Definitions

As used in 101 CMR 416.00, unless the context requires otherwise, terms have the meanings in 101 CMR 416.02. Average Daily Attendance. A measure of the average number of clients served each day by a program. The average daily attendance is assigned to the program based on prior fiscal year attendance data. Client. An adult for whom a governmental unit purchases clubhouse services. Clubhouse Services. Services provided under a clubhouse program to individuals with behavioral and/or mental health issues, including employment, educational, social, and support services. Clubhouse services assist individuals to develop social networking, independent living, budgeting, self-care, and other skills that will assist them to live in the community and to secure and retain employment. Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required. EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A. Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth. Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers clubhouse services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been adopted by a purchasing governmental unit. Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR). Service Day. A service day is the unit of service used to bill the governmental unit. In general, a service day is a day during which an enrolled client either participates in a clubhouse services activity or activities related to a specific goal or objective documented in the client’s Action Plan. The governmental unit will determine the specific events and conditions that qualify as billable activity. A provider can invoice only one unit of service per member per day. (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 will be 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. (4) 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 416.03(4). Clubhouse Services Rates Unit Rate Average Daily Attendance of 29 and under Per Service Day Average Daily Attendance of 30 through 70 Per Service Day Average Daily Attendance of 71 and above Per Service Day Program located in Nantucket or Dukes County Per Service Day (1) General Provisions. (a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the executive director or chief financial officer of the provider. (b) Examination of Records. Each provider must make available to EOHHS or the purchasing governmental unit upon request all records relating to its reported costs, including costs of any entity related by common ownership or control. (2) Required Reports. Each provider must file (a) an annual Uniform Financial Statements and Independent Auditor's Report completed in accordance with the filing requirements of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services; (b) any cost report supplemental schedule as issued by EOHHS; and (c) any additional information requested by EOHHS within 21 days of a written request. (3) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 416.04(3). The provisions of 101 CMR 416.00 are severable. If any provision of 101 CMR 416.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 416.00 or application of those provisions to applicable individuals, entities, or circumstances.