden, Hancock, Hatfield, Hawley, Heath, Hinsdale, Holland, Holyoke, Huntington, Lanesborough, Lee, Lenox, Leverett, Leyden, Longmeadow, Ludlow, Middlefield, Monroe, Monson, Montague, Monterey, Montgomery, Mount Washington, New Ashford, New Marlborough, New Salem, North Adams, Northampton, Northfield, Orange, Otis, Palmer, Pelham, Peru, Pittsfield, Plainfield, Richmond, Rowe, Russell, Sandisfield, Savoy, Sheffield, Shelburne Falls, Shutesbury, Southampton, South Hadley, Southwick, Springfield, Stockbridge, Sunderland, Tolland, Tyringham, Wales, Ware, Warwick, Washington, Wendell, Westhampton, Westfield, West Springfield, West Stockbridge, Whately, Wilbraham, Williamsburg, Williamstown, Windsor, Worthington.