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) Service Component Payment Methods. (a) General. Purchasing governmental units will pay providers a total payment per completed service component as defined in 101 CMR 428.03(4). (b) Standard Progress Documentation. Providers must use a standard form to document initiation and completion of a service component for each client. Providers must submit all progress documentation, billing, and performance reporting through the Enterprise Invoice Management Service. (c) Initial Payment. The purchasing governmental unit pays the provider an initial payment based on a specified percentage of the total payment at the initiation of a service component for a client. For assessment, the purchasing governmental unit makes an initial payment equal to 20% of the service component payment in 101 CMR 428.03(4). For all other service components, except ongoing and interim supports, the purchasing agency makes an initial payment equal to 40% of the service component payment in 101 CMR 428.03(4). EOHHS may revise these percentages by administrative bulletin. (d) Final Payment. The purchasing governmental unit pays the difference between the initial payment and the total service component payment upon completion of the service component and submission of required documentation pursuant to 101 CMR 428.03(3)(b). (4) Service Components. Payment is based on the following five separate service components. (a) Assessment. This service component requires the client to articulate initial goals, commit to a service plan, and engage in services. Provider activities included in this service component include, but are not limited to, solicitation of client referrals; review of applications; initial client screening; interview of applicants; assessment of client abilities, interests, skills, and needs; performance of a situational assessment; identification of recommended support services; and completion of a comprehensive service plan. (b) Independent Living Skills Training. This service component is designed to ensure that the client has sufficient independent living, pre-employment, and skills training. Specific provider activities include, but are not limited to, depending on client skills and learning style: vocational English language training; “fast-track,” HiSET testing; short-term “soft” or “technical” job skills training; and work adjustment, job search, and interviewing skills. (c) Community Resource Access. This service component is designed to assist the client to be able to access community services in order to assist them with their ability to live and work independently in their community. (d) Plan of Achieving Self-support (PASS Plan). This service component is designed to assist the consumer with completing Social Security Administration (SSA) paperwork. Additional supports assist the consumer to set aside resources in order to obtain a product or a service; and to assist them to work or live independently in the community. (e) Single Service Purchase. This service component is designed to assist the client to work and live in the community successfully. (5) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate. (6) 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. (7) 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 428.03. Program Rate Unit Deaf and Hard of Hearing Independent Living Services Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly ASL Interpreter Add-on Monthly Monthly Monthly 1.0 FTE Monthly Recovery Learning Communities Monthly Vocational Rehabilitation Independent Living Services Assessment $617 Per Component Independent Living Skills Training Per Component Community Resource Access Per Component PASS Plan Per Component Single Service Purchase Per Component Service Add-on $154 Per Hour Group Training Add-on $55.84 Per Client per Class