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 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 will be used to offset the amount of the purchasing governmental unit’s obligation for services rendered to the participant. (3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate. (4) Services Provided in Dukes or Nantucket County. In accordance with the provisions of St. 2016, c. 133, payment for services provided in programs located in Dukes or Nantucket County is the rate for the service contained in 101 CMR 414.03(6) times a factor of 1.07. (5) 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. (6) Approved Rates. 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 414.03(6). (a) Family Support Services. Service Center Size Unit of Service Agency Rate Adolescent Support Network -- Enrolled day Adult Companion -- 15 minutes Adult Companion Group Services Group of 2 -- 15 minutes Adult Companion Group Services Group of 3 -- 15 minutes After-school Respite -- Half day After-school Respite -- Full day Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Service Center Size Unit of Service Agency Rate Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Autism Support Center/Family Support Center Month Agency with Choice -- N/A IC Agency with Choice Admin Fee -- Month Behavioral Support Services Bachelor's -- 15 minutes Behavioral Support Services Master’s -- 15 minutes Behavioral Support Services PhD -- 15 minutes Client Financial Assistance/Flex Funding -- N/A IC Client Financial Assistance/Flex Funding Administration -- Transaction Community-based After-school Social and Recreation Programs -- Group Hour Combined Hourly Services: Nonclinical -- Hour Clinical -- Hour Comprehensive Services: Model A-1 Direct Care–Nonclinical, Less Intensive -- Enrolled day Model A-2 Direct Care–Nonclinical, More Intensive -- Enrolled day Model B Direct Care and Clinical, Less Intensive -- Enrolled day Model C Direct Care and Clinical, More Intensive -- Enrolled day Model D Clinical -- Enrolled day Model E Direct Care and Clinical, High Intensive -- Enrolled day Model F Direct Care and Clinical, Highest Intensive -- Enrolled day Service Center Size Unit of Service Agency Rate Model G Direct Care and Clinical, Higher Intensive -- Enrolled day Educational Coordination -- Enrolled day Family Navigation -- 15 minutes Family Resource Center -- Month Micro Family Resource Center -- Month Micro Family Resource Center Add-on -- Month Family Resource Center Per Diem Add-on: Family Support Worker -- Per Diem Family Resource Center Per Diem Add-on: Clinician (LCSW) -- Per Diem Family Resource Center Per Diem Add-on: Clinician (LICSW) -- Per Diem Family Resource Center Per Diem Add-on: Family Partner -- Per Diem Family Resource Center Per Diem Add-on: School Liaison -- Per Diem Family Training Groups: Specialty Family Skills Development Program Model -- Session Add-ons for a Specialty Family Skills Development Program Model: Occupancy Purchase of Space -- Session Family Skills Development Program Model -- Session Add-ons for a Family Skills Development Program Model: Facilitator/Coordinator -- Session Meals -- Session Child Care -- Session Occupancy Purchase of Space -- Session Transportation -- Session Parent Skill Development Program Model -- Session Add-ons for a Parent Skill Development Program Model: Facilitator/Coordinator -- Session Meals -- Session Child Care -- Session Occupancy Purchase of Space -- Session Transportation -- Session Family Training -- 15 minutes Family Training Group of 2 -- 15 minutes Service Center Size Unit of Service Agency Rate Family Training Group of 5 -- 15 minutes Intensive Flexible Family Support Services -- Enrolled day Medically Complex Programs -- Month Peer Support -- 15 minutes Peer Support Group of 2 -- 15 minutes Peer Support Group of 5 -- 15 minutes Planned Site-based Respite for Children -- Day Planned Site-based Respite for Children, High- intensity Support Needs -- Day Planned Site-based Respite for Children -- 30 minutes Planned Site-based Respite for Children, High- intensity Support Needs -- 30 minutes Respite in Caregiver’s Home, Level 1 -- Day Respite in Caregiver’s Home, Level 2 -- Day Respite in Caregiver’s Home, Level 3 -- Day Respite in Recipient’s Home, 1:1 -- 15 minutes Respite in Recipient’s Home, 1:2 -- 15 minutes Respite in Recipient’s Home, 1:3 -- 15 minutes Respite in Recipient’s Home -- Day Site-based Respite -- Day Site-based Respite with Nursing -- Day Unbundled Intensive Foster Care Special Support -- Child day Family Navigation Administrative Service -- Transaction (b) Flexible Support Services. Flexible Supports Service Level Hourly Rate Monthly Rate Monthly Rate Monthly Rate Monthly Rate Program Manager N/A Program Manager N/A Clinician Clinician Clinician Family Partner Family Partner Peer Mentor/Therapeutic Support Specialist Flexible Supports Service Level Hourly Rate Monthly Rate Monthly Rate Monthly Rate Monthly Rate Peer Mentor/Therapeutic Support Specialist Support Specialist