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 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 will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client. (3) Payment Limitations. (a) No purchasing governmental unit may pay less than or more than the approved program rate. (b) Governmental units do not pay for Integrated Team services for clients residing in Intensive Group Living Environment service locations. (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. 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 426.03(5). (a) Service Rates. Program Service Model Per Enrolled Day Rate Integrated Team Integrated Team with GLE/SIE Supervised Group Living Environments (GLEs): Fewer than 13 Beds (Standard GLEs): Four to Six Beds Seven to Nine Beds Ten to 12 Beds Supported Independent Environments (SIEs): 13 to 16 Beds (Model A) 17 to 25 Beds (Model B) 26 to 35 Beds (Model C) Intensive Group Living Environment Services: Medically Intensive Group Living Environment: Four to Six Beds Medically Intensive Group Living Environment: Seven to Nine Beds Medically Intensive Group Living Environment: Ten to 12 Beds Intensive Behavioral Group Living Environment: Four to Six Beds Intensive Behavioral Group Living Environment: Seven to Nine Beds Intensive Behavioral Group Living Environment: Ten to 12 Beds Intensive Behavioral Assessment Group Living Environment: Four to Six Beds Intensive Behavioral Assessment Group Living Environment: Ten to 12 Beds Intensive Fire Safety Group Living Environment: Four to Six Beds Clinically Intensive Group Living Environment: Four to Six Beds Clinically Intensive Group Living Environment: Seven to Nine Beds Clinically Intensive Group Living Environment: Ten to 12 Beds Intensive Dialectical Behavioral Therapy Group Living Environment: Four to Six Beds Intensive Dialectical Behavioral Therapy Group Living Environment: Seven to Nine Beds Enhanced Medical Group Living Environment: Four to Six Beds Program Service Model Per Enrolled Day Rate Enhanced Medical Group Living Environment: Seven to Nine Beds Enhanced Medical Group Living Environment: Ten to 12 Beds Program Service Model Add-on Per Client, per Month Lease Management Add-on (b) Occupancy Rates. 1. Occupancy rates are determined by multiplying $13,015 by the applicable regional occupancy modifier listed below at 101 CMR 426.03(5)(b)3. This is then multiplied by the provider’s total bed capacity to arrive at the occupancy rate. 2. The occupancy rate is determined on an annual basis and paid in 12 monthly units. 3. The applicable regional modifier determination for towns and cities that appear in more than one region is at the discretion of the purchasing governmental unit. Region Occupancy Modifier Boston Brockton Buzzards Bay Fall River Fitchburg Framingham Greenfield Hyannis Lawrence Lowell New Bedford Pittsfield Springfield Worcester (6) Geographic Areas for the Regional Occupancy Modifier. The following cities and towns comprise the geographic areas encompassed by the Regional Occupancy Modifier. (a) Boston: Allston, Boston, Brighton, Chelsea, Dorchester, East Boston, Hyde Park, Jamaica Plain, Mattapan, Readville, Revere, Roslindale, Roxbury, South Boston, West Roxbury, Winthrop (b) Brockton: Abington, Bridgewater, Brockton, Carver, Duxbury, East Bridgewater, Halifax, Hanover, Hanson, Hingham, Hull, Kingston, Lakeville, Marion, Marshfield, Mattapoisett, Middleboro, Norwell, Pembroke, Plymouth, Plympton, Rochester, Rockland, Scituate, Wareham, West Bridgewater, Whitman (c) Buzzards Bay: Aquinnah, Barnstable, Bourne, Brewster, Chatham, Chilmark, Dennis, Eastham, Edgartown, Falmouth, Gosnold, Harwich, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Truro, Wellfleet, West Tisbury, West Yarmouth, Yarmouth (d) Fall River: