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. No purchasing governmental unit may pay less than or more than the approved program rate. (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 427.03. Service Model Unit of Service Rate Alternative to Lock-up Program A Month B Month C Month Conflict of Interest Services 1 Family Month 5 Families Month Extraordinary Circumstances/Flex Funding N/A N/A IC Teen Pregnancy Prevention Program In school Curriculum Hour Outside school Curriculum Hour Remote Add-on Hour Alternative School Engagement N/A Hour Parent/Caregiver Engagement N/A Hour Peer Leadership & Youth Development N/A Contact Hour Partnership Development N/A Hour Therapeutic Day Services Model 1 Month Model 2 Month Model 3A Month Model 3B Month Model 4A Month Model 4B Month Young Parent Support Program (YPS) A Month B Month YPS Specialty Direct Care III Add-on (.5 FTE) A Month YPS Specialty Direct Care III Add-on (1 FTE) B Month Add-on Staff for Teen Pregnancy Prevention Program Title Unit of Service Rate Direct Care Hourly Direct Care III Hourly Add-on Staff for Therapeutic Day Services Title Unit of Service 1 FTE Clinical (LICSW) Monthly Peer/Direct Care Monthly Direct Care III Monthly