General Payment Provisions

(1) General. Nursing facility payments are prospective rates based on reported costs for a prior base year. (a) The nursing standard payments and the operating cost standard payments are established in 101 CMR 206.04. The base year for the nursing standard payments and the operating cost standard payments beginning October 1, 2025, is 2023. The nursing standard payments are increased from the base year by a cost adjustment factor of 5.48%, plus an additional 0.683% administrative adjustment, resulting in a total adjustment of 6.163%. Operating payments are increased from the base year by a cost adjustment factor of 6.31%. (b) The capital payments are established in 101 CMR 206.05. The base year for the capital payments beginning October 1, 2025, is 2023. The capital payments are increased from the base year by a cost adjustment factor of 5.42%. (c) Payments may be adjusted to include additional payments in accordance with 101 CMR 206.06. (2) Ancillary Costs. Unless a provider participates in the Ancillary Pilot Program with the MassHealth agency, or a provider’s payments include ancillary services pursuant to the regulations or written policy of the purchasing agency, the provider must bill ancillary services directly to the purchaser in accordance with the purchaser’s regulations or policies. (3) Disclaimer of Authorization of Services. 101 CMR 206.00 is not authorization for or approval of the substantive services, or lengths of time, for which rates are determined pursuant to 101 CMR 206.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, and approval of services and lengths of time provided to publicly aided individuals. Information concerning substantive program requirements must be obtained from purchasing governmental units.