Fall River, Freetown, Somerset, Swansea, Westport (e) Fitchburg: Ashburnham, Athol, Auburn, Barre, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dudley, East Brookfield, Fitchburg, Gardner, Grafton, Hardwick, Harvard, Holden, Hopedale, Hubbardston, Lancaster, Leicester, Lunenburg, Mendon, Milford, Millbury, Millville, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Petersham, Phillipston, Princeton, Royalston, Rutland, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sutton, Templeton, Upton, Uxbridge, Warren, Webster, West Boylston, West Brookfield, Westboro, Westminster, Winchendon, Worcester (f) Framingham: Acton, Arlington, Ashby, Ashland, Avon, Ayer, Bedford, Bellingham, Belmont, Billerica, Boxboro, Braintree, Brookline, Burlington, Cambridge, Canton, Carlisle, Chelmsford, Cohasset, Concord, Dedham, Dover, Dracut, Dunstable, Somerville, Stoneham, Stoughton, Stow, Sudbury, Tewksbury, Townsend, Tyngsboro, Wakefield, Walpole, Waltham, Watertown, Wayland, Wellesley, Westford, Weston, Westwood, Weymouth, Wilmington, Winchester, Woburn, Wrentham (g) Greenfield: Ashfield, Bernardston, Buckland, Charlemont, Colrain, Conway, Deerfield, Erving, Gill, Greenfield, Hawley, Heath, Leverett, Leyden, Monroe, Montague, New Salem, Northfield, Orange, Rowe, Shelburne Falls, Shutesbury, Sunderland, Warwick, Wendell, Whately (h) Hyannis: Aquinnah, Barnstable, Bourne, Brewster, Chatham, Chilmark, Dennis, Eastham, Edgartown, Falmouth, Gosnold, Harwich, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Truro, Wellfleet, West Tisbury, West Yarmouth, Yarmouth (i) Lawrence: Amesbury, Andover, Beverly, Boxford, Danvers, Essex, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lynn, Lynnfield, Manchester By The Sea, Marblehead, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover (j) Lowell: Acton, Arlington, Ashby, Ashland, Avon, Ayer, Bedford, Bellingham, Belmont, Billerica, Boxboro, Braintree, Brookline, Burlington, Cambridge, Canton, Carlisle, Chelmsford, Cohasset, Concord, Dedham, Dover, Dracut, Dunstable, Somerville, Stoneham, Stoughton, Stow, Sudbury, Tewksbury, Townsend, Tyngsboro, Wakefield, Walpole, Waltham, Watertown, Wayland, Wellesley, Westford, Weston, Westwood, Weymouth, Wilmington, Winchester, Woburn, Wrentham (k) New Bedford: Acushnet, Dartmouth, Fairhaven, Gosnold, Marion, Mattapoisett, New Bedford, Onset, Rochester, Wareham (l) Pittsfield: Adams, Alford, Becket, Cheshire, Clarksburg, Dalton, Egremont, Florida, Great Barrington, Hancock, Hinsdale, Lanesboro, Lee, Lenox, Monterey, Mount Hermon, New Ashford, New Marlborough, North Adams, North Egremont, Otis, Peru, Pittsfield, Richmond, Savoy, Sheffield, Stockbridge, Tyringham, Washington, West Stockbridge, Williamstown, Windsor (m) Springfield: Agawam, Amherst, Belchertown, Blandford, Brimfield, Chester, Chesterfield, Chicopee, Cummington, East Longmeadow, Easthampton, Goshen, Granby, Granville, Hadley, Hampden, Hatfield, Holland, Holyoke, Huntington, Longmeadow, Ludlow, Middlefield, Monson, Montgomery, Northampton, Palmer, Pelham, Plainfield, Russell, South Hadley, Southampton, Southwick, Springfield, Tolland, Wales, Ware, West Springfield, Westfield, Westhampton, Wilbraham, Williamsburg, Worthington (n) Worcester: Ashburnham, Athol, Auburn, Barre, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dudley, East Brookfield, Fitchburg, Gardner, Grafton, Hardwick, Harvard, Holden, Hopedale, Hubbardston, Lancaster, Leicester, Lunenburg, Mendon, Milford, Millbury, Millville, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Petersham, Phillipston, Princeton, Royalston, Rutland, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sutton, Templeton, Upton, Uxbridge, Warren, Webster, West Boylston, West Brookfield, Westboro, Westminster, Winchendon, Worcester