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) Services Provided on the Islands of Martha’s Vineyard and Nantucket. In accordance with the provisions of St. 2016, c. 133, payment for services provided in programs located on the islands of Martha’s Vineyard and Nantucket will be made at the rate for the service contained in 101 CMR 432.03(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 432.03. Service Tier Unit of Service Rate Lead Agency Month Month Month Month Month Month Flex Funding n/a IC Case Manager/ Education Coordinator (0.5 FTE) Add-on Month Case Manager/ Education Coordinator (1.0 FTE) Add-on Month