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 a provider, as explicitly set forth in the terms of the purchase agreement between the 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) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2022. 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 449.03(4). (a) Home Health Aide Services. Terms used in 101 CMR 449.03(4)(a) that have not been defined elsewhere in 101 CMR 449.00 have the meanings in 101 CMR 350.02: General Definitions. Code Unit Rate Per Unit Rate Add-on Total G0156 Per 15 minutes G0156 UD Per 15 minutes Per 15 minutes (b) Home- and Community-based Services Waivers. Terms used in 101 CMR 449.03(4)(b) that have not been defined elsewhere in 101 CMR 449.00 have the meanings in 101 CMR 359.02: Definitions. 1. Approved Rates. Code Service Unit Rate Per Unit Rate Add-on Total S5130 U4, S5130 U8 U1 Homemaker (Agency Rate) Per 15 minutes S5130 U8 U2, S5130 U8 UB Homemaker (Non-agency Rate for Individual Providers and Self-directed Services) Per 15 minutes G0156 U8 Home Health Aide (Agency Rate) Per 15 minutes See 101 CMR 449.03(4)(a). T1019 U4, T1019 U8 U1 Personal Care (Agency Rate) Per 15 minutes 2. Non-agency Rates for Self-directed Services. The non-agency rates for self-directed services consist of two components: the self-directed worker rate and the employer expense component (EEC). Service Unit Self-directed Worker Rate Employer Expense Component Self-directed Service Rate Homemaker Per 15 minutes (5) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2023. (a) Home Health Services. For dates of service on or after July 1, 2023, see 101 CMR 350.00: Rates for Home Health Services. (b) Home- and Community-based Services Waivers. For dates of service on or after July 1, 2023, see 101 CMR 359.00: Rates for Home and Community-based Services Waivers